Fulfilling Lives Responds to the Domestic Abuse Act 2021

In June 2020, the Fulfilling Lives South East team responded to a call for evidence by the government on the draft Domestic Abuse Bill and published a blog detailing our response and thoughts on the subject. We called for

  1. a clear definition of multiple complex needs,
  2. access to appropriate housing options and specialist DA domestic abuse services,
  3. domestic abuse and complex needs training for non-specialist services, and
  4. lived experience voices to be included in the Bill.

As the Domestic Abuse Bill achieved Royal Assent in April 2021, the Fulfilling Lives’ team reflects on how far the measures go in meeting the needs of women with multiple complex needs.


Time to reflect, review and re-think

Perhaps the biggest impact that the Act will have on our client group will come from the new duty placed on local authorities to assess the need and commission support to victims of domestic abuse and their children in safe accommodation services in their areas. When the Fulfilling Lives team reviewed the new Act we also considered the corresponding statuatory guidance published by the Department for Levelling UpHousing and Communities (DLUHC), formerly the Ministry for HousingCommunities and Local Government (MHCLG). This sets out the operation of Part 4 of the Domestic Abuse Act to be delivered by local authorities, and what they should do to fulfil their statutory responsibilities and provides further clarity on how the new duty should be delivered on the ground.

Naming ‘Multiple Complex Needs’

As the Domestic Abuse Bill progressed through parliament last year, Fulfilling Lives South East called for the inclusion of a clear definition of multiple complex needs that expresses the needs of women who experience domestic abuse and complex needs. Whilst we welcome the widening of the statutory definition of domestic abuse to include emotional, coercive and economic abuse, we are disappointed in the lack of inclusion of a clear definition of multiple and complex needs within the Act. Nevertheless, we are pleased to see the direct inclusion of and frequent reference to ‘multiple and complex needs’ as a term, as well as ‘additional and/ or complex needs’, within the DLUHC’s corresponding statutory guidance. We know this is important because women who have multiple and complex needs are disproportionately affected by domestic abuse; In a snapshot in December 2018, 93% of the women on our caseload had experienced domestic abuse (25 out of 27 women), a prevalence that has been consistent throughout the lifetime of this project. Yet this group are often the most challenging to reach in terms of having their voices heard and needs met. So, the recognition of this group within the statuatory guidance is a welcome development in the delivery of support to victims of domestic abuse.

‘’In a snapshot in December 2018, 93% of the women on our caseload had experienced domestic abuse.’’

FLSE Manifesto for change

Despite this progress, we still feel there needs to be an explicit definition of multiple and complex needs within the guidance provided by DLUHC. As currently drafted, Local Authorities can use their discretion in defining multiple and complex needs, which creates the risk of fragmented, variable responses nationally and a postcode lottery of appropriate safe accommodation services for those who experience domestic abuse and complex needs. To ensure a cohesive support response to those with multiple and complex needs, where individuals receive the right help when needed, without being judged, stigmatized or unfairly treated or excluded, it is imperative for this group to be distinctly recognised in the form of a comprehensive explanation of their experiences in such statuatory guidance.

‘‘My hope would be that women on the edges of society who face multiple barriers and stigma on a daily basis, will now be seen as a distinct group of people, with distinct needs when experiencing domestic abuse’’

Sandra, Systems Change Officer

A spotlight on ‘safe accommodation’

Throughout the Bill consultation, Fulfilling Lives South East continued to advocate for access to appropriate housing options for those experiencing domestic abuse and complex needs. We hoped to see the Bill pave the way for creative forms of accommodation that provide emergency rapid-access accommodation with specialist wrap-around support. As such, it is positive to see a focus on safe accommodation for woman who experience domestic abuse and complex needs in the Act and statutory guidance and we welcome the new statutory duties placed on local authorities to provide safe accommodation for victims and survivors of domestic abuse. We believe that the inclusion of specialist, dispersed, and emergency accommodation that includes wrap around specialist support, including mental health and substance misuse support, in the DLUHC’s categorisation of appropriate safe accommodation to be a sign of considerable progress. We must now ensure that funding allocated to Local Authorities is ringfenced to support the provision of innovative accommodation options that are readily available for women who experience domestic abuse and complex needs.

‘’ I would hope that the complexity of these women will not be missed and do not end up slipping through the net and not receiving the help and support they so desperately need in a crisis”

Kate, Engagement and Co-production Worker
FLSE DA bill asks

What next?

