Author: Fulfilling Lives South East

Thank you & farewell from FLSE

Fulfilling Lives South East

Here we are, at the end of the eight year Fulfilling Lives South East Project, and what an incredible journey it’s been.

The project has involved many people and we have learned and achieved so much. I remember speaking at the project’s launch event in 2014 looking forward into an unprecedented eight years of funding with a brief to change individuals lives, improve services and influence systems. I believe we have made an impact at all three levels.

We have forged new partnerships and connected with like-minded people right across Brighton & Hove and East Sussex. We have developed innovative projects, forged a model of co-production that others wish to emulate, we have influenced national policy, informed new governance arrangements locally, and advocated so that individuals experiencing multiple disadvantage have been recognised locally as a strategic priority. We have hosted learning events and conferences, engaged in national debates, participated in local partnerships, facilitated new networks, used data to shine a spotlight on people’s needs and case studies to celebrate their achievements but most of all we have ensured that individuals facing multiple disadvantage are not ignored, othered, labelled or given up on.

Although we have achieved a lot the work is not over. There is still much to do. Still shocking inequalities experienced, individuals let down by services and facing early death, stigma and discrimination. It is now time to hand over the baton to you to continue the work to effect positive change. The next chapter for multiple disadvantage has already started with the government’s Changing Futures programme, which arguably would not have come about had it not been for the work of Fulfilling Lives.
 
Thank you to everyone who has been with us on this journey. To our host organisation BHT Sussex, who have trusted the project to act with autonomy yet offered ongoing support and stable leadership. To every single person who has worked or volunteered on the project since 2014. To our clients who bravely shared their stories and inspired us to continue this work, even on the tough days. 
 
Thanks to our partner agencies and delivery partners who helped us to shape best practice, model trauma-informed, assertive yet compassionate case coordination and crush the myth of ‘non engagement’. To our national partners across the country, sources of peer support and inspiration. Finally, to our great colleagues at the National Lottery Community Fund, without whom none of this would have been possible. To be trusted to try new things without fear of failure has been a rare gift which has been cherished.
 
From 1st July, Fulfilling Lives South East as a project will cease to exist, as team members join past colleagues in moving onto other roles and opportunities. The team has evolved over the years and people have joined and left along the way but what has remained has been a consistent thread of collaboration, compassion and hope that we can make a difference and that things can change for the better. We sincerely hope that Fulfilling Lives as an ethos and repository of ideas will live on. BHT Sussex will be the custodians of the learning resources we have developed and they will curate the Fulfilling Lives webpages for the next period.
 
For the next phase of change it is up to you, and to us.
 
From Fulfilling Lives, this is thank you and good bye, and please remember you can be the change you wish to see.

Over and out 😊

Stonewater and Fulfilling Lives South East- Supporting Women experiencing Multiple Disadvantage in Refuge

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In this blog we reflect on how effective partnership working can support new outcomes.

Stonewater and Fulfilling Lives South East (FLSE)

In 2021 Stonewater was awarded the new contract to provide refuge accommodation for women and children experiencing domestic abuse in Brighton and Hove

Stonewater is:

“…a leading social housing provider, with a mission to deliver good quality, affordable homes to people who need them most. We manage around 34,500 homes in England for over 76,000 customers, including affordable properties for general rent, shared ownership and sale, alongside specialist accommodation such as retirement and supported living schemes for older and vulnerable people, domestic abuse refuges, a dedicated LGBTQ+ Safe Space, and young people’s foyers.”

(source: https://www.stonewater.org/about-us/)    

The FLSE project, hosted by BHT Sussex, is one of 12 partnerships funded by the National Lottery Community Fund to provide intensive support for people experiencing multiple and complex needs (MCN), involve people with lived experience at all levels and challenge and change systems that negatively affect people facing MCN. While this eight-year project will soon be coming to an end, we recognised the value of collaborating with Stonewater.

At FLSE, we were keen to collaborate with the Stonewater team as we saw a real opportunity, when they were awarded the new refuge contract, to work together to share our learning of working in a trauma-informed way with women facing MCN and domestic abuse to help this particular group of women to better access and sustain their stay in refuge.

The importance of defining MCN or multiple disadvantage

There is much disagreement in this sector about the merits of having a unified definition of MCN or multiple disadvantage. There are concerns in some quarters around the negative effects of labelling on people experiencing multiple disadvantage. At FLSE we understand and respect this viewpoint. However, from eight years of learning, when it comes to the design and commissioning of services for this client group, we know that there is more risk in not naming multiple disadvantage than providing a clear definition. We feel this is important so that services are designed with the specific needs of this group, who are often excluded from services, in mind. For women experiencing intersecting needs including homelessness, mental ill health, substance or alcohol use, repeat contact with the criminal justice system and the repeat removal of children, when domestic abuse is added to this complex array of issues, it is vital that services are equipped to work with these women, who will all have experienced trauma and require an appropriate response.

Recently, FLSE worked alongside the Sussex Police and Crime Commissioner’s Office that led on the Needs Assessment – a requirement of the DA Bill – to assess the need for safe accommodation and support for victims/survivors of domestic abuse across Sussex. We coproduced a written submission detailing the specific needs of women fleeing domestic abuse using case examples from our client-facing work. We were delighted to read in the final Pan-Sussex Strategy for Safe Accommodation and Support for Victims/Survivors of Domestic Abuse that FLSE’s definition of multiple disadvantage was included and ‘responsive to multiple disadvantages’ was cited as a key priority in the Strategy. We recommend that all agencies in Sussex use this definition when commissioning or designing domestic abuse services and safe accommodation options:

Multiple Complex Needs (MCN) has a variety of meanings in services and third sector organisations, depending on the needs of the client group. In general, MCN includes people on the edges of society who are often excluded from or who cannot access who is experiencing 3 out of 4 of the following:

What we did together

The FLSE team and Stonewater managers discussed ways we could work together to support improved outcomes for women with MCN.

In April and May 2022 the FLSE team delivered two training sessions for refuge staff. The first session focussed on complex trauma; its causes and how it manifests in behaviours and tools to manage potentially difficult situations and was informed by the refuge team feedback in a pre-training survey.

The second session focussed on deepening conversations around:

  • The window of tolerance.
  • Dissociation – being the most misunderstood responses and the most common in women and children experiencing domestic abuse and how to recognise and work with it.
  • Practising some grounding techniques and tools.
  • The working together tool.
  • Further reading and training that staff can access.

