Employing People with Lived Experience of Multiple and Complex Needs

We would like the knowledge our toolkit contains to travel far and wide, making its way into the hearts and minds of organisations across the country, and for employers to recognise the benefits of employing people who have been through hardship and continue to fight for themselves.


A toolkit for employers

Fulfilling Lives South East (FLSE) has been running for eight years.  Eight years is a long time.  Over the course of the project, a lot has changed.  We have tried, tested, adapted, won some, and lost some.  Through all this experimentation, we have learnt a lot about the ‘system’, and a lot about people.  As the project draws to a close, we want to share what we have learned along the way

A major feature of the FLSE project was its employment program, the purpose of which was to employ people with lived experience of multiple and complex needs (MCN) and support them through their recovery from a work-centred perspective.  Those employed were titled Project consultants (PC) and attached to the Service User Involvement (SUI) team.  Their lived experiences varied in combinations and intensities across the spectrums of substance misuse, mental health, repeat offending and homelessness, while their duties were similar, their skillsets differed.  Those occupying the role came from a variety of backgrounds, including but not limited to design, research, psychology, biological sciences. They were also tasked with mentoring lived experience volunteers whose experiences ranged from students to city workers.

In the eight years, the project has seen many lived experience team members come and go.  The majority successfully moved on to other employment, either directly from FLSE, or within six months of leaving the project, while others were not quite at the right stage of their recovery to complete their contract.  Throughout this time, the managers and supervisors have evolved their support practices as they’ve learned what helps (and what doesn’t help) staff with experiences of MCN.  More than that, they’ve helped those staff members to harness their own skills to drive systems change forward. 

Inclusive, supportive workplaces for all

In 2021, we decided to develop a toolkit aimed at employers to consolidate what we have learned about employing people with experience of MCN.  The more we discussed the idea, the larger in scope it became.  In essence, it is a guide to help organisations foster a culture where lived experience of MCN is not only supported but valued.  It’s about creating an inclusive, supportive workplace culture that benefits employers and employees, regardless of whether they have experience of MCN or are just going through a difficult time.  Our toolkit exists to support organisations in creating that culture by providing tools, approaches and practices that help them to help their employees thrive and be successful so that they, in turn, can give their best in their working roles.

So, what does that support look like?  Having seen 41 Project consultants pass through FLSE, all with different life experience, we have a wealth of knowledge to share.  Our toolkit distils down to the overarching support themes that – although written for people with lived experience of MCN – can be applied to all employees.  Its foundation is three principles: Psychologically Informed Environments, Co-production, and Trauma-informed Practice.  Together, these concepts underpin the way people work together, how they treat each other, and how the working environment respects and reflects the (sometimes) difficult life experiences of its employees.  On the surface, they are simple to understand, but require consideration when put into practice.  It is a culture-change, so that means staff need to be on board at all levels, and it takes time and diligence to overwrite old habits, thought processes, and ways of relating.  These three principles should be applied throughout the recruitment process, supervisions, and day-to-day working practice. 

The toolkit also highlights the benefits that people with these life experiences can bring to organisations and the people working within them.  The chances are high that there are multiple people in any organisation who have personal experience or know someone close to them who has experienced addiction, mental ill-health, offending behaviour, or has either been homeless or close to being homeless.  Having someone relate to these circumstances can help with feelings of isolation and shame.  This alone can build stronger, more trusting relationships, while reducing stigma and improving wellbeing within organisations and teams.

The British Medical Association reported in their July 2016 publication (that alcohol use is prevalent among those who work, more so than those who are unemployed, and that it is a growing concern for employers.  The Office for National Statistics reported on their website that in the UK in 2020, 11.6% of absences from work were due to mental ill-health.  Criminal behaviour is not uncommon in wider society.  Violence and substance use are daily occurrences.  These intertwined issues are not confined to people with MCN histories; they apply to people from all walks of life in any profession.  Although our toolkit is designed for supporting people who have combinations of adverse experiences, it can be just as useful for people who are struggling for a single reason.  