Whilst Royal Assent of the Domestic Abuse Act was a pivotal moment for survivors and specialists in the sector, the legislation represents many beginnings as support systems locally and nationally review accommodation and support needs to shape future provision. We look forward to working with local statutory agencies to help shape a new local strategy to translate guidance into action and create the change needed to protect those women at the sharpest end of inequality.


Author: Emily Page

For further information about Fulfilling Lives work in this area, please contact Rebecca, Systems Change Lead: rebecca.rieley@sefulfillinglives.org.uk

Unfamiliar places – The impact of out of area placements

Looking at out of area accommodation placements and the impact on people with multiple complex needs


In the last seven years, Fulfilling Lives has supported people with multiple and complex needs (MCN) to get access to suitable housing. The particularly acute housing shortage in the South East means that higher numbers of people with multiple and complex needs are being placed in unsupported temporary accommodation, including out of area placements, and are remaining in this accommodation for longer.

This crisis of supply has led to local authorities placing some people who require housing out of area. Fulfilling Lives client data shows that out of area placements were offered by a local authority to our client group 20% of the time. This presents people with multiple and complex needs with impossible decisions around choosing between receiving the support they need or accepting accommodation out of area.  As a result, only 10% of out of area placement offers made to our clients were taken up.

The Issues

Relocating away from their local area creates a range of issues for people experiencing multiple and complex needs, such as –

  • Being unable to benefit from outreach services
  • Support workers are unable to effectively monitor well-being
  • The area is unfamiliar, so it is difficult to find services and facilities
  • Financial problems e.g. travel costs and council tax
  • Living away from social and personal support networks

In 2015, a Supreme Court ruling brought greater attention to the issue of out of area placements. Titina Nzolameso, a single mother of five children, was evicted from her home in Westminster and after making an application for housing support, was offered a house in Bletchley, Milton Keynes (approximately 50 miles away). Ms Nzolameso turned this offer down on the basis that she had already been a resident of Westminster, had on-going health concerns and did not want her children to have to change schools. Nzolameso decided to take her case to the Supreme Court, and the Court ruled in her favour. The case has impacted housing practice across the country and many local authorities subsequently reviewed and updated their allocations policies following the ruling.

Recommendations

A report completed by Fulfilling Lives and the University of Brighton reviews the policies relating to out of area accommodation placements of Brighton and Hove, Eastbourne and Hastings local authorities and sets out recommendations for how these policies can better support people with multiple and complex needs. 

Key recommendations:

  • All local authorities should publish their Temporary Accommodation Allocation policies publicly online. This provides greater transparency and clarity in order to avoid misinterpretation in practice and to ensure that clients and their support networks are aware of the allocations criteria.
  • Out of area placements are rarely suitable for people with multiple and complex needs and local authorities should make every effort to house this group in their local area.
  • The Nzolameso case should be revisited by local authorities and the learnings reviewed to ensure compliance with best practice in all areas.
  • If people with multiple and complex needs are offered a placement out of area and they refuse it, they should not then be considered ‘intentionally homeless’ and the local authority should continue to carry out its duty to house the person.
  • Should an out of area placement be unavoidable, the local authorities should maintain regular contact with the host local authority to ensure that there is continuity of care and intensive support available to people with MCN.
  • There should be cross county discussions between local authorities around supporting each other with out of area placements. There are similar challenges named by each local authority and we feel dialogue between local authorities and the production of joint working protocols would be useful steps.

Read the full report on out of area placements here: https://bit.ly/3zTiV5h


Author: Eve McCallam

Hospital discharge – a road to recovery?

Reflections on the experiences of patients with complex needs and thoughts on how discharge approaches can be developed


At Fulfilling Lives South East, we’ve seen how hospital discharges can be a challenging time for patients with multiple and complex needs (‘MCN’). Our client casework has shown us how clients are often discharged to unsuitable accommodation, or to the street in the very worst of cases.  The NHS is a complex system, and in the area of discharge this complexity is compounded by the fact that there is a shared responsibility with Adult Social Care for discharge planning in complex cases.

Hospital discharge – Case example:

S is a female homeless client who had been in hospital for five weeks. She was diagnosed as suffering from endocarditis, with damage to the mitral valve, two thalamic infarcts and two cysts on the brain. At the beginning of week six, despite her being homeless, it was recommended that she be discharged and that she “go home and gain further weight and return after a month to review her health ahead of a referral for heart surgery”.