Impact

Following the two training sessions, the Stonewater refuge team felt they had a better understanding of:

  • The meaning of MCN.
  • What women experiencing MCN and domestic abuse might need.
  • Different trauma-related responses.
  • How to take a different approach to clients affected by alcohol and substances, including ways to organise a multi-agency meeting involving clients.
  • A number of staff reported feeling confident creating and using a Working Agreement.
  • All staff reported that they felt ‘completely comfortable’ now with using grounding techniques.

The Stonewater team felt that the collaboration and sharing learning had a positive impact on their work, with one staff member sharing:

“The training was absolutely excellent, I felt as though I learnt a lot and I have already used the working together agreement and the window of tolerance work sheets in my case work sessions”.

Looking to the future

As FLSE is now reaching the final stage of the project, we are proud to know that Stonewater will continue influencing the system to make refuge accommodation more accessible to, and impactful for, women experiencing MCN.

Sandra Sylvester from the FLSE team reflected that “it is so positive to see what can be achieved when working in a strengths-based way with a partner such as Stonewater, who have been open to learning from our 8 years’ experience to develop the tools they need to successfully accommodate women with complex intersecting needs, but also how to give the amazing staff the space to reflect on the difficult work and to provide opportunities to attend relevant training. It has been an honour to be part of this project.”

Wendy Sheehan from Stonewater, shared how enthusiastic the staff were to attend the two training sessions and how they really appreciated them being in person.

“The support and training that the Refuge team have received from Fulfilling Lives has been invaluable. The training was tailored to the specific needs of the team and was based on real life case studies.  The feedback from the team has been extremely positive and has improved their confidence with supporting women with MCN’s.  This will ensure that we can support more women with MCN a group that is often excluded from accessing many refuge services.”

Sarah Pugh, also from Stonewater, is in the process of developing the organisation’s training package and is using the learning from the training and partnership to inform the content of this framework.

“Refuge has to be more than just bricks and mortar and the practical and therapeutic support survivors, including children, receive is crucial to their recovery.   Stonewater are dedicated to ensuring that refuge staff have the opportunity for continual professional development and are equipped with specialist knowledge and confidence to support the multiple and complex needs that residents present with.  The feedback from staff who attended this training is overwhelmingly positive and has whet their appetite for more!  Learning in the field of domestic abuse and its radiating impact on all aspects of its survivors lives is continuous and we’re working on a Domestic Abuse training plan for all Stonewater employees, incorporating what we’ve learnt so far and utilising all the resources you have provided.  Knowledge is power, and effective training results in knowledgeable, skilled staff resulting in improved outcomes for survivors.   Thank you Fulfilling Lives, for your time and energy!”

Authors:

Sandra Sylvester, Systems Change Officer

Rebecca Rieley, Systems Change Lead

For further information about Fulfilling Lives work in this area, please contact:

rebecca.rieley@sefulfillinglives.org.uk

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Co-Production……because it’s worth it! 

Fulfilling Lives South EastLeave a comment

In our previous blog posts and on our website, we’ve talked in great detail about the how, the when, the who and the what of Co-producing with people with lived experience.  We’ve also shared our learning around the potential challenges, how to overcome them and how to be creative when co-producing.  In our final blog, we’ll look at what is probably the most important piece of the co-production jigsaw puzzle… the why. 

So, why is it better for a service to change from their established way of working to co-producing with service users?  

Firstly, it’s worth stating that the purpose of any service is to deliver that service to those who need it.  It should be accessible to everyone from any demographic.  In the context of our work, we are referring to housing, substance misuse, mental health, domestic abuse, and those related to prison release.  It can be difficult enough for someone to access any of these services even if they are experiencing a single complex need, and accessibility is a fundamental aspect of an effective service.  Service users are best placed to inform how the services aren’t accessible for them, either individually, or connectedly.  If they aren’t accessible for them, then the service hasn’t been designed for others in similar circumstances.  Working closely with the people who understand the needs of those falling through the cracks is the best way understand the service’s design flaws so the cracks can be filled.  They can tell you what needs to change and what they feel they needed from the service at that time in order to access the support on offer.  With every additional complex need, it becomes more difficult for someone to access a service on its terms.  Genuinely co-producing with people with lived experience of multiple and complex needs can help the service reach those in the most chaotic circumstances. 

If a service is co-produced from the start, it will be designed to be more efficient while making the best use of the resources available.  There will be fewer missed appointments due to improved accessibility, thus less wasted time and money while reaching more service users and increasing the chance of better outcomes. 

A service can be inaccessible even before attending an appointment.  The service’s reputation can help or hinder the staff who are offering support.  It may be that before someone walks through the front door and meets their support or key worker for the first time, they will have expectations that may be positive or negative based on word of mouth or service reputation.   If a service has been co-produced with those who use it, this will help to increase trust amongst the community it serves, leading to better relationships between workers and service users, and a greater chance for positive outcomes. 

Co-production can benefit service users not just by improving service provision.  Through the process of involvement, service users will be empowered with the opportunity to harness their experiences and direct them in a way that benefits others, providing purpose and a sense of belonging.  Furthermore, services who show trust and value in the co-production process can have a strong impact on the self-esteem, self-worth and confidence of the people taking part, while concurrently helping them to gain skills and experience.  This involvement can be a significant step in someone’s recovery journey.  It also represents a cultural shift in the way society views those with the most complex needs, paving the way for less stigmatising beliefs. 

There is a growing emphasis amongst funders to incorporate co-production into service design.   It is encouraged by procurement regulations and favoured by commissioners, so its value has been recognised.  Bids are likely to be seen more favourably when co-production is part of the service operation.  In these cases, it’s important that co-production is well understood so it can be implemented effectively. 

And finally, people have the right to be involved in their own care; professionals and service users working together to find the best path forward.  When someone is living in chaos, they may not feel they have much control over their own circumstances.  Working with someone in this way provides a sense of agency which can have positive knock-on effects in other areas of their life. 

