CGL Women’s Hub: A new Treatment Pathway?

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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Building inclusive goals in Sussex  

Engaging in the development of a Pan-Sussex Strategy for Domestic Abuse Accommodation and Support


Setting the scene

Part 4 of the Domestic Abuse Act, which achieved royal assent in April 2021, placed a new statuatory duty on local authorities to assess the need and commission support to victims of domestic abuse (DA) and their children in safe accommodation services in their areas. Local Authorities were required to conduct a local needs assessment and prepare and publish a strategy for the provision of such support, and to monitor and evaluate the effectiveness of this strategy.

At Fulfilling Lives South East (FLSE), we know that women who have multiple and complex needs (MCN) are disproportionately affected by DA yet are often felt to be the most challenging to reach for consultation activity and service design and as such, are most at risk of not having their voices heard and needs met. This is a group that services most struggle to build trusting relationships with, and as a result often fail to provide appropriate, person-centred, empathetic support. This is why FLSE is passionate about sharing these women’s voices through coproduction.

What we did

In August 2021, FLSE submitted a report to the Sussex Local Authority Project Team in the Office of Sussex Police and Crime Commissioner (OSPCC), which focused on the needs of women with MCN, to support the development of the Brighton and Hove City Council, East Sussex County Council and West Sussex County Councils, Pan Sussex Accommodation Based Support Needs Assessment. When writing this report, we adopted a co-produced approach by including staff and volunteers with lived experience of complex needs and domestic abuse in the process, including attending and participating in planning meetings, in-depth research of our case study database and in writing the final report. The evidence presented was gathered from our client work and FLSE volunteers and staff to express both the needs of this group of women as well as their reflections on how the wider housing and support system can be developed.

Members of the FLSE team also attended an online market engagement event to consult on specialist refuge accommodation for those with MCN, hosted by East and West Sussex County Councils. We reflected on the needs of women with MCN who experience domestic abuse and facilitated discussions on the various operating models for refuge provision and the factors that need to be considered when designing these services.

Upon the release of the draft Pan-Sussex strategy for domestic abuse accommodation and support in October 2021, the FLSE project group presented a subsequent report to the OSPCC, to support their public consultation. This expressed our impressions of the draft strategy, identifying what we were pleased to see and areas for improvement. Project group members also completed the online survey conducted by the County Councils to share feedback on behalf of our organisation.

Measuring our Impact

Within our contribution to the Sussex needs assessment, FLSE made a specific recommendation for women with MCN to be named and considered in the strategy. We are delighted to see ‘Responsive to Multiple Disadvantage’ listed as one of six key strategic priorities in the finalised strategy published in January 2022. This priority establishes the need for specialist provision to support victim/survivors with MCN, and makes recommendations for Sussex local authorities, specialist domestic abuse accommodation providers and support services to holistically support those with MCN, whilst ensuring accessibility of services

We also raised concerns around limited and unsuitable move-on options for victims/survivors with MCN. We highlighted the benefits of adopting a ‘Housing First’ model paired with specialist DA wrap-around support, in ensuring accommodation is appropriate to MCN and simultaneously provides a long-term housing solution. As a result, the strategy commits to exploring accommodation and support options appropriate for the needs of survivors with MCN including short-term respite facilities, specialist housing, move-on pathways, and long-term floating support.

Reflections and Recommendations

Engaging and consulting in the development of the Pan-Sussex strategy for domestic abuse accommodation and support provided space for FLSE to have an open channel with local commissioners to share our learning and support the commissioning teams to engage with discussions about the needs of those who experience domestic abuse as one of several complex and intersecting needs. We believe that this was best achieved by giving prominence to the voice of those with lived experience:

‘’The contribution and time invested by the team in providing Sussex with the lived experience work demonstrated to us and further strengthened the importance of ensuring better support is provided to survivors with MCN…by being given the opportunity to corroborate our findings with lived experience feedback was invaluable and helped provide a more meaningful evidence base for our recommendations’’ – Commissioning Project Manager, OSPCC

With the strategic goals in place, we are hopeful that many women with MCN experiencing domestic abuse will have improved opportunities to access appropriate safe accommodations and would be more likely to reach out for help and support. However, in order to break down current barriers experienced by those women with MCN, local authorities, commissioned services and the wider support system must develop tangible action plans that will operationalise the commitments made within the strategy and bring the voices of experts by experience to the forefront.  


Authors:

Emily Page, Systems Change Project Assistant

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

Systems Change Project Assistant

emily.page@sefulfillinglives.org.uk

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

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Open letter to MP Maria Caulfield re. The ‘Women’s Health Strategy: Our Vision’

In 2021, the government called for input on the Women’s Health Strategy with the following key themes:


We fed into this consultation with experts by experience, front line workers, the service user engagement team as well as the systems change team.