In April 2021, FLSE and the Brighton Healthwatch Hospital Discharge Project invited organisations from the Voluntary and Community Sector as well as the NHS to discuss how hospital discharge for people experiencing MCN can be improved.  The overarching themes identified were that community mental health support services are stretched and can be difficult for patients to access after hospital discharges but also that hospital discharge means different things to different organisations. We understand that the health, social and third sector are funded and set up quite differently and this runs the risk of services being fragmented which in turn contributes to the difficulties when supporting patients and clients. These difficulties include challenges around information sharing and communication between services and lack of knowledge on where to find the right support depending on referral criteria and thresholds.

At Fulfilling Lives, we have dug deeper into the processes and procedures of hospital discharge and challenged ourselves to articulate what a better hospital discharge system could look like. This involved a focus group of specialist workers who support people with multiple and complex needs, systems change staff and those with lived experiences of hospital inpatient and discharge procedures.  Our key thoughts are outlined below.  

Key Thoughts

Underpinning PrinciplesWe feel that all processes should be informed by the following principles

  • Support starts early when planning for hospital discharge with the first paramedic / GP / professional contact. These people help inform the patient’s needs and contexts that should be considered in discharge plans.
  • Treatment will be delivered in a Psychologically Informed Environment (‘PIE’) which respects privacy (i.e. no interviews in glass interview rooms) and client ‘agency’ i.e. respects the fact that the client is in the room and isn’t ‘spoken about’ as though they are not.
  • Being human   We want the best medical outcomes for clients and understand that this is best supported by recognising the humanity of the client and taking a trauma informed approach to their care and recovery.
  • Ensure that the client’s voice is heard early in the process and consistently throughout.
  • Hospital discharges for people with multiple complex needs will have clear accountability and oversight within the healthcare system.
  • Discharge planning takes patient’s outside circumstances into account and reflects their impact on health – this will require consistent consideration for health determinants not just the presenting clinical healthcare needs.
  • Recognition that in-patient treatment, including the impact of medication, can impact on a patient’s ability to make decisions.

Underpinning Behaviourswe believe that certain professionals’ behaviours enable successful hospital discharges.  

  • Demonstrating kindness and flexibility is key to providing reassurance to people with MCN who have had multiple negative experiences of support services.
  • Creating opportunities for friendly conversation is important to minimize the perception of care being perceived as ‘business like’ or the patient feeling unwanted in the hospital and helps to build trust.  The client will be alert to any signs that they are being judged in a negative way and will be at high risk of self-discharging.
  • Be mindful of one’s own stigmatising views and unconscious bias. Be aware that factors such as workplace stress and our own health and wellbeing will have an impact on our work.  Take active steps to maintain your equilibrium and expect the workplace to support your performance through supervision, reflective practice and other means.

Toolsenabling factors that will support positive hospital discharges

  • The hospital will keep details of the client’s support network.  This will include details of community-based professionals trusted by the patient to help them communicate with the hospital and likely provide care post-discharge.
  • Published policy regarding MCN patients including standards relating to discharge planning.
  • Explicit monitoring, and management of hospital discharges for patients with MCN.
  • Training in trauma informed care for staff at all levels of the hospital to support effective engagement, communication and support for patients with MCN.
  • Mechanisms for feedback that enable feedback from the voices people with lived experiences to be easily captured and learnt from with minimum bureaucracy.
  • A strategy to tackle ‘self discharges’ and unplanned exits from hospitals.

Ideas

Ideas for hospital discharge protocols – tangible practices that we feel can inform hospital discharge protocols for patients with MCN

Admission

  • Patients with Multiple and Complex Needs (MCN) should have a risk assessment and support plan to improve the prospects of the patient engaging with the full course of treatment and reduce risks of unscheduled discharge.
  • The client’s admission paperwork will include the contact details of support staff who can help the patient communicate with the hospital and articulate their views. For patients with MCN, this may include social workers, mental health nurses, GPs, probation workers and members of the voluntary sector. The ward staff are encouraged to help the patient liaise with that support network to ensure that they are included in the whole process.
  • The admission will take an overview of their housing situation, pets, family and medication. The client may need help to pack a bag or provide themselves with the things they need for a stay in hospital. 
  • In an unplanned admission the multiple and complex needs of the patient will be recorded by the Accident and Emergency team (or earlier where the patient has received an initial assessment by a paramedic) and communicated to ward staff when that patient is admitted to a ward. 
  • At admission, or preferably before, there will be an assessment of the patient’s safety and needs.  This assessment will include drug and alcohol use, issues concerning visitors and issues of domestic abuse.            
  • We would also recommend informing the patient’s GP of the hospital admission.