Sharing our knowledge

We would like the knowledge it contains to travel far and wide, making its way into the hearts and minds of organisations across the country, and for employers to recognise the benefits of employing people who have been through hardship and continue to fight for themselves.

If you are an employer and would like to discuss this further or have some support around employing people with lived experience of MCN and how to do it well, then please get in touch at the contact email below by 1st June 2022. We’d be more than happy to help!


Author:

Ian Harrison, Engagement and Co-production Worker

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

Andree Ralph, Co-production and Engagement Lead:

andree.ralph@sefulfillinglives.org.uk  

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Journeys towards a Psychologically Informed Environment (PIE)

There is a growing interest in the support sector to operate Psychologically Informed Environments (PIE) and to adopt trauma informed practice, but this is hard to do. In this blog we reflect on Brighton & Hove City Council’s (BHCC) PIE journey that Fulfilling Lives South East (FLSE) supported with experts in this field and what we learnt from the experience.


What sparks collaborations?

After conversations between the FLSE team and BHCC about changes to language and policy seemed to stall in the face of detailed revisions and large authorisation processes, the FLSE team decided to re-group and re-evaluate priorities. We reflected that we actually wanted to support larger-scale changes beyond the immediate policy in question and that we were passionate about encouraging PIE and trauma informed practices across the service.

We shared these reflections openly with the BHCC managers and this unlocked a different mode of conversation. We were able to discuss broader principles and values of the department and we found this was a much more open dialogue, welcomed by both ourselves and the BHCC team.

What happened in the journey – ‘How about a mystery shop?’

In a meeting that followed sharing our reflections, a volunteer said: ‘how about we do a mystery shop?’ He reassured the groups that this was a learning opportunity, with an established process which had been carried out in the Hastings Housing Department to support their service development too. The BHCC Managers embraced this opportunity and a month later we were training up volunteers to carry out a mystery shop and conduct environment assessments of the housing customer service centre.

To find out more about mystery shopping please read our toolkit here. The learning from these activities was shared at both a managers’ level and with the whole department. These meetings and presentations were co-produced and co-delivered with people who have lived experiences of multiple and complex needs (MCN) and we highlighted positives as well as areas we felt could be developed. Paired with this, BHCC housing managers made time for staff to reflect on the learning and share hopes and aspirations for the Department. They wanted staff to have space for de-brief and dialogue.

The BHCC Housing Department was starting to shape its vision and plans for the future using the learning from the mystery shop and environment assessment paired with staff feedback.

Following this, the Department reached out to Dr Peter Cockersell to support with staff training in PIE and trauma informed approaches. Peter is a leading expert in this field and one of the co-authors of the national guidance on PIE. Peter worked in collaboration with FLSE, partnering with volunteers and experts by experience to design the training which was then delivered by the team. This programme saw over 100 staff participate in training across the whole of the BHCC Housing Department.

Following this, in late 2020/early 2021, the Department released its revised strategy, which included a commitment to becoming a department that operates as a PIE.

Covid-19 has obviously put all housing departments under huge strains, and we hope that as the world takes steps to recover from the pandemic that the BHCC team can have space to revisit this work and time for non-crisis activity.

What impact did this have?

Having the mystery shopping exercise and environment assessment as the foundation for this partnership, centred the voice of lived experience and helped to shape BHCC’s plans for the future around the service-user.

One volunteer who was key to shaping FLSE’s involvement in the partnership shared their reflections on this work:

“So my interest in the work was to do with the fact that the first time I was homeless I went through the system, and it was decided that they had no duty of care. So I just wanted to see if the system had changed or not.

I do think that the majority of the staff [at the council] were very open minded.  The few staff members who did object at first did eventually came around after we managed to convince them that the work was about testing the system and not them.

I don’t know about all the staff, but I do remember one lady who said that as a result of the mystery shops that she had re-evaluated the way she worked, and that after it, when she was meeting with people she made sure that she had some water and tissues in case they were needed.”

Learning

Based on the learning and values of the Project, there are golden threads that run through all of our systems change work. We share these below as useful starting point for anyone looking to spark or support a journey of change similar to the one we reflect on above.

