Fulfilling Lives South East Project

Fulfilling Lives The South East Project operates across Brighton & Hove, Eastbourne and Hastings and is one of 12 Projects nationally funded for 8 years by the Big Lottery It will change lives It will change systems It will involve service users We are 2 years into an 8 year programme. There are 3 overarching outcomes the national Fulfilling Lives programme aims to achieve and these are: 1) It will change lives. Individuals experiencing multiple needs will benefit through better established partnerships and networks which best support individuals. 2) It will change systems. Evidence will be produced showing which elements of the programme are effective. Local and national decision-makers will be encouraged to review and adopt these elements where appropriate. 3) It will involve beneficiaries. Both positive changes to individuals and system change will be underpinned by the collaborative, genuine and honest involvement of individuals with lived experience.

What is multiple complex needs? Mental ill health Homelessness Drug and alcohol misuse Offending Sources: MEAM and Revolving Doors (2011) Turning the Tide: A vision paper for multiple needs and exclusions, MEAM/RDA, London, p.4 MEAM (2009) A four-point manifesto for tackling multiple needs and exclusions, MEAM, London, p.8 Before I go into more detail about how our project intends to achieve these outcomes, it is probably useful for me to set the context. Our project is concerned with individuals with multiple and complex needs, but what do we mean by this? We mean individuals who experience several problems at the same time, such as mental ill health, homelessness, drug and alcohol misuse, offending and family breakdown. They may have one main need complicated by others, or a combination of lower level issues which together are a cause for concern. These problems often develop after traumatic experiences such as abuse or bereavement. They live in poverty and experience stigma and discrimination. They have ineffective contact with services. People facing multiple needs usually look for help, but most public services are designed to deal with one problem at a time and to support people with single, severe conditions. As a result, professionals often see people with multiple needs (some of which may fall below service thresholds) as ‘hard to reach’ or ‘not my problem’. For the person seeking help this can make services seem unhelpful and uncaring. In contrast to when children are involved, no one takes overall responsibility. And they are living chaotic lives. Facing multiple problems that exacerbate each other, and lacking effective support from services, people easily end up in a downward spiral of mental ill health, drug and alcohol problems, crime and homelessness. They become trapped, living chaotic lives where escape seems impossible, with no one offering a way out. There are no consistent locally agreed figures for the numbers of people who fit into the category of long-term multiple and complex needs. MEAM estimate that there are approximately 60,000 adults in this situation at any one time in England, with more people constantly moving in and out of the group. (0.011% of the population) This roughly translates Brighton and Hove Population 243,00 - 275 people with multiple and complex needs Eastbourne Population 100,049 - 110 people with multiple and complex needs Hastings Population 90,345 - 99 people with multiple and complex needs While relatively small in number, this group imposes disproportionate costs on government and society. We believe we can change lives…..

Team Structure The Fulfilling Lives South East Project is made up of a partnership of 4 teams; one in Eastbourne based with CGL, one in Hastings with Seaview project and one in Brighton & Hove hosted by Equinox, plus a service user engagement team employed directly by BHT. There are 25 staff in all, plus around 30 current volunteers. Each local team is made up of 2 frontline specialist workers and a service improvement officer who focusses on systems change, overseen by a team leader. BHT retain the overall project management. Each of the 4 teams will undertake new interventions/pilots/ways of working with the client group Area leads and Service Improvement Officers will work with service users, stakeholders and funders to review and redesign systems, not just to enable access for this client group, but to provide tailored and exceptional services, support and care for this group, to enable them to live full lives and realise aspirations. The specialist workers will work directly with clients, providing assertive, specialist, personalised interventions, co-ordinate all services involved with each individual client and work pro-actively and creatively to ensure clients are able to navigate and access the services they need, and can remain engaged. Project Consultants, bringing the benefit of lived experience of using support services will facilitate genuine service user involvement in developing improvements in the way services work for people with multiple and complex needs. The project’s governance is overseen by a core Strategic Group plus Steering Groups in each area which meet every 2-3 months.

Changing Lives Trauma Informed Care Assertive Outreach Case Co-ordination of care and support So, returning to our 3 key outcomes; outcome 1: It will change lives So far the project has worked with 54 clients across the 3 areas. Each of the 6 Specialist workers has a caseload of between 8 and 10 clients. The work has been characterised by several key principles: TIC FL project experience indicates 100% of clients have experienced trauma during childhood, and around 80% have experienced sexual abuse. This trauma is manifested in behaviours such as PTSD, dissociation, avoidance, anger outbursts, and cognitive distortions. An awareness of this is essential in building a supportive relationship with the client group. Assertive outreach: Frequent engagement. Offer a mobile phone Build trust; creative, flexible & compassionate Persistent and non judgemental – keep going back Practical support – food, clothing Case Co Integrating services around an individual’s complex needs Advocacy and coordination Reinvigorate multi agency working For as long as it takes

Outcomes Moving into and maintaining accommodation. Reducing drug and alcohol use, including obtaining methadone prescriptions and attending detox and rehab. Improved mental health. Increased confidence, self-esteem and self-worth. Improved physical health. Better self-care (for example being less likely to skip meals). Reduced offending. Securing benefits. A sense of purpose and identity. Positive aspirations for the future. Looking into education and training. Re-establishing contact with family. Some of the outcomes the clients have achieved with support from FL have included: Accessing accommodation Reducing D&A use, accessing treatment Improved mental and physical health, Reducing offending, Re establishing contact with family Also through our psychological interventions budget we have been able to provide funding for therapy for clients who would normally not be considered “stable enough” or “ready” But it’s not all about the outcomes achieved. Part of the role is to bear witness to systemic failures and highlight areas which need to be explored and changed. Case studies are an important way we intend to influence change, and each worker produces case studies every quarter which feed into the systems change work Going into the next phase we will be seeking to work with more hidden groups and those not so visible to services. The local teams will be actively engaging woith locla, specialist services to ensure that the project’s reach is as broad as possible to maximise learning.