As mentioned in the Mental Health Act Review 2021 (Chapter 4), we support the idea of strengthening the patient’s right to refuse and choose treatment.

We would like patients to have:

  • greater influence over decisions about their care and treatment,
  • their wishes and preferences respected and followed
  • the opportunity to challenge their care and treatment if their wishes are not followed. 

FLSE would like to see an ‘advanced choice document’ across all healthcare sectors, physical and mental. With a system in place that communicates between services, information sharing is increased which in turn helps patients to feel more confident and less stigmatised.

We would strongly encourage for the healthcare system to introduce this trauma informed approach.

To read more about how we contributed to the Mental Health Act Review please see our blog post here.

Discharge

  • We would strongly suggest that prior to discharge of a person experiencing MCN, Adult Social Care is required to assess the patient’s needs. This would include closer collaboration between discharge coordinators, social workers in hospital and Adult Social Care.
  • Ideally, a multi-agency health and complex needs forum is created to discuss more vulnerable patients. This is to make sure that a support system is in place prior to discharge. This includes informing GPs and other non medical support networks of the discharge and we are aware that in Brighton & Hove there is such a forum to discuss patients with complex needs to support their care in the community – this is an approach we support.
  • In our experience, patients with MCN being discharged on a Friday is difficult. This is because there is sometimes not enough time to organize and set up support for the weekend and the accommodation they may need, especially when at risk of homelessness.
  • The patient’s GP would be notified of the discharge and given the community care/discharge plan.

Monitoring

  • There will be a specific record kept of the steps taken to include the patients voice including specific details of what they have done differently to capture innovation.
  • Patients with MCN will be recognized throughout the patient record data systems and accountability will sit with an accountable person within the hospital staff team for hospital admission and discharge of those patients with MCN.
  • There will be a loop for patients to be able to provide feedback and suggestions to improve interactions.

Hopes for the future hospital discharge system

During the Connectivity Meeting, it was clear that communication between different services (NHS, social care and the Voluntary and Community Sector) is difficult.

We discovered that hospital-based social workers don’t automatically collaborate with community based social workers and information isn’t being shared with other non-medical support networks. We also learnt that the Voluntary and Community Sector services, as well as mental health services, have long waiting lists and that their services are stretched.

The group has also identified that the different systems feel silo-ed and there are few opportunities for collaboration and smooth discharge transitions into the community.

The below was an attempt to map the different services involved in hospital discharge and how these relate to each other. It prompted us to reflect on the commissioning of services to support hospital discharges and how there is an opportunity for commissioners to improve linkages between services and help the support system organise in more joined up and efficient way.

Image showing connectivity in the system

However, the group also suggested that it would be useful to improve communication between hospital, social care and community teams by introducing joined access meetings. These meetings would focus on all aspects (medical and non-medical) of the patient’s support system and that the patient would be able to join this meeting.

Our conclusion is that the hospitals need to review their discharge protocols and develop revised ways to support patients with MCN through the system. This needs to include mechanisms for joint planning with the patient and their closest support networks.


Author: Michaela Rossmann & Rebecca Rieley

Independent Review on Drugs: Perspectives of women and creative recovery groups

In 2020, the Service User Involvement team at Fulfilling Lives South East fed into the public consultations towards the Independent Review of Drugs by Dame Carol Black, commissioned by the Home Secretary. This blogpost outlines the process of gathering the unique lived experience perspectives of women who had used the substance misuse services as well as creative recovery groups. The findings from our submission have now been published into a report which provides the local context of accessing drug treatment and recovery in East Sussex.


Context

In February 2019, the Home Secretary appointed Professor Dame Carol Black to undertake an independent review of drugs to inform the government’s thinking on what more can be done to tackle the harm that drugs cause. The study took place in two phases; the first phase was published in February 2020 and included a rigorous and ground-breaking analysis to understand the complex and overlapping markets for illegal drugs, which can be read here: https://www.gov.uk/government/publications/review-of-drugsphase-one-report/review-of-drugs-summary.