  • Drivers for change: At FLSE we have found it useful to reflect on and write down what drives all our efforts and partnership work. These are a useful reminder on a challenging day about why you do the work. 
  • Guiding principles: We have worked to certain values, principles and practices and this has helped shape what we do as much as how we do it. For FLSE, these have been:
    • Co-production
    • Trauma-informed practice
    • Naming Multiple and Complex Needs (and multiple disadvantage)
    • Using project management tools to guide activity
  • Building trust: Making concerted efforts to build trust between all stakeholders who need to be involved in a PIE journey or further systems change activity is crucial.  We’ve learnt that this is a bedrock of all good partnership working and when we have built trust effectively, this has led to the most impactful outcomes.


Author:

Rebecca Rieley, Systems Change Lead

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

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

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Employment and the road to recovery

Meaningful work is right up there among the activities known to help wellbeing, support successful maintenance of recovery and reintegration and to help people with lived experience of multiple complex needs (MCN) move forward with their lives.


Our work

Since 2014 the Fulfilling Lives South East Project has employed a total of 41 individuals with lived experience of MCN, through its employment programme.

Throughout the employment program we sought to learn what it takes to successfully recruit and employ people with lived experience of MCN. We have adapted systems and processes, tested things out, reflected continuously……got it wrong sometimes and after seven years, gathered a wealth of information and evidence of what works and how organisations and employers can effectively recruit, support and develop people who have experienced disadvantage.

This period of intense learning has led to 39% of former employees moving directly on to other employment opportunities and 17% who gained employment within six months of leaving Fulfilling Lives. A total of 56% of former project consultants have successfully moved on from the project into new employment. Five people are still working in the project and three of them have already secured jobs to move on to when the project finishes in June next year!

Let’s be honest though, we could quote statistics and numbers all day.

But it isn’t just about numbers and data.  For Fulfilling Lives South East it’s also been a journey of discovery about how employees with lived experience of MCN can be supported to grow, thrive and excel in their roles, being proactive in taking on new challenges, leading on projects and seeing within themselves potential that previously may have been hidden.

The numbers will only ever tell us so much. To really understand why meaningful employment in a trauma informed environment and organisation can truly change lives, we need to hear from the people who have experienced it. So, we asked some of our team….

How have you benefited from being employed in the Fulfilling Lives Project?

“Working at FL has been an important part of my recovery journey.  It’s a large slice of my life that contributes to something positive, personal, and meaningful.  The job is the foundation for me to start over, while allowing me to work in parallel on the deeper issues that led me here in the first place.  The support and flexibility make it possible to do the difficult personal work whilst being employed”

I worked as a volunteer for 7 months before being employed by Fulfilling Lives. Prior to that, I had been unemployed for 2 and a half years and had really low self-esteem as a result. I had lost all my confidence; I was scared about everything and I felt hopeless and worthless. But this time around, I was determined to turn my life around and I received the support and guidance I needed through FL. I started taking on pieces of work where I was able to build on my strengths, tap into the recovery networks that I was a part of and apply the skills I had learnt before I fell ill. My negative experiences with my illness and with services didn’t haunt me anymore because I was able to use my lived experiences constructively. I started feeling less lost and FL helped me regain a sense of purpose. Most of all, I benefitted from meeting like-minded individuals and working in a team where each one of us had a story to tell. We had all been through a lot in our lives and FL became a conduit for our transformations. Now I have a different story to tell …of what it feels like to be on the other side of a trauma, illness and isolation.”

How has being employed in a trauma informed environment helped you?

“Recovering from trauma is a journey, not a destination. Working in a trauma informed culture has helped me gain a deeper understanding of my journey and to sharpen the tools I have, to survive and thrive after trauma. I’ve been supported to apply my skills in new situations and take on new challenges.  Working in a trauma informed way can result in sense of empowerment for individuals and create a trauma informed culture within an organisation.  Having regular space for reflective practice, focusing on growth and learning has really accelerated my development. Learning from each other’s’ strengths and experiences, being honest in a group setting and problem-solving challenges has been really useful.”