Key Messages:

So, to summarise, co-producing with people with lived experience of multiple and complex needs is beneficial to the service and service user because: 

  • It is more efficient in the long run as the service will be set up to cater for the needs of all its users, with fewer wasted resources 
  • Outcomes will be better for service users and more sustainable 
  • Co-producing can lead to creative solutions to difficult, long-standing problems 
  • Involving people in their own care is the right thing to do and offers some control over their lives which may be lacking 
  • Service users gain skills and experience that can help prepare them for work 
  • Co-producing provides service users numerous psychological benefits such as a sense of belonging, purpose, and achievement, while building self-esteem, self-worth and confidence 

Below are some quotes from volunteers on co-producing pieces of work with Fulfilling Lives: 

“We had a voice, made me feel I’m not the only one who had experiences like I did at [service] as heard other people’s experiences doing this project, builds confidence. Not very often you have a voice. Hopefully speaking for people who don’t have a voice. We were trusted to do this – self-esteem, not being judged on our past” Service User Involvement Volunteer – FLSE 

— 

“Possibility to have a voice. Feeling valid. Being given agency. It felt good to take difficult experiences and turn them into something productive and taking the chance to step into a more active role, after a long time of feeling powerless and hidden”  Service User Involvement Volunteer – FLSE 

— 

“Everybody should be part of decisions and making a change. Lived experience brings unique perspective, emotional intelligence. Can’t learn it from a textbook. Think that trying to heal and overcome hard times is a difficult and long journey but it also gives incredible insights into yourself and the world, for better and for worse. When the experiences of hard times collide with social services police and other systems, I think that insight and emotional intelligence is particularly valuable if not essential as a window into the client base”  Service User Involvement Volunteer – FLSE 

The only question that remains then is “When are you getting started?” 

Author: Ian Harrison – Co-Production and Engagement Worker

Thanks to colleagues & volunteers at FLSE: 

Vikki Hensley – Co-Production and Engagement Worker

Aditi Bhonagiri – Co-Production and Engagement Worker

Kate Jones – Co-Production and Engagement Worker

Andree Ralph – Engagement and Co-Production Lead

Service User Involvement Team Volunteers

For further information about Fulfilling Lives work in this area, please contact:

ian.harrison@fbht.org.uk

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Punching Above your Weight: Getting Academically Published as a Non-Profit

Fulfilling Lives South East

Our Research and Evaluation Officer explores the benefits and pitfalls of getting articles published in academic journals as a non-profit organisation

Why try to get published?

Have you ever completed a report or evaluation and thought ‘what will happen to all this work when my project ends’?  It can often be the case that great learning is lost over time and not referred to in future work. But what if there was a way to make your work available for years to come, forming a permanent part of the conversation?

Academic publication is one way to make this happen. A well-placed article can benefit non-profits by increasing the legitimacy and profile of their work, and can benefit the journal allowing them reach audiences they might not otherwise have access to. Publication can strengthen existing evidence on what works, and shape work of the future by being readable and citable for others who are interested in the topic of the paper.

At Fulfilling Lives South East we have submitted three articles across the course of our funding. We have been published in ‘The Voluntary Sector Review’ for research discussing the value of clinical supervision for frontline workers, we have been published in ‘Counselling and Psychotherapy Research’ evaluating the effectiveness of pre-treatment therapy for people experiencing multiple and complex needs, and a case study on improving unsupported temporary accommodation Approaching systems change at Fulfilling Lives South East in efforts to improve unsupported temporary accommodation: a qualitative case study | Emerald Insight (the full article is available at ref: DOI 10.1108/HCS-12-2021-0043).

Writing an article for an academic journal is more accessible than it ever has been. Increasingly journals welcome practice-based examples, in formats that don’t require a university degree or a university ethics form to create.

Key challenges for non-profits to overcome

Whilst the opportunities to write for journals for non-profits are increasing, the submission systems still largely cater for academics.  This can mean anything from asking for a university email address to verify you as an author, or not recognising references you may have made to non-academic articles. If your article is peer-reviewed, the reviewers might assume you have access to papers they think you should add in – when in reality there is a paywall between you and that reference!

Timeframes for writing can be another challenge. For academics, a large part of their job description is often writing articles. For non-profits, it is more likely to be an add-on at best. Writing for publication can take a lot of time, both in terms of planning, drafting and re-drafting with editor’s comments – it’s a time commitment not to be underestimated.

Top tips for getting your work into journals

Pick your journal and your paper type well. Have a search on google scholar for the sort of journals which might be interested in the work you’re doing. Anything with the word ‘practice’ in the title might indicate that the journal is open to a range of article formats. Look at their information on submitting an article, do they have a type of submission that suits your work, like case studies, professional reflections or practice papers? These formats tend to be lower word-count and more accessible to non-academics.

Talk to editors before you get started. Never start writing before you’ve spoken to an editor! You might want to book a video call and share an essay plan for the work before putting pen to paper. The last thing you want is to invest time and effort into an article that is not what the journal is looking for.

Give yourself enough time. Journal articles are not something to write in the last months of a project. They require time to research and write, time to submit and time to edit. Almost every journal will come back with amends (often quite a lot of them) and might ask for contracts to be signed and final proofs reviewed before publication. Make sure it’s an investment your organisation has the capacity to make.

Find ways to beat the paywall.  Journal articles are becoming increasingly publicly available. Websites like Research Gate host many free-to-view articles, making it easier to research literature reviews, and also to host your own finished article. Most journals would ask that only unedited manuscripts are included on these types of website though – so make sure you check with your editor.

Be a systems changer! Don’t pretend to be a professor. Being a non-academic author is valid and so is asking for help from the journal to get published. Most articles will be for a practice audience so there is no need to use complicated language, just be clear and easy to understand. Whilst the publishing process is becoming more open to non-profits there are still barriers in the systems journals use. These are opportunities to positively challenge the status quo!

Authors:

Kerry Dowding, Research and Evaluation Officer

For further information about Fulfilling Lives work in this area, please contact:

kerry.dowding@bht.org.uk

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Clinical Supervision and how it can support the work of non – specialist client facing workers

Fulfilling Lives South East

What is clinical supervision?

Clinical supervision isn’t new, having been used for many years in a variety of healthcare settings, including mental health. Clinical supervision is a formal mechanism through which individual and professional development occurs by the worker reflecting and learning with the supervisor. People who receive clinical supervision have jobs that are emotionally demanding, in the case the of the Fulfilling Lives South East (FLSE) project supporting people with significant trauma histories and/or multiple and complex needs (MCN).  

A key piece of learning from the FLSE Perspectives Project and Perspectives Project: Part 2 work was how statutory mental health professionals could support non-specialist client-facing workers to safely hold high levels of risk. This blog shares learning and aims to illustrate the important role that clinical supervision can play, or could play, in providing a form of mental health specialist support via the worker to clients with a coexisting condition. In building confidence and knowledge in workers to understand the complex nature of this client group, develop appropriate methods for risk taking and sharing risk, managing worker wellbeing, and navigating complex systems when advocating for clients.