In July 2020, public consultations began for the second part of the review and focussed on understanding the challenges involved in drug treatment, prevention and recovery and opportunities for improvement. Fulfilling Lives South East Partnership (FLSE) fed into the public consultations though the National Expert Citizens Group (NECG), who were approached to gather the views of people with experience of substance misuse as well as other intersecting complex needs such as mental ill health, homelessness, domestic abuse, and removal of children.

The NECG is a partnership of people connected to all of the 12 Fulfilling Lives projects across the country, who also have direct experience of multiple disadvantages. Their aim is to raise the bar on co-production and to demonstrate how lived experience leadership and insight can change systems and services.

Collecting Insights

As part of our contributions, team members from FLSE’s Service User Engagement team conducted a series of 1-2-1 and group discussions to collect unique perspectives from women who have experienced drug and alcohol misuse as well as with mixed gendered peer-led creative recovery groups. The conversations centred around four questions:

1. How can we make it easier for people to access drug treatment and recovery services, and stay in contact with those services?

2. How can we ensure the mental health needs of people in treatment are met?

3. What is the best way to meet the employment and housing needs of those in treatment and recovery?

4. What else stops people recovering and why might they relapse? What would help?

Summary of Findings

Throughout these conversations there were common threads; regardless whether the individuals were currently using services, had used them in the past, or were themselves providing support at present. These consistent messages highlighted the following:

1. Trauma needs to be addressed as part of any treatment.

2. The need for a holistic approach to treatment and support; mental and emotional health, access to employment and housing, community support, etc.

3. The importance of personal development; rebuilding one’s identity, develop self-esteem, focus on assets, learn healthy interactions and relationships.

4. The power of peers; they act as role models, inspiration and aspiration.

5. The impact of the Recovery Community; that it’s not necessarily focussed on addiction, develops creativity, sense of community, enjoyment and fun.


Author: Aditi Bhonagiri and Nelida Señoran-Martin

The full report on FLSE’s submission with in-depth findings on the lived experience perspectives from our target group for the Independent Review of Drugs by Professor Dame Carol Black can be found here: Fulfilling-Lives-Lived-experience-Dame-Carol-Black-Independent-Review-of-Drugs.pdf (bht.org.uk)

Dame Carol Black’s recommendations on the second phase of the Review can be found here: https://www.gov.uk/government/publications/review-of-drugs-phase-two-report

Housing Assessment – a guest perspective

Fufilling Lives South East has collaborated with the University of Brighton to conduct research on how local authorities can effectively support people with multiple and complex needs during the housing assessment process. The work draws together interviews with Fulfilling Lives Workers and existing academic research to present a detailed list of recommendations for local authorities.


The Problem

It is well-acknowledged that mainstream services often struggle to engage with people living in complex situations and people with multiple and complex needs often go without the help they need (McCarthy et al, 2020). At the forefront of the disadvantages experienced by people with multiple and complex needs is the difficulties they experience accessing appropriate housing. There are significantly reduced housing options for people with multiple and complex needs and they are increasingly difficult to access.

Throughout their work and research so far Fulfilling Lives South East found a significant knowledge gap on approaches to the housing assessment process and how it can best support people with multiple and complex needs. Most people with multiple and complex needs will be assessed by a local authority at some point to see if they are eligible for housing support. This assessment is a crucial step and often happens when a person is most in crisis and in need of shelter. The process can be frustrating, long winded and invasive, therefore this research sought to develop a better understanding of effective approaches to this pivotal process that demonstrates a positive impact on their lives.

The Solution

The three themes identified in the research lead to this list of recommendations for local authorities in how their housing assessments can best support people with MCN:

  • Follow a clear more concise assessment process, that doesn’t take too long to complete.
  • Ensure that the assessment process follows a trauma informed approach. This means being understanding of the trauma applicants may have experienced and ensuring the process is not re-traumatizing
  • Show compassion and kindness to the applicants. 
  • Maintain confidentiality throughout the assessment. This includes providing a safe and private environment to carry out the assessments in order for applicants to feel more comfortable sharing their situation and experiences.  
  • Take an interprofessional approach to the assessments, in which housing officers utilise the applicants existing support network. This could include working alongside the individual’s key worker who will know them well. 
  • Allow for flexibility in the application process, work creatively around the obstacles that may arise when assessing people with multiple and complex needs.

