In May I’ll be spending two weeks learning about homeless services in the United Kingdom!
This is an opportunity funded by The National Alliance to End Homelessness (www.endhomelessness.org) in the United States and Homeless Link (www.homeless.org.uk/) in the UK to increase understanding and collaboration around best practices in working with people experiencing homelessness. Through a competitive application process, five candidates were chosen to go to the UK and five from the UK will come to the US, spending 2 weeks at different placements around the country. My placement is in Newcastle which is Northern England, close to the Scottish border, with a program called Fulfilling Lives. From what I have read and in talking to several people there, they are doing great work in care coordination and with Peer Specialists. I will be there from May 16-27th and I’m very excited about this incredible learning opportunity.
As part of the Practice Exchange experience, in order to spread the word about the work, and to provide a structured place for participants to reflect on their experience, they asked each of us to set up a blog; this is the result!
Even though my practice exchange doesn’t officially start until May 16, I wanted to send out some background information prior – thus the links here to the agency, Fulfilling Lives (www.fulfillinglives-ng.org.uk/), as well as links to articles about homeless programs and services in the UK and reflections from the providers that participated in the practice exchange in 2014. Also, I’ve included below the proposal I wrote up as part of the application process, that explains my area of interest.
I have two main intersecting areas of interest that I would like to explore during the Transatlantic Practice Exchange Program: the essential elements of a successful Care Coordination model, and the holistic involvement of Peers, or people with lived experience in this model. I am also interested in ways to measure participant’s experience of care.
The United States (USA) and The United Kingdom (UK) are both grappling with the question of how to better address the needs of their respective nation’s most vulnerable individuals. Based on what I have recently learned about the work of Making Every Adult Matter (MEAM) and Fulfilling Lives this vulnerable group in each country is composed of people struggling with similar problems: substance misuse, mental health disorders, chronic physical health problems and housing instability. (In the USA, the offender label is not commonly used to describe people in this group although a high percentage of vulnerable people in the USA interface with the criminal justice system.) In both countries, one of the primary reasons for focusing on the most vulnerable has to do with reducing costs associated with the high utilization of community services like hospital, jail, and emergency care.
One of the biggest problems currently for vulnerable people in my community is navigating a health care system that is not well integrated and highly inflexible. The service providers with whom people have regular contact don’t have formalized ways of sharing information and “case management” is only reimbursable under certain conditions so there is a lack of resources to help people navigate the fragmented system. Recently, due to an increase in community awareness around the topic of homelessness, steps have been taken toward more local government and inter-agency collaboration around the question of how to increase housing opportunities for this vulnerable group; at the same time, I have become more aware of how supportive services are tied to specific agencies or funding but seldom cross over to sustain an individual as they navigate multiple touch points within the system. This is in contrast to the aforementioned programs I have been learning about in the UK.
One of the first things that stood out for me when I read about the MEAM project was the high level of collaboration between multiple professionals and agencies. Subsequently, in a brief conversation with Neil and Sophie with Fulfilling Lives, I learned about Service Navigators and System Brokers who work together with the participant, focusing on engagement and connection to existing services, while also identifying and working to eliminate barriers to care. I was struck by something Neil said about the System Navigators working out of a variety of settings where vulnerable people might interface with the care system. In my experience, this is a novel approach and one that requires a great deal of community investment and relationship building. By experiencing the model used by Fulfilling Lives, I hope to learn how to encourage and support inter-agency collaboration and help create culture change within my own workplace. To that point, I am interested in a better understanding of the roles of the Service Navigators and System Brokers, and I hope to learn about how they have successfully influenced system change.
I am also interested in how to create more space for participant involvement and decision making in their care and more generally, opportunities for Peer involvement in service delivery.
My understanding is that in the UK there are fewer barriers to including Peers at all levels of service delivery. A participant lead “professional meeting” as practiced in MEAM is not common practice here; nor is Peer involvement in staff selection or program evaluation as occurs in Fulfilling Lives. I am curious if Peer involvement in evaluation helps to more full capture participant voice. Locally, as a first step, I am interested in developing a Peer Advisory Committee composed of people who were formerly homeless to make recommendations and be involved in the planning process that is occurring around a new Housing First program. I believe Peers have important things to say about what was helpful for them that will contribute to a better model and the opportunity to give back is something Peers in counseling frequently talk about as a value. In addition, I see the development of a Peer Advisory Committee as a way to more fully integrate a system of Peer Support into our service delivery model.
Transatlantic Practice Exchange 2014 (PDF)
Making Every Contact Count; a Joint Approach to Ending Homelessness (PDF)
Fulfilling Lives; Understanding Multiple and Complex Needs in Newcastle & Gateshead (PDF)
Transatlantic Practice Exchange Information (PDF)