In what ways can clinical supervision help non-specialist frontline workers?

  • Feeling connected

Working in a role providing support to clients experiencing MCN on a one-to-one basis can be an isolating experience for the worker. The danger of vicarious trauma is more likely in this type of role when in your day-to-day work you are surrounded by complex trauma. Not having a space where you can discuss feelings and emotions that the work might be bringing up for you is an unsustainable approach that will lead to workers having to take time off sick. Clinical supervision offers a space for workers to process the emotional aspect of the work and understand the interplay in the client worker relationship. Being able to talk about what comes up when supporting clients to recognise transference and how this can conflict with your own attachment styles is vitally important.

  • Confidence and knowledge

Clinical supervision equips non-specialist client-facing workers with a framework of language that gives knowledge and confidence when adjusting to different audiences and situations. It can help workers advocate for clients using language that statutory mental health workers will recognise and listen to, as well more authoritative robust language to explain the risks and consequences of not responding to the needs of the client.

Additionally, clinical supervision supports workers to facilitate and lead multi-agency meetings that illustrate to partners trauma understanding and this helps other agencies work in the same way, modelling what good can look like when a multidisciplined team approach is adopted to working with complex needs clients.

Another way in which workers’ development of communication is important, is learning through clinical supervision how to interpret the client’s language as well as gauging what language is appropriate to use in response to a variety of situations that can and will arise when supporting MCN clients.

  • Innovative, flexible, new approaches

Services can be risk averse which stifles creative approaches to working with MCN clients. Working with this client group requires new approaches and time to build the vital relationships that set the foundations for positive support work to take place. Training staff to have the confidence, knowledge, and skills to work in this way is key to working in a trauma informed way. Non-specialist client-facing workers having the opportunity to discussion innovative ideas in clinical supervision where thinking can be refined, and potential risks can be identified, and mitigation strategies can be worked though. Is incredibly valuable and reassuring for a worker to know that a specialist is endorsing their case planning and now leaving the worker exposed to holding the risk alone.

  • Wellbeing and burnout

While clinical supervision is not therapy, it can be used for times when workers are triggered and to think about why that may be. Sometimes these discussions do not happen with managers until the worker has to go off sick and the reason for absence must be disclosed. Clinical supervision offers a regular slot in a worker’s diary where the focus won’t be frontline operational priorities, rather a time to talk with someone who isn’t part of their day-to-day working life. This protected time affords the worker safety to disclose issues and feelings resulting from the nature of the intense client work. Any sense of uneasiness around disclosing feelings that may be perceived as weakness or make the worker feel shame is diminished by the containing space provided through clinical supervision.

  • Feeling valued

One of the main impacts that clinical supervision has is it gives a message to staff that the organisation genuinely cares about them and their work. Staff are aware that clinical supervision is something that professionals with specialist qualifications receive, so it sends a signal that the organisation is treating the vital work they do with seriousness. There is often a sense that non-specialist frontline workers are regarded as professionals with a small ‘p’. This kind of investment in staff is validating making workers feel that their role in the support system and the contribution they make is being rewarded by the organisation looking after their wellbeing and professional development.

Why we need to protect our workers?  

The current headwinds buffeting third sector healthcare settings are some of the most difficult we have faced. The system is more stretched than ever, the number of people requiring support continues to grow as the level of complexity people are presenting with increases. Coupled with staff shortages and reduced funding the sector is producing a workforce that is stressed, under pressure and poorly supported. Of course, the Covid-19 pandemic has amplified these long-standing issues in the system, while at the same time creating an opportunity to embed clinical supervision in the sector. Giving meaningful professional support and development to non-specialist client-facing workers would be a decisive and welcome contribution to the system.

To read more about how clinical supervision can benefit client-facing workers providing intensive support to clients with MCN, please read ‘The effectiveness of clinical supervision for workers supporting people experiencing multiple disadvantage’. Written by Juliet Hough, and independent researcher, published on the FLSE website in January 2021, the research found that the provision of regular one-to-one clinical supervision was highly beneficial to workers and to the FLSE programme. It was critical to workers trauma informed practice, and in supporting their well-being in the following areas: Increased workers’ understanding and skills around providing trauma informed care, helped workers to successfully advocate for support from other services, helped to protect staff from burnout and compassion fatigue, reduced sickness absence and staff turnover, benefited the people being supported

For further reading about how clinical supervision can play a vital role in our wider communities, please read an academic paper, ‘Could clinical supervision help us to support increasingly complex needs in the community?’ The paper is a collaboration between Kerry Dowding, FLSE Research and Evaluation Officer, and, Juliet Hough, an independent researcher. First published online 15th February 2022, this paper presents qualitative research exploring the benefits of clinical supervision for workers supporting people experiencing multiple disadvantages. The paper illustrates how clinical supervision supported worker wellbeing, lessened compassion fatigue, and created space for workers to think creatively, manage risk and develop trauma-informed and reflective practice.

Locally, the FLSE team have taken a deep dive into the ways in which clinical supervision has supported our Practice Development team as they trial new ways to engage with people experiencing MCN. We wanted to see to what extent clinical supervision could provide a form of specialist mental health support to clients, via the practice development workers. Read more here https://www.bht.org.uk/wp-content/uploads/2022/06/PP_clinicalsup_FINAL_21062022.pdf

Authors:

Alan Wallace, Systems Change Officer

For further information about Fulfilling Lives work in this area, please contact:

Alan.Wallace@bht.org.uk

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FLSE responds to the ‘Tackling Domestic Abuse Plan’

Fulfilling Lives South East

As Fulfilling Lives South East (FLSE) welcomes the government’s long-awaited Domestic Abuse Plan, we reflect on how far the measures go in meeting the needs of women with multiple and complex needs (MCN).

Specialist support in safe accommodation

Throughout our project work, FLSE have continuously advocated for access to appropriate housing options for those experiencing domestic abuse as one of several intersecting needs. We know that for those made homeless by domestic abuse, the path to stable accommodation is not easy, particularly for those experiencing MCN. Refuge referrals are frequently rejected on the grounds of clients’ mental health and substance use needs being too high. This results in women facing multiple disadvantage being excluded from accessing the current refuge service models, meaning many women are being forced to return to their partner and abuser or being placed in non-specialist accommodation settings.