Read the full report: here.


Author: Izzie Bloxham-Shelley

If you would like to hear more about our work in housing, then please do get in contact with Rebecca in the Fulfilling Lives team:

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

Strength-based working and Multiple Complex Needs

During the spring of 2021, a study between Fulfilling Lives South East and the University of Brighton was conducted. With the client-facing work coming to an end for the project in June 2021, this study aimed to evaluate the use of strengths-based approaches FLSE and BHT Sussex staff employ, when supporting individuals experiencing MCN. This work drew together interviews with key workers and relevant literature to highlight the benefits and issues raised in a strengths-based practice.


A strengths-based practice is one that takes into account each person’s strengths and resources, abilities and skills, and, with the help of the practitioner, helps utilise them towards the attainment of personal goals (Rapp et al., 2005).

Good Practice

  • Strengths-based practice is not to just be nice or positive all the time, neither imposing a list of tasks on individuals, without them having a say in the process.
  • Instead, strengths-based practice is collaborative, with the practitioner acting as a facilitator for the recognition of skills and goals; it is trauma-informed, acknowledging not only the adversities someone has faced, but also the strategies they employed to survive; and it is based on a hope-inducing, honest, open-minded relationship between the practitioner and the service user.

Impact

  • On service users: it helps create a different narrative for themselves and their life, one with strengths, skills, and capabilities, instead of only problems and deficits.
  • On workers: reflecting on service user’s positive attributes, boosts practitioners’ resilience, can protect from burn-out, and improves their work.
  • On other services: with more positive narratives on their hands and training on strengths-based practice, this new approach  has only started to be embraced.

Challenges

  • Service users might at first have a hard time thinking in a positive light about themselves and reflecting on their strengths and capabilities.
  • Frontline staff need to have small caseloads and a lot of time on their hands, to build on a trusting relationship, which is rarely the case the way services are commissioned.
  • There is huge lack of knowledge and training in other services, as well as a lack for “one-stop-shops”, which will treat individuals holistically.

This study will hopefully be one of the first steps in providing evidence for the benefits of strengths-based practice, so it will be widely embraced and employed in all sectors, but, of course, further research and training is needed for it to be established.

My experience with Fulfilling Lives has definitely convinced me: Strengths-based practice is a way of seeing other people and ourselves, and I believe it should be taken up by any professional who wants to do good in their line of work – I know I will.

Read the full report: here.


Author: Dora Soulantika

If you would like to hear more about our work in healthcare, then please do get in contact with Michaela and Rebecca in the FL team:

Michaela Rossmann, Systems Change Officer: michaela.rossmann@sefulfillinglives.org.uk

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

Equipping Researchers to Adopt a Trauma-Informed Approach

We are pleased to announce the launch of a new resource, ‘Trauma-Informed Social Research: A Practical Guide’, written by Kerry Dowding, Research and Evaluation Officer with Fulfilling Lives South East Partnership.

This brief and accessible guide gives practical hints and tips on how to apply the principles of trauma-informed practice to research activities with vulnerable groups, notably those affected by multiple disadvantage. The guide contains interactive checklists for carrying out focus groups, one-to-one interviews, and conducting observations.

Who is this for and how should it be used?

The guide is suitable for evaluators, researchers (including peer researchers), service leads, commissioners, or anyone else who would like to conduct research with vulnerable groups. It can be used as a point of reference to help plan for and reflect on the research journey, making sure researchers have structures in place to support themselves and the participants throughout the process.

Why a trauma-informed approach?

We have found that people experiencing multiple disadvantage are often eager to share their experiences and contribute to learning and research to help bring about positive change in services. However, inviting people to talk about their experiences has the potential to be re-traumatising. A trauma-informed approach to research activities involves researchers establishing safety and trust with participants, allowing them to share openly and participate collaboratively.

How did it come about?

The guide combines the author’s specialist knowledge of research methods and an understanding of the importance of a trauma-informed approach gained through conducting co-produced research with people affected by multiple disadvantage.

During its development, the guide was shared in a working group attended by staff and volunteers with lived experience of multiple disadvantage as well as those with extensive experience of supporting this client group. The working group gave feedback and advice on the content and direction of the guide, and their contributions were invaluable. The guide was designed by Ben Pickersgill, Media and Communications Officer with Fulfilling Lives.