“I think trauma is something that sometimes we are working on our whole lives. There’s not a before point and after point it’s like continuous building and healing and resilience and coping skills. That’s maybe part of why even at the point of being employment ready we can still benefit from trauma informed culture because we are continuously developing. Always some processing, realising, healing, learning and growing to do”

“Life can be very cruel and many of us carry some kind of trauma that is unaddressed. Additionally, it is not uncommon to hear of workplaces that are exploitative towards the people that work for them. Working in a trauma-informed environment feels like some sort of rebellion against a work culture that doesn’t value kindness towards or the well-being of their workers. Being employed in an organisation that is trauma informed is nourishing. It creates a fertile ground for creativity, imagination and innovation, where people can explore their strengths, heal from their negative experiences and grow in a place where people truly care about you”

Are there any examples of trauma informed practices that really stood out for you while at Fulfilling Lives?

“Person-centred and psychologically informed supervisions have allowed me to develop my confidence and relationships of trust with people supervising and managing me. When I was new my supervisions were really tailored to my needs in terms of negative self-concept and tendency to magnify real or perceived imperfections. I learned to evaluate my performance more objectively by doing this with my supervisor and now I am able to recognise and speak about highlights and achievements, as well as raise areas I’d like to develop or work on without fear of punishment/harsh judgement. I feel I can be 100 % open and honest “

“I’ve never been in a job where I’ve needed to be so organised, chopping and changing between different tasks, taking different trainings, absorbing so much information.  It was very overwhelming having not worked for three and a half years.  It was a world I’d never experienced.  The induction period was very helpful.  I was able to ease into a work routine at a pace that worked for me.  I didn’t have to hit the ground running and fill my calendar with meetings.  It gave me time to settle in and get used to just being at work. It was low pressure with some guidance to keep me on track and focused on the right things.  There were development sessions which kept me on target to learning or re-learning key skills, normal workplace skills that I’d forgotten.  Thinking back, the induction period served as a safe place to start from scratch.  It really did feel like starting again.  My manager and supervisor were like guides who helped me to function in the world.”

“Having an attitude of learning and development in our team really helped me too. The skills I found challenging were reframed from things “I’m just not good at” to something I can improve at, practice and were achievable.  If something was a challenge, there was support to work on it”

So, what do trauma Informed practice and psychologically informed principles look like at work?

Well, it looks like any good employment should!

In reality, what we are talking about isn’t the proverbial ‘rocket science’ but it does need to be thought about properly, valued across the organisation and embedded in everything.

It means creating supportive and accessible workplaces; in a nutshell, getting the culture right! 

The values of Trauma-Informed Practice, Psychologically Informed Environments and Co-production should underpin everything.  It’s also about recognising the undeniable link between wellbeing and performance and embedding activities and processes that promote and maintain wellness for all employees throughout the organisation.

These principles and values need to be part of all the policies and processes that an employee with lived experience of MCN (and in fact any employee) will have to navigate and be a part of: The recruitment process and application form; attending an interview and being recruited; going through Induction; succeeding at any probation period and participating actively in supervision and professional development throughout their role.

Really though, shouldn’t we be striving for this anyway? In all roles?

And it’s a two-way street too! Our project has benefitted enormously from employing people with lived experience of MCN.  Bringing their commitment and unique engagement qualities and skills, this team has been crucial in the development, implementation and success of our systems change, engagement and co-production objectives.

In a series of blogs around employing people with lived experience of MCN, we want to unpick some of the key elements and practices that make employment successful, both for the employee and for the employer. 

We are also currently creating a resource for employers around employing people with lived experience of MCN and how to do it well. If you would like a copy of this resource once it’s published, please contact andree.ralph@sefulfillinglives.org.uk or nelida.senoran-martin@sefulfillinglives.org.uk


Authors: Andree Ralph

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Further reading and resources

Working with the DWP (not against them)

Using co-production as the foundation to drive positive change for people with multiple complex needs.