Systems Change From the outset of the Programme being introduced, Systems Change was integral to achieve the long term outcomes the programme is aiming to achieve. To bring about a system/s that can achieve lasting positive impact on the lives of people with multiple and complex needs will require fundamental changes, many of which will be discovered over the lifetime of the project. Our second project outcome is changing systems: What we mean by systems change is making practical, tangible improvements or changes to existing services and roles which enable improved engagement and outcomes for people with multiple and complex needs. These changes will be verified and tested by people with lived experience.

Systems Change The project achieves small scale systems change through the work of the Service improvement Officers in each local team, work that we refer to as system and service reviews. Gaps and barriers are identified through the frontline work, via feedback from Action Group members or from consultation with local stakeholders. The SIO then works with local stakeholders to identify tangible improvements and an action plan is agreed for changes to be implemented. The changes agreed and implemented are tested several months later to check that changes have been embedded and are lasting.

Systems Change Improving access to recovery groups by providing satellites in other services (Eastbourne) Improving awareness of services available by creating a homeless map and service directory (Eastbourne) Reviewing the local implementation of Severe Weather Emergency protocols for rough sleepers (Hastings) Workforce development – training on multiple and complex needs for ward staff in Millview Hospital (Brighton) Information sharing and joint care planning between hostels and substance misuse services (Brighton) The System and Service Review process has led to action plans for improvements being agreed in a number of areas. These have included: Improving access to recovery groups by providing satellites in other services (Eastbourne) Improving awareness of services available by creating a homeless map and service directory (Eastbourne) Reviewing the local implementation of Severe Weather Emergency protocols for rough sleepers (Hastings) Workforce development – training on multiple and complex needs for ward staff in Millview hospital Brighton Information sharing and joint care planning between hostels and substance misuse services (Brighton)

Systems Change Hospital discharge and admission Workforce development and Psychologically Informed Environments Data sharing and access to information Accommodation pathway in East Sussex Women leaving prison SU Involvement in recruitment Challenging Stigma Dual Diagnosis Case Coordination and effective partnership working The project has focussed on achieving smaller scales systems change during the first phase to gain some traction and ensure our work is practical and tangible. We are now in positon to begin to address larger scale systemic change and there are a number of themes that have risen to the surface during our work to date which will form our project systems change plan. It is expected that these work streams will be worked on by members of the Core Group and Steering Groups. Work has started already on a number of the themes.

Service User Involvement A pathway to employment Representation within FL Recruitment External engagement and influence Service User Involvement is a key principle which underpins the project, and our 3rd overarching outcome. We are committed to challenging ourselves to be exemplars of best practice in this area. We know we are not there yet but we have a lot to be proud of. The project consultant roles provide a genuine route into employment. To date 11 PC’s have moved onto other employment. 4 previous volunteers have successfully been employed as PC’s on the project 1 previous client has become an active volunteer. We have SU representation at all levels of governance within the project, including core group, steering groups, team meetings, working groups And service users are involved in all staff and delivery teams recruitment processes Service users have also begun to be involved in external forums to influence commissioning and service design and this is an area which we intend to develop over the next 2 years.

Involvement Opportunities Pathway to Employment Peer Support to clients A Voice in decision making Involvement in Service Design and Commissioning I’m now going to handover to Eleanor one of the Project Consultants on the project who is going to talk a little bit about her experiences with Fulfilling Lives There are a range of different ways that individuals with lived experience of multiple and complex needs can become involved in the project; As paid Project Consultants, who facilitate Action Groups and gather ideas and evidence to feed into the systems change process As Action Group members, registered as volunteers, who meet weekly and discuss their experiences of service and conduct wider consultation within their networks As Peer Mentors who provide support to the project’s clients under the direction of the Specialist Workers As peer researchers who conduct interviews and surveys with service users to support the project’s evaluation The common theme is the project’s commitment to provide a quality offer and a genuine route into employment. Every volunteer receives a full package of support and training and a mentor within the team to support them to reach their goal and move on to other opportunities.

Looking forward Effective service user involvement is included in local commissioning practice Local systems change plan including methodologies and measurement Growing the partnership Maximising learning As we move into years 3 and 4 we enter a new phase of the project. Years 1 and 2 were all about building our local profile; implementation and service delivery. Years 3 and 4 will be about building the momentum for systems change, and taking out our model of effective service user involvement into external forums. Over the next few months we will be holding a number of learning events which will be publicised locally. We welcome the opportunity work with new organisations and formulate new partnerships, either directly through the project delivery or via the strategic forums. We want to grow our volunteers numbers and maximise the opportunity of leaving a legacy of better connected services for this client group and better outcomes and opportuntities for all

Fulfilling Lives South East Project