Pilot project one: Lewisham Reach

Lewisham Reach is a floating support service for hard-to-reach clients, aimed at preventing people from becoming homeless through intensive one to one work. Thames Reach has led the way at providing successful interventions in the community that not only keep people in their homes, but link people into employment, education and meaningful activity by working closely with the Thames Reach employment team. Thames Reach decided to try implementing a personalised approach across a floating support service as much of the work done previously across the sector has concentrated on accommodation or outreach services.

How did they go about personalising their service?

A project board and project delivery group was set up to oversee the project. The project board included the chair of the organisational steering group,  the quality team and the service manager.  The project delivery group included deputy managers and two frontline workers who were responsible for helping the project board carry out the equality and impact assessment as well as the action plan. An initial personalisation audit was conducted, exploring how the service complemented the key principles and components of personalisation. This was followed by discussions seeking to understand how the service currently limited choice, what things were fixed and what was flexible, similar to the ‘core’ and ‘flexi’ approach adopted by Look Ahead (see Look Ahead case study). This work culminated in the development of a floating support personalisation service pathway, which aimed to offer meaningful choice across the service provision by:

• Providing an additional assessment /brokerage stage to the service pathway
• Providing choice of support worker
• Providing choice of support package offered
• Providing choice around the types of tools and interventions used with clients
• Providing individual budgets to support clients meet the aims of their individual support plans

Staff training in person-centred planning
 

Staff training is a vital part of changing core aspects of service delivery, therefore all staff involved in the pilots were trained in person centred planning. The training across the organisation gives staff the tools and confidence to provide self directed support, using new motivational interviewing tools and various person-centred planning techniques. Staff have also been trained in supporting clients to use Blue Salmon, an online outcomes tool for clients to use themselves, access their progress and set goals and outcomes that are meaningful to them. This approach supports clients to identify their own outcomes that have meaning to them.
 

Initial assessment and brokerage

Reviewing the service for this pilot enabled the staff to be involved in identifying areas for improvement. A key area identified at Lewisham Reach was the initial assessment stage, which is now carried out by a specific allocations worker, who acts as the broker for the service. This stage now allows clients to choose:

1. No service at all (if appropriate)
2. An alternative service – they are either supported by sign posting or brokerage
3. Brief intervention – the allocation worker will carry out some work there and then to resolve the issue and sometimes refer them on to the main Brief intervention service if they require a few more sessions
4. They can be allocated a case worker and receive longer term support

This change to the service delivery and to staff involvement in shaping it has meant staff now feel empowered by the process of allocation and therefore feel able to work more effectively. Clients are also more empowered by the pathway options, which facilitates excellent engagement between staff and client.

Choosing a key worker

Once clients have decided to opt for a service type they  can then choose an available key worker based on a profile given to them. The profile includes things such as work experience, specific knowledge or interests and time spent working for the service. A big concern for staff around choosing key workers was that diversity issues could become problematic. To overcome this an equality impact assessment was carried out prior to the pilot’s launch, which meant modifications to the action plan were made to reduce problematic issues arising. However staff felt that it actually offered an opportunity to challenge diversity issues as and when they arose. The new approach meant potential issues were highlighted straight away, rather than previous methods of working which sometimes led to clients disengaging from support without any particular explanation.

Staff had a lot concerns about this approach as it does present an entirely different relationship with staff and clients, but Lewisham Reach have had success with this new model and clients have benefited from the open approach. One staff member said; “When you know you’ve been chosen by the client, I feel more responsibility to do a good job as opposed to previously when I was simply allocated the client by my manager” (Project worker).This process had been reviewed and updated by the Lewisham Reach team and project group throughout to ensure they respond to client need.

Personal budgets – used to support clients sustain stability after case closure
 

Personal budgets were introduced as Thames Reach was keen to examine how these can be used to sustain service user outcomes after case closure.  Thames Reach wanted to empower service users to continue exercising choice and control long after Lewisham Reach had stopped working with them. They introduced individual budgets at the end of the pathway to enable service users to sustain positive outcomes and retain the control exercised whilst receiving their services. This differs from the organisational welfare fund which is often used in times of crisis rather than through support planning. To date the fund has been accessed to sustain positive outcomes and remove barriers to independence through:

• Enrolment onto education courses
• Mobile phones
• College materials
• Work clothes; uniforms and interviews
• Music equipment

One client purchased a lap top with the individual budget. The client had a physical disability and the lap top helped him sustain his tenancy by giving him the facility to use internet shopping services. The client was in considerable debt and the lap top enabled him to arrange various payment plans and keep track of his finances via internet banking, thus supporting him to remain independent.

Ongoing evaluation

Throughout the pilot process Lewisham Reach have evaluated and monitored the pilot in various ways. Evaluation and monitoring has happened through the equality and impact assessment mentioned and they have also conducted a snap shot study which will enable them to gain a better understanding of the interventions and methods used to support  clients achieve their outcomes. To do this the staff team (including managers) recorded their day to day activities for a period of two weeks. They used a specifically developed recording tool that covered 3 main areas:

• Activity
• Type of intervention
• Area of need (that the activity and intervention were aimed at addressing)

It also recorded whether those activities were ‘with’ or ‘on behalf of’ the client.

This snap shot study will help Thames Reach understand what they need to do differently or more of to get better results for clients. The study will also help them to improve their ability to explain to individuals and brokers what they do and how they do it. Nicole Njie explains that “the homelessness sector is very used to explaining services in terms that commissioners understand and it needs to translate this to work more effectively with clients. It is crucial that the broker’s role is to enable the individual to make informed choices around the support they receive and how they potentially spend an individual budget.” The pilot evaluation will be used internally to support further development.