We are particularly encouraged by the government’s commitment in the plan to provide funding for specialist support services in safe accommodation to ensure that vacancies are available to a greater number of victims and survivors, no matter how complex their needs. It is also heartening to see that the Ministry of Justice will look into introducing national commissioning standards across all victim support services and the Department for Levelling Up Housing and Communities’ Quality Standards for support in safe accommodation. This will ensure that the commissioning of support in safe accommodation for domestic abuse victims and survivors and their children will be subject to the same standards as all victim support services.

Training for non-specialist services

At a local level, FLSE have made specific recommendations for staff in non-specialist services supporting women with MCN to be equipped and trained to better respond to domestic abuse. We have evidenced the need for MCN specific domestic abuse training to be provided across Sussex, to ensure that police forces are more informed of the complexities facing women with complex needs experiencing domestic abuse.

As such, the provision of up to £3.3 million to fund the rollout of Domestic Abuse Matters training to forces which have yet to deliver it, or do not have their own specific domestic abuse training, is a welcome step. We also welcome the government’s commitment to provide £7.5 million to upskill healthcare professionals to identify and refer victims and survivors to support services and ensure that healthcare professionals are appropriately equipped to support those suffering trauma from abuse. We hope that these measures will be built upon, with the long-term view for all public services and non-specialist services to be able to respond appropriately to domestic abuse, with an intersectional understanding of the experience of women with MCN.

Collaboration and coordination across the sector

Women with MCN who are experiencing domestic abuse do not typically present at specialist domestic and sexual violence services. For example, they may present for help in the first instance at their Local Authority Housing Options Service, where clients can experience judgemental and stigmatising responses and unsatisfactory outcomes. Women frequently do not receive a service which reflects an understanding of the complexities, dynamics and risk issues of domestic abuse or receive a trauma-informed response.

As such, it is positive to see the importance of collaboration and coordination between and within statutory services in better supporting survivors recognised within the plan. We are hopeful that the government’s upcoming new Domestic Abuse Statutory Guidance, which will provide further details on the different types of abusive behaviours, will help to facilitate a common understanding of domestic abuse across the whole system, ensuring that women do not fall through the gaps in provision.  

The measures set out in the ‘Tackling Domestic Abuse Plan’ represents a positive step toward better coordinated and trauma-informed support services which can holistically meet the needs of the most marginalised women. The government must now bring lived experience voices to the forefront in decision-making forums when translating these objectives into practice and instigate the change that is truly imperative.

Authors:

Emily Page, Systems Change Project Assistant

For further information about Fulfilling Lives work in this area, please contact:

emily.page@bht.org.uk

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Seeing the whole person: Reflections on a journey into employment

Fulfilling Lives South East

This blog post has been written by a colleague with lived experience of multiple disadvantage and is a personal reflection of the employment journey they travelled, including within their role at Fulfilling Lives South East. 

Citrus Ornge

My employment journey began over three years ago, when Rob Robinson who was working with me as part of the IPS (Individual Placement and Support) trial at a substance misuse service introduced me to Jason at Citrus Ornge. At the time I was volunteering, studying and taking part in wellbeing groups but I could not really visualise a pathway into employment for myself. Looking back, I realise I had internalised a lot of stigma and my self-esteem was quite low – I didn’t think anyone would believe in me enough to offer me paid employment. Many of my IPS meetings had been spent agonising over gaps on my C.V, which felt like a road block… something which even if I got to an interview I could be faced with trying to explain or apologise for. I felt I had wasted the career I had before.

Rob came with me to meet Jason informally. It took a while to absorb the fact I was in a room with a potential employer who was in recovery themselves and open about that, and that I was invited to be too. There was no need to explain gaps in my C.V or that my references would be from people I volunteered with rather than worked for. And so, I became the first employee of Citrus Ornge.

I had no media or business experience and did not even own a laptop, so Jason lent me one and I went to work one day a week. I was shown how to do what I needed to do – learning new skills in the process – and I did it. What I did know was that Citrus Ornge had a social mission that I admired and wanted to help with if I could.

Emotionally, it was a time of change and growth. Like many people in recovery, I had experienced trauma and feeling safe in different spaces was something I was working on. Sitting in an open office space surrounded by people with laptops from 9am to 5pm was something new, and I had to learn to be in that space. Facing anxiety and not letting it win, grounding myself in a place where I felt the acceptance of being with someone else in recovery. Continued regular IPS support was vital to keep me focussed on the positives, recognising my achievements and moving forward.

Jason introduced me to the idea that people in recovery have unique assets that should be valued by employers, and I learned from how open and honest he was about his own recovery that it is not something we should be ashamed of in professional spaces.  I wondered if other employers existed that thought about recovery this way.

Months on, Citrus Ornge had grown to a handful of employees. Someone at the service I was still volunteering with showed me an advert for a job at Fulfilling Lives. Having lived experience of multiple complex needs was a requirement for the role, much of my volunteering experience was relevant and I now had recent experience of employment. The project looked too interesting to let the opportunity pass by, so, I decided to apply for the role. I didn’t expect to get the job or even an interview and had prepared for that outcome with people in my support network but saw applying as a step in the right direction.

Fulfilling Lives

I started in a 3 day per week role at Fulfilling Lives and was then promoted to full time. I have been here 2 and a half years now. During my early months, I benefitted greatly from having regular supervisions where I could measure what I was learning against an induction checklist, raise any concerns and set goals. Having a list of what I was expected to achieve during my first six months was a reassuring, clear and objective way to look at my progress – this was important as I was tending to focus on my perceived failures and shortcomings at that time.

Like my experience at Citrus Ornge, I saw others being open about their lived experience but took time to feel I could start to do that myself. After building relationships of trust with my team, discussions in reflective practice sessions, and training about professional boundaries, I became more confident about judging what to share and when, knowing what I was comfortable with, how to speak from lived experience without sharing details I was not comfortable with, how to assert boundaries and making judgements about whether sharing something about myself would be of benefit to someone I was supporting or a piece of work. Over time I have started to make peace with my lived experience, integrate those experiences into my current identity, and rather than making a journey from a person in recovery to a professional, I have become a professional who is also in recovery.   