In January 2022, the new Vision for the Women’s Health Strategy has been published and we are pleased to see a local Member of Parliament- MP Maria Caulfield, leading this initiative.

We now are keen to share our reflections on the recent Vision for the Women’s Health Strategy for England by publishing the letter we have sent to MP Maria Caulfield in response to the publication on the 7th March 2022. And we hope to get an opportunity to discuss this further.


Open letter from Fulfilling Lives South East to the ‘Women’s Health Strategy: Our Vision’ publication

Subject: Women’s Health Strategy: Our Vision 

Date: 07/03/2022

Contributors:
Kate Jones, Engagement and Co-production Worker
MichaelaRossmann, Systems Change Officer michaela.rossmann@sefulfillinglives.org.uk
Rebecca Rieley, Systems Change Lead- rebecca.rieley@sefulfillinglives.org.uk

Sue Westwood, Expert by Experience
Victoria Hensley, Engagement and Co-production Worker
Contact details: Rebecca Rieley & Michaela Rossmann, Fulfilling Lives South East – BHT Sussex,144 London Road, Brighton, Sussex, BN1 4PH

 

Dear Maria Caulfield,

We are a local charitable project who are keen to share our reflections on the recent Women’s Health Strategy and are pleased to see a local Member of Parliament leading this initiative.

  1. OVERVIEW OF FULFILLING LIVES SOUTH EAST PARTNERSHIP

The Fulfilling Lives South East (FLSE) Project started in 2014 and is funded until July 2022 by the National Lottery Community Fund, and operates in Brighton and Hove and East Sussex, as one of 12 projects across England. 

We are funded to:   

(a) provide intensive support for people experiencing multiple disadvantage,   

(b) involve people with lived experience of multiple disadvantage at all levels and,   

(c) challenge and change systems that negatively affect people facing multiple disadvantage.  

We have highlighted six themes that have arisen from our work to date and within each theme we have further identified several Commitments for Change – changes that we believe will help improve support systems and services for people with multiple and complex needs.    

One of our core themes of our  Manifesto for Change is addressing Health Inequalities. 

  1. MULTIPLE AND COMPLEX NEEDS (‘MCN’)

Multiple and complex needs (MCN) are persistent, problematic and interrelated health and social care needs which impact an individual’s life and their ability to function in society.  They are likely to include; repeat street homelessness, mental, psychological and physical health problems, drug and/or alcohol dependency, and offending behaviour. People with MCN are more likely to experience violence and abuse, including domestic violence, live in poverty and have experienced trauma in childhood and throughout their lives.

  1. OUR RECOMMENDATIONS

How we are feeding into the Women’s Health Strategy- Consultation: 

FLSE has fed into the open call for evidence for the Women’s Health Strategy as a collaboration between the Systems Change Team and the Service User Involvement team. Together, we have used case studies, experts by experience and data from our project to inform the below recommendations:

A) Women’s Voices:

FLSE would like to see the healthcare system change to a more inclusive, trauma informed and collaborative system, where women don’t feel stigmatised when seeing professionals. Ideally, specific women’s only spaces are created so that taboos (such as sex work) and re-traumatising experiences are minimised. We would also like to be given a choice of being seen by female professionals instead of male professionals.

Our experts by experience feel that being listened to by a professional is crucial, but there’s a difference between being listened to and actually being heard.

Women experiencing MCN feel underrepresented and sometimes ignored or belittled. There are currently lots of gaps and barriers when trying to provide a person-centred health service. 

In contrast to the 96.9% of women who shared their own experience via the online consultation, our client group also faces digital exclusion and we feel that their voice has been left out.

We are happy to see the acknowledgement of stigma and taboo in the new Vision document but we strongly feel that trauma informed training needs to be rolled out across the healthcare system, not only in connection with Violence Against Women and Girls specific services/aspects of the healthcare system.

B) Healthcare Policies and Services:

Our clients and experts by experience would like to see a more flexible appointment system and walk-in clinics for women experiencing MCN. One of our experts points out that ‘GP surgeries should ditch using Covid as an excuse for failing of health services. We need a new approach and start again.’ The real issue for our clients is accessibility. This can’t be overlooked. If you can’t get through the GP’s door, then health outcomes won’t be improved.

We appreciate that ‘Ensuring equitable access to services and reducing disparities in health outcomes’ between women is now on the government’s radar and geographic disparity and women with disabilities are mentioned.

We are, however, concerned that women experiencing MCN, or multiple disadvantages, have not been named as a population category itself. It is often difficult for our clients to make appointments with GP surgeries by a certain time and day, which is exacerbated by feelings of not deserving help. In our experience, especially in Eastbourne since the closure of the walk-in clinic, it is extremely