The view and download the guide, click here where you will be directed to our website.

Lewis Edwards, Learning and Impact Manager

Stopping the Prison Cycle for Women

In just over six years of client facing work, the Fulfilling Lives project has worked with a total of 69 women across the three project areas of Brighton & Hove, Eastbourne and Hastings, of a total caseload number of 118 clients. The Fulfilling Lives offer is a flexible one; a mixture of practical support to address immediate safety combined with psychosocial, trauma informed interventions to support behaviour change, and has had a hugely positive impact on the lives of many of the women with multiple and complex needs that we have worked with.

Sometimes the more interesting learning comes from exploring where things haven’t been successful however. In spite of the intensive and flexible support offer from FL, some individuals haven’t been able to make significant change in their lives and remain stuck in patterns of repeat offending. Work has remained focussed on immediate crisis and risk-led interventions, rather than on planned or preventative work to support individuals to break the cycle of reoffending.

The women on our caseload who are in contact with the criminal justice system have some of the most complex difficulties of any of the clients working with Fulfilling Lives. All have mental health diagnoses, including anxiety and depression, personality disorder and bipolar disorder, all use alcohol and drugs and all have experienced domestic violence and abuse.

These individuals are engaged in repeat cycles of offending, often driven by active addiction. They receive short custodial sentences and are regularly released as street homeless where the chaotic nature of their lives leads to breaching license conditions and being recalled to prison after only a short time in the community.

The majority of female offenders with complex needs are also victims; this does not, however, result in them receiving better coordinated support.

The majority of female offenders with complex needs are also victims; this does not, however, result in them receiving better coordinated support. It is widely accepted that women need a dedicated pathway of support that takes account of the multiple trauma experienced and their victim status; but there remains a shortage of trauma-informed, gender-specific interventions for women locally.

At Fulfilling Lives South East we have worked really effectively with local multi agency partners including CRC probation colleagues (soon to be National Probation Service), Brighton Women’s Centre, Oasis and others in coordinating creative and flexible support arrangements to maintain positive engagement with women experiencing multiple disadvantage in the community. However, much of the positive work achieved in the community can be interrupted by recalls to prison which interrupt housing and support plans in the community.

We have recent case studies which highlight how women are trapped in cyclical offending patterns often driven by mental distress and desperate cries for help. The offender journey here highlights how a woman supported by Fulfilling Lives experienced mental health crises in the community after leaving prison homeless 3 times in one year; a cycle which was only broken by identifying a suitable accommodation placement on release with high enough support to manage her mental health needs.

The Fulfilling Lives project is committed to systems change. However, in terms of affecting real change, the systemic issues which contribute to these patterns of behaviour are difficult to tackle at a local level alone.

We know that short sentences don’t contribute to recovery or stabilisation.

We know that short sentences don’t contribute to recovery or stabilisation. The solution must lie in taking a genuinely systemic approach in addressing the underlying issues which are driving women to offend.

We don’t need to seek the answers. Many of the recommendations outlined in the 2007 Corston report are still relevant and mostly still not implemented. We want to see more specialist women’s support in the community, more liaison and diversion schemes to divert women away from custody into support and sentencing reform with greater use of alternatives to custody and women’s community support services.

With these national changes in place the excellent work that is happening locally to coordinate multi agency case support in the community for all women experiencing multiple disadvantage can be embedded further and more lives can be turned around.

Author: Jo Rogers, Senior Manager, Fulfilling Lives South East Partnership

Joint Working: The Power of Collaboration

Throughout the COVID-19 pandemic and lockdown, many services (statutory and third sector alike) stopped all face-to-face contact with service users and started working remotely. This shift in support was especially difficult for clients experiencing multiple and complex needs (MCN), including learning disabilities (LD), where the right type of communication is vital for understanding.

This article is about the importance of collaboration between services and an example of good practice when supporting women with MCN and LD through care proceedings.

We, at Fulfilling Lives South East (FLSE), together with Brighton & Hove Speak Out (BHSO) are currently working with the same mother, who has MCN and a LD. This mother’s child is subject to care proceedings and is currently living in foster care. This collaboration has highlighted some obstacles in the system for the mother from a front-line perspective, as well as advocacy point of view.