Co-Production and driving change

Brighton Jobcentre Plus (JCP) is not known for its inviting exterior or the promise of fond memories for those who cross its threshold. Its brutalist form sits stoic and unforgiving next to the Law courts and a stone’s throw from Brighton Police Station. The three front-mounted security cameras cast a suspicious eye over all who enter. Over the past 7 years, working with people with lived experience has taught us that approaching the Brighton Jobcentre can leave people feeling, nervous, fearful, judged, and powerless. For locals, Brighton Jobcentre has not – historically – conjured images of warmth, compassion, or community.  Well, that’s changing.  Right now.  Not the exterior though, sorry!

The Fulfilling Lives South East (FLSE) partnership with the Brighton Jobcentre began in the summer of 2019.  From the beginning, Fulfilling Lives (FL) project staff and volunteers worked together with Brighton JCP management to design a Mystery Shopper exercise to evaluate how the Brighton JCP staff engaged with customers presenting with multiple complex needs. As well as this we assessed the building environment with the aim of understanding how at times the Brighton JCP could have a confusing and negative impact on some of the service’s most vulnerable customers.

To assess the service at its most authentic, Fulfilling Lives and Brighton JCP management decided it would be best to conduct the Environment Assessment and Mystery Shopper evaluation covertly. Without informing the staff. Yep, that happened.  This decision – made at the start of our partnership – shows the humility of our local DWP partners and their willingness to address any power imbalance; it was a risk to assess their own service without informing their workers, it was a risk to partner up with a small project to help them do so.  Lived experience volunteers and FL staff took part in planning the mystery shops, writing character biographies, and acting out the roles. The environment was assessed for its ‘Psychologically Informed’ design, which includes highlighting potential triggers that might hyper-arouse visitors with complex trauma histories, as well as areas of comfort. The FL project team presented the findings and recommendations from both the Environment Assessment and Mystery Shops to the whole Brighton JCP staff team.

Despite some staff understandably feeling displeased at being kept in the dark and the unforeseen impact of coronavirus and the immense pressures and challenges that have come with it, the Brighton JCP team have stayed with us and continued to work as equal partners towards our common goal of improving the system for those customers with multiple complex needs.   

Following the evaluations, working groups were setup with JCP and FL staff and volunteers to discuss the mystery shopper and environment assessment recommendations and how they could be translated to real change.  Due to having practically zero budget to work with, there was discussion of JCP staff donating their own personal items, such as cushions, to make the environment more welcoming. This commitment on such a personal level is worlds away from the impression many have of the Jobcentre as a cold institution. Art from the local Brighton & Hove Recovery College was hung on the walls, security guards were repositioned to appear less intimidating, toilet access was made easier, a reception desk was added, staff were given relevant additional training, private safe rooms were made available, and more. Fulfilling Lives went on to deliver workshops and webinars to over 350 JCP staff. And produce an eight video training series with lived experience volunteers to support the JCP staff to work more effectively with customers living with multiple complex needs. 

Instead of two organisations trying to further their own agendas, we wanted to embark on this relationship in the spirit of co-production; a single team made up of individuals with varied skills and experiences setting out to achieve a common goal.  As organisations, we are both working to make life easier for people who are struggling.  By working together instead of digging our heels in and fighting our respective corners, we have built a relationship of trust and reciprocity, where we understand each other’s roles, responsibilities, capacities, and capabilities.  With this attitude, the third-sector, local government, and people with lived experience have come together to create positive, social change, the influence of which has the potential to spread far and wide.

Coming up

In the next instalment of this blog series, we will hear more from the DWP managers at the heart of this partnership on how they leveraged the learning from this collaboration to drive the change internally.


Author: Alan Wallace, Ian Harrison

Should you wish to find out more about our partnership work or our systems change efforts, please contact:

Alan Wallace, Systems Change Officer: alan.wallace@sefulfillinglives.org.uk

Or

Rebecca Rieley, Systems Change Lead: rebecca.rieley@sefulfillinglives.org.uk

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Launch of Guide for Child Protection and Care proceedings, and Women’s Rights Leaflet

An example of co-production activity in action


Download the resources here

These are open-source resources, if you would like to host these resources on your own website please contact michaela.rossmann@bht.org.uk

In our Manifesto for Change, Fulfilling Lives South East (FLSE) identified that women experiencing multiple disadvantage going through child protection and care proceedings should be offered independent advocacy, with the aim of helping women understand each stage of the process, including what is going to happen next.