Monthly strengths-based, psychologically informed supervisions have facilitated development of my confidence and I am now able to recognise my own strengths and interests and more likely to take on new challenges at work. Being in an environment that genuinely supports me to perform at my best means I feel like my team are behind me even when I’m working as an individual. I know that if something is a challenge for me, I can view it as an area to work on rather than something I have failed at. As an example, the first time I had to stand up and speak in front of a room of people, I was so nervous I could not even stand up from my chair and a colleague delivered my part of the presentation. After working with my manager and development worker, and conversations with colleagues who were so non-judgemental and generous with their own stories of taking on challenges, I presented at a conference two weeks later. To date I have taken part in delivering training to hundreds of people.

This style of supervision has also positively influenced the way I mentor others within my role, by modelling a collaborative approach based on trust, building on and affirming strengths, supporting people to achieve their goals and creating safe strategies to cope with times resilience is tested.

I hope that anyone reading this gets a sense of how grateful I am for the IPS Trial, Citrus Ornge and Fulfilling Lives, and the impact they have had on my life. As I write this, I am about to start a new role and continue my employment journey – a journey I wasn’t sure would ever happen. We acknowledge the critical importance of believing in people whilst they are accessing support services and in the early stages of recovery, but recovery, learning, and growing never stop. Can we say we really believe in people if we only believe in them up to a certain point?

Learn more about employing people with lived experience of MCN

For those who are interested in Fulfilling Lives’ learning about employing people with lived experience of multiple complex needs such as my myself, we have created an employment toolkit which is available to download here:

Download here

For more information about Citrus Ornge and their social mission

Visit Citrus Ornge website

Authors:

Anonymous Fulfilling Lives Team Member

For further information about Fulfilling Lives work in this area, please contact:

Andree.Ralph@sefulfillinglives.org.uk, Co-production and Engagement Lead:

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Co-production: Definition is in the detail

Fulfilling Lives South East1 Comment

“Co-production is a high level of such participation that involves sharing control with those using (or who have used) a service, and ensures they have equal influence over the design, delivery and commissioning of any service that affects them.”

The above quoted text is the official Fulfilling Lives definition of co-production in the context of working with people who have experience of multiple and complex needs, as shown on our website.  It isn’t dissimilar to other definitions which can be found by searching for the term online.  The idea is simple and speaks for itself, yet when considering working in this way, this definition and many others can become increasingly vague.  It is a way of working that can be applied to a wide variety of activities and projects within differing organisations.  These projects and organisations will have their own ethos, goals, values, management structure, rules, regulations, policies, guidelines, and other restrictions on flexibility that need to be considered when deciding to co-produce.  Furthermore, there isn’t one way to approach co-production.  The same task can be divided a multitude of different ways.  It is up to you (all) to decide on the best approach to meet your goals, while considering who you are working with, the skills and interests they possess, and the various regulations previously mentioned that may restrict choice and freedom.

At Fulfilling Lives, we aimed to co-produce from day one of the project being in operation.  As well as a systems change project, we are an experimental one.  We have learned about co-production along the way and evolved our practices accordingly to fit our purposes.  It is through trial and error, continuous reflective practice, regular analysis of how we operate, and regular feedback from those we are co-producing with that has helped us to see the challenges and nuances of the co-production process.  From this, we are better able to foresee potential sticking-points or areas of conflict that may emerge.

An example in practice:

As an example, consider co-producing in the following scenario:

Co-ordinated by a member of staff, a service user group decide to produce an information brochure to help others navigating social services’ childcare proceedings.

Questions or dilemmas that might arise during the process:

  • Are we being inclusive and accessible?
  • Do people feel confident and knowledgeable enough to meaningfully contribute?
  • Who has personal experience of childcare proceedings?
  • How might taking part impact service users? – discuss with them.  What emotional support might they need and is this available?
  • Have you asked service users what they will need to complete their task e.g. regular check-ins with their mentor? Do they feel they can reach out for help if they need it?
  • If someone wants to drop out, do they feel they can let us know so the work can be undertaken by someone else and completed before any deadlines?
  • Is there a member of staff who would need to authorise the content and design?
  • Are there branding guidelines that need to be followed?
  • Does anyone have design experience?
  • What is the division of workload?
  • Who can commit?
  • Do the group want to work on the whole brochure collectively, or would people prefer to own sections from start to finish?
  • Should people have specific roles based on personal experience and interests?
  • Should someone be responsible for ensuring the writing flows consistently throughout the final document?
  • If someone can’t make a session, are they happy for someone else or the group to take on their work?
  • Should people be appointed the power to override decisions based on their expertise or experience?
  • What if there is a conflict over content or design?
  • Does the final product have to be of professional quality?

This is not an exhaustive list of potential questions that may come up, but it serves to illustrate the intricacies of power sharing and the nature or working in a co-produced way.  Thinking about the questions and challenges that may arise has several benefits; firstly, it demystifies the unknown.  When you can visualise what’s up ahead, it’s less intimidating getting started.  Secondly, it will help avoid or manage potential conflict while minimising occasions when you may have to explain why a suggestion may not be possible.  Saying ‘no’ highlights a power difference, can result in people feeling rejected, and can shake trust in the relationship and faith in the process.  Like any members of staff, service users need as much clarity and transparency on their role and the work they are taking part in right from the start.

What Co-Production is NOT ….

Exploring questions around barriers and restrictions is one way of gaining clarity when co-producing.  Another, is to think about areas of uncertainty around what does and does not count as co-production: 

  • Co-production is not about individual agendas  
  • Co-production does not mean an equal share of the workload 
  • Co-production does not mean all group members need to commit an equal amount of time 
  • Co-production does not mean equal accountability and responsibility 
  • Co-production does not preclude the project group having a leader/manager/coordinator 
  • The co-production process in not free from rules and limitations 
  • Ideas and opinions shared when co-producing a piece of work does not mean they are all equally considered by default.  It is important to remember that there is a common goal as defined by the objective, and that ideas should be considered on their merit and relevance  
  • Co-production is not assuming everyone will want to be involved 
  • Co-production should not be tokenistic  
  • Co-production is not consultation 
  • Co-production does not mean an individual must be part of the process from start to finish 

Connecting all the pieces for your project ….

Through curiosity about the process and discussions with service users, over time you’ll gain a more complete picture of what co-production will look like in the project you are taking part in, like piecing together a jigsaw puzzle.  We would suggest starting with the vital things that need to be in place – how will you co-produce in a trauma-informed way that keeps people safe, enables them to make informed choices, work collaboratively, build on relationships of trust, and honour everyone’s voice? There may always be elements of unpredictability and uncertainty when compared to the standard role-based hierarchical management structure, and it is important to be transparent about these from the start, as far as possible, with everyone taking part.