The FLSE Women’s Specialist Worker and BHSO Advocate agreed that it was much harder to build a trusting relationship remotely, and that effective communication was impaired

Whilst FLSE continued face-to-face support throughout the pandemic; the BHSO Advocate and Specialist Adult Social Worker were only able to offer remote support. When reflecting together, the FLSE Women’s Specialist Worker and BHSO Advocate agreed that it was much harder to build a trusting relationship remotely, and that effective communication was impaired. In some instances, the client’s mistrust of professionals and their misunderstanding of her and her partners’ behaviour, led to them making assumptions, which the FL Women’s Specialist Worker needed to challenge.

During the client’s pregnancy and post-birth, all Children’s Services meetings were held using video-conference facilities. Court hearings, parenting assessments and support, were also remote during this period. Children’s Services enabled digital access for some of the meetings at their premises; at other times the FL Women’s Specialist Worker had to provide equipment in alternative locations. Where the physical equipment was available, the FLSE Women’s Specialist Worker supported the client to use the technology, and to understand, communicate, and regulate their emotions. The BHSO Advocate was able to support the understanding of information before and after each meeting and feed the client’s voice back into the process. Without FLSE’s support, the client risked complete exclusion from the care proceedings.

Unfortunately, digital inclusion does not always reach the most marginalised people, including people experiencing MCN. The push for digital inclusion when providing essential services, for example health care appointments, adult social care support and court proceedings, has demonstrated just how many vulnerable adults do not have easy access to laptops and the internet. Even when digital access is available, communication via this method offers challenges to all participants. Non-verbal communication is much harder to recognise, multiple voices can be hard to follow, and a large number of participants can be intimidating. This type of communication is additionally difficult for those with a LD who have additional communication and processing needs and requirements.  With the parenting assessment and support also being conducted on-line, this again creates a further barrier for those with MCN.

FLSE would like to call for a person-centred approach for key meetings, to enable professionals to meet clients in a safe way to reduce the impact of exclusion and reduce the infliction of further trauma

FLSE would like to call for a person-centred approach for key meetings, to enable professionals to meet clients in a safe way to reduce the impact of exclusion and reduce the infliction of further trauma. In this case, the Local Authority applied for the child to be removed from the mother’s care at birth. The FLSE Women’s Specialist Worker supported the mother at hospital just after her birth, to make sure her voice was heard in meetings, medical exams and at the virtual court hearing. As the mother had a diagnosis of LD, she had access to a Specialist Adult Social Worker who was able to arrange this support and other reasonable adjustments whilst she was on the ward. Without this collaboration between the Local Authority, NHS and FLSE, the event of having a child removed at birth would have been even more traumatic for the mother.

When reflecting with BHSO, we agreed that the child protection process is very child focused – and rightly so. However, we would like to see an improved understanding and implementation of the communication and support needs of parents with LD, at the start of Local Authority interventions. Easy read documentation of the processes, key reports and assessments are rarely made available by children’s professionals, yet they are essential for the vast majority of MCN and LD mothers, as is, allowing additional time for processing and understanding information. Advocacy at the earliest opportunity is also essential within the tight child timescales, along with referral to adult services and other 3rd party support as needed.

FLSE and BHSO, would also like to see specialist support for parents with LD going through child protection and care proceedings. This includes conducting parenting assessments in a more LD friendly way, focussing on what parents can achieve, rather than just their struggles. Where support needs are identified, commissioners should ensure that services are available and accessible. This includes longer-term parenting support options, (such as Shared Lives- a scheme that matches someone with care needs to an approved carer), relationship safety support and awareness, and a holistic approach as provided by FLSE.

The right support and a trauma informed approach with the time and care put in at early stages can have a lasting positive effect on their recovery and reduce the likelihood of another pregnancy

We know that women who are going through child protection processes and care proceedings are likely to be experiencing MCN and LD. These parents often face increased stigma, and without advocacy to challenge professional behaviours, this will continue to exacerbate harm. However, the right support and a trauma informed approach with the time and care put in at early stages can have a lasting positive effect on their recovery and reduce the likelihood of another pregnancy.

Throughout our client’s journey and together with BHSO, peer support between the FL Women’s Specialist Worker and BHSO Advocate was appreciated and this collaboration has shown that a flexible and trauma informed approach can lead to positive relationships, not only for organisations but most importantly for the wellbeing of the mother.

Authors: Michaela Rossman, Gemma Harfleet & Nicola Johnson