Our internal Project Group identified a lack of resources available to explain the process of what happens when Children and Family Services get involved.

In January 2021, FLSE created a sub-group which included volunteers, experts by experience as well as other team members to help prioritise the different discussions and we created a mind-map together, shown below.

As a team, and together with SpeakOut, we wanted to ensure that the information is accessible and available. Over the years, clients, front- line staff and experts by experience voiced the need for a leaflet and a simple explanation of the process of what could happen at different stages when social services are involved in childcare proceedings. Together with the sub-group we reflected on this and identified the lack of coordinated information and support. This really did highlight to us the importance of creating new resources to support women with MCN going through care proceedings. That is why FLSE has worked together across teams, with co-production at its heart, to develop and share our Guide to Child Protection and Care Proceedings as well as the new Women’s Rights leaflet.

We are also lucky to have dedicated volunteers and a passionate action group. Their input was crucial on how the resources have been created and designed.

Reflections

Reflections from Linda, a volunteer with FLSE:

The creation of these resources was the first project I helped to co-produce as a volunteer for FLSE from start to finish.


Co-production requires everyone’s involvement, ideas and feedback. Getting feedback on a piece of work that someone has done can be scary or upsetting and was something I was worried about. However, one of the highlights of the project for me turned out to be getting feedback from other volunteers, having them input ideas on how to make the design as accessible and useful as possible, as well as the thoughtful opinions and information provided by the frontline staff team.


I had the opportunity to experience the highs and lows of “getting things done” in a safe, pressure-free environment. It has given me an idea on how services operate (or should operate?) and helped me realise how teamwork is necessary to break down daunting tasks into more manageable steps, thus expanding what can be achieved by people in order to change, and helping people navigate various systems.

Reflections from Vikki, FLSE Engagement Worker:

It has been a privilege to work alongside Michaela and Linda creating this important set of resources. This work is a great example of co-production in action and the positive impact it can have – both on the work produced and the individuals taking part. Linda is a very motivated and reflective volunteer with many skills, and it was great to be working in a project where we place trust in volunteers to take ownership of pieces of work of their choosing and allow them space to shine. She was also able to identify development goals that she would like support to achieve during this process, such as presenting the work to groups of people and incorporating their feedback into the final product.

By consulting with frontline staff, systems change staff, managers and a diverse lived experience group we have ensured our final resources approach this sensitive and potentially triggering topic sensitively and that they will be useful to a wide range of people. Building relationships of trust across teams of staff and volunteers, and holding our meetings in a safe, boundaried, trauma-informed way meant that people felt comfortable using their voice and sharing their opinions.

This project is also an example of a volunteer having value beyond their lived experience – Linda used her lived experience perspective in creating the resources but also drew on other personal and professional qualities to take part in these pieces of work.


Producing such sensitive resources involved lots of conversations with FLSE’s project group, partners like SpeakOut as well as front-line staff and social workers.

For us it was crucial to use the full ladder of co-production to make sure we are inclusive, support people to voice their opinions, give them choices for how they take part, and offer chances to give feedback and build that feedback into the work.
To ensure accountability, our experts by experience actively fed into the design and content of the video, as well as deciding the content and colours of the leaflet. We are very happy that Linda took the leading role in designing the leaflet.

And we are now happy to launch the online guide to child protection and care proceedings together with the Women’s Rights Information Leaflet.

There is still a lot more work to be done to ensure women experiencing MCN and recurrent child care proceedings are being fully supported across systems and we continue taking steps to minimise this gap.


Authors:

Vikki – Project Consultant
Linda – FL Volunteer
Kate Jones- Project Consultant
Michaela Rossmann- Systems Change Officer