Authors:

Ian Harrison, Engagement and Co-production Worker

Vikki, Engagement and Co-production Worker

For further information about Fulfilling Lives work in this area, please contact:

Andree.Ralph@sefulfillinglives.org.uk, Co-production and Engagement Lead:

For more information sign up to our newsletter:

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CGL Women’s Hub: A new Treatment Pathway?

Fulfilling Lives South East

Ideas about who uses drug and alcohol services and how they use them need to be challenged. In Hastings, the CGL Women’s Hub has been quietly doing this. However, in the run up to the publication of a report on its work, the noises coming out of the Women’s Hub are getting louder.

In a way it’s a simple idea. Create a place where service users want to go, that meets their needs… and meet them there.

CGL (or Change Grow Live to give it it’s full name), is the main provider of drug and alcohol support services across Sussex. In August 2021, a new initiative with Fulfilling Lives saw the appointment of Rachel Payne, a practice development worker who identified a need for better treatment pathways for women. Nationally, treatment services have seen considerably more men access their services than women (69% to 31%, PHE 2020). For many this has reinforced the idea that men are more likely to need the service. However, there are a few working in these services who have been questioning whether the way a service is offered can be a barrier to more women accessing effective treatment. The CGL Women’s Hub seems to suggest this is the case.

Katie Lowe went to the weekly Women’s Hub to see first-hand what is happening at a service which is seeing a 78% increase in engagement compared with keyworker meetings and a nearly 300% increase in their participation compared to groups run out of their high street offices. As a psychology student on placement with Fulfilling Lives, Katie had no previous experience with drug and alcohol services and really didn’t know what to expect:

When I got there, I was given a warm welcome and encouraged to get involved in the craft session that had already started. I later found out this is run every week by one of CGL’s volunteers. What struck me early on was how much everyone seemed to want to be there. Not just the women but the staff too. Rachel filled me in on the details: The Hub meets every Tuesday at a local community venue. This allows the service to provide an inclusive women-only space. This neutral venue is not associated with medical treatment, men who may or may not pose a risk or the stigma of being seen walking in from a busy high street. Deciding to run it on a Tuesday was not an accident. Rachel mapped out the other services women might want to attend and found a space that didn’t clash. Staff at the Hub have encouraged women to try out these different services, with small groups arranging by themselves to go together. In some cases, their participation has gone from just turning up for a required medical appointment to attending multiple support groups across the week.

Women can come and go as they please, take part in any of the available activities or just sit and chat. It’s their choice. With an average of 2.6 hours spent at the Hub when they do go, it suggests they get involved in a lot. Local charity Dom’s Food Mission provides supplies for breakfast and lunch. There’s the 2-hour creative group which I dropped in to, often running alongside a beautician offering hair and nail treatments and once a month a hairdresser. After lunch there is an accommodation specialist on hand for drop-in advice, a space to generally chat and get support and regular visits from an NHS sexual health nurse (who reports being able to see as many clients in an hour at the Hub as a whole day trying to meet them in the community). Then there’s acupuncture with a guided meditation followed by a yoga session before everything ends at 3pm. Coming together in this way has allowed women to meet with friends and make new ones in a place that feels safe. It seems to restore social and relational experiences in a way that feels normal in a sector where treatment can be retraumatising for many women.

Friendships, community, meals and clothes are all things we can take for granted if we are not dealing with multiple complex needs. However, Rachel will tell you this busy schedule wasn’t always the plan. Local services have been as much drawn to the Hub as the women themselves, offering support and staff time, all focused on a shared desire for women to get the service they need. Outreach workers, care coordinators and keyworkers from CGL, Seaview and Project Adder have all been involved in running and planning activities. Others have provided quality clothes donations and the combination of a local branch of Tesco and the Hygiene Bank provided items to give to women for free.

Taking this approach has the potential to make a huge impact on the way substance misuse services are structured, and how clients access treatment. There are spaces at the Hub for care coordinators and outreach workers to meet confidentially with women. The Women’s Hub has also been used by occupational therapists, domestic violence workers from Respite Rooms, HomeWorks and the Rough Sleepers Initiative, to meet clients and connect them to CGL’s treatment pathway. So far there’s been cases of women accessing CGL treatment by coming along to the Hub, assessments being carried out at the Hub, and this has even led to women going to detox and rehab. In a way it’s a simple idea. Create a place where service users want to go, that meets their needs… and meet them there. The statistics back this up as a place women with multiple and complex needs want to go. Since it began in November 2021, the Hub has seen 47 different women with an average attendance of 63% – no mean feat for a weekly programme with a service user group often considered ‘difficult to engage.

With Rachel’s own interest and the years-long investment of Fulfilling Lives in specialist women’s services, this approach made sense. However, there is already talk of how this approach might better meet the needs of other marginalised and minority service user groups who are not accessing treatment at CGL’s main offices. With 65% of service users accessing treatment by self-referral or through family and friends (PHE 2020), creating spaces that feel safe for marginalised people will be vital to genuinely inclusive treatment pathways.

Providing the service is inexpensive, with activities and groups being offered free of charge by the different services involved. Many of the staff can use the space to do work that they would have been doing anyway and reach several clients at the same time. There is a small cost for venue hire and arts and crafts projects but that is easily justified by the reach of the service. Creating and chatting with other women is what makes the Hub what it is. Rachel and the team are using these activities to engage with some of the most marginalised and excluded women, reaching out and connecting in a meaningful way.

It’s early days but all the indications are that the Women’s Hub is demonstrating a model of drug and alcohol treatment that is meaningful. There are many positives to this approach; building a safe, inclusive environment for women to access services which otherwise might have felt unsafe. Of course, moving from centralised office spaces would be unfamiliar to most in substance misuse services. There are also some logistical challenges to booking suitable community venues (made easier in the wake of the pandemic as bookings dried up leaving space for new initiatives like this). However, the early signs present an exciting challenge to drug and alcohol services that will be hard to ignore.

Authors:

Katie Lowe, Psychology student on placement with Fulfilling Lives

David Garret, Practice Development Coordinator

For further information about Fulfilling Lives work in this area, please contact:

david.garret@bht.org.uk

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Common Ambition and Fulfilling Lives South East- a flourishing partnership

Fulfilling Lives South East

In this blog we reflect on a productive partnership that has helped nurture systems change. We look at what elements most contributed to this relationship and the role coproduction can play in catalysing change.

Common Ambition and Fulfilling Lives South East (FLSE)

The Brighton and Hove Common Ambition project works with people who have lived experience of homelessness, frontline providers and commissioners in order to improve health services and outcomes for people experiencing homelessness in Brighton & Hove. This is done through co-production. Common Ambition is funded by Health Foundation and is run in partnership between ARCH Healthcare, Justlife, University of Brighton, Brighton and Hove CCG and Brighton and Hove City Council Public Health Department. Funding was secured in 2021 and the project is guided by a passionate steering group of experts by experience.

The FLSE project, based at BHT Sussex, is one of 12 partnerships funded by the National Lottery Community Fund to provide intensive support for people experiencing multiple and complex needs, involve people with lived experience at all levels and challenge and change systems that negatively affect people facing MCN. While this eight-year project will soon be coming to an end, we recognised the potential of collaborating with Common Ambition.

At FLSE, we were keen to collaborate with the Common Ambition team from the start; we saw a real opportunity to share our learning while amplifying our voices to champion for changes in healthcare services and systems to improve outcomes for people experiencing homelessness.

What we did together

Ever since early 2021, monthly catch ups between staff members helped facilitate a collaborative approach, providing a regular space for exchange. Nicky Pyper, Project Manager of Common Ambition, says ‘The support Fulfilling Lives has given Common Ambition since the very beginning of the project has been invaluable. Always on hand to discuss arising issues, share learnings and make connections, we would not be where we are now without them. The monthly catch ups have been really useful as a place to share best practice, look at how we can work together and ask for advice. Then knowing the team were always willing to share their knowledge or could point us in the right direction for help when we were designing the project, bringing our lived experience groups together and then carrying out research was such a support to the project.’

We invited Common Ambition to internal Project Group meetings about promoting changes to address health inequalities, shared our reports and blogs and invited the Common Ambition team to our Action Group to get first-hand accounts of service experiences from FLSE volunteers with lived experience.

Both FLSE and Common Ambition teams share a commitment to co-production and this was an important part of our partnership work. FLSE has worked for eight years to test lots of ways to bring co-production to life and have learnt useful ways to align co-production and systems change efforts. We wanted to share the FLSE approach and learning of facilitating co-production in practical systems’ change projects to support the Common Ambition team shape and set up their co-production approaches.

Co-producing with partners and people with lived experience weaves authenticity and integrity into the fabric of systems change.  It makes sense to involve the people who will be using services in their design, delivery, and evaluation, and to work closely with those who know them best to ensure a safe, accessible working environment.  Furthermore, the professional relationship that develops as a result of inclusive, equitable collaboration is different in quality to one that does not prioritise these approaches.  When all invested parties work together towards a common goal, without rivalry or a defensive position, the partnership becomes supportive in nature; with the attitude that we are helping each other to achieve a common goal.  This mutual trust is the foundation for a respectful, strong, supportive, and effective partnership.

Sharing learning – a deeper dive

One of the highlights of this collaboration was FLSE’s Service User Engagement team creating and facilitating custom-made training sessions for Common Ambition’s Steering Group members. The sessions focussed on topics such as confidentiality, professional boundaries, mutual respect, effective communication, active listening as well as what real co-production looks like in practice and how it is different from other forms of engagement.
 
Our team adopted a trauma-informed lens while co-designing the sessions. Prior to the training, our team visited a steering group meeting to familiarise themselves with the members of the group and find out what their expectations and asks were for the content of the sessions – what and what not to include. Then, we invited the staff from the Project to review and feedback on the training to account for any sensitivities or requirements and ensure that we enhanced the group’s ongoing learning. This was a successful strategy because it allowed us to build an open and trusting relationship from the very beginning and develop a sense of psychological safety for the group members. This was also reflected in the feedback we received from the participants, with all of them giving us a 10/10 score to the question whether they would recommend us to a friend or colleague.

For us, these are the three tips to consider when facilitating workshops for service user groups:

  1. Get to know your audience and use a trauma-informed approach based on principles of safety, trust and transparency, choice, collaboration, and voice.
  2. Address barriers to inclusion which can be thought of in terms of making language accessible, accounting for any mobility/disability issues for example.
  3. The topic you present on may be entirely new to your group, so be prepared to tailor your session and change tack if any tricky situations arise.

Nicky Pyper commented about the training that “We can’t thank the Fulfilling Lives team enough for the fantastic training you delivered. It was exactly what the group wanted and was thoroughly sensitive to the group’s needs throughout. It was the perfect mix of presenting, group work, activities and discussion. The group all commented on how great the trainers were, in particular noting their down to earth and caring approach. It didn’t feel like we were in a classroom setting, rather that the whole group was going on the journey together. Group members commented that they felt like they learnt a lot. We will be building on the work Fulfilling Lives did with us and making sure we revisit our learnings regularly.

Looking to the future

As FLSE is now reaching the final stage of the project, we are proud to know that Common Ambition will continue influencing the system to make primary healthcare more accessible to and impactful for people experiencing multiple and complex needs.

Michaela Rossmann from the FLSE team reflected that “being open and proactive in partnerships is key when trying to influence systems. For me, sharing learning and supporting each other, finding commonalities and focussing on the positives are what makes the partnership with Common Ambition so unique. It’s built on trust, mutual respect and understanding. Common Ambition has been an ally for FLSE from the start and it’s been great to see the project go from strength to strength.”

Nicky Pyper reflected that “Common Ambition will carry on the FLSE legacy of putting the voice of those with lived experience at the heart of system and service change and will continue to advocate for co-production. We will also be continuing to shine a light on ‘Bright Spots’ and raising awareness around the challenges people experiencing MCN face when accessing and using healthcare services. Areas that our lived experience groups have found particularly interesting are the implementation of frailty scores for people experiencing MCN and treatment in A&E, we hope to continue to explore this.”

For more information about FLSE’s systems change work to address health inequalities please read our Ripple Effect impact report

Click to read the Ripple Effect Impact Report

For more information about the Common Ambition project, please visit their website

Click here to visit Brighton & Hove Common Ambition

Authors:

Michaela Rossmann, Systems Change Officer:

Aditi Bhonagiri, Engagement and Co-production Worker

Ian Harrison, Engagement and Co-production Worker

Rebecca Rieley, System Change Lead

For further information about Fulfilling Lives work in this area, please contact:

rebecca.rieley@sefulfillinglives.org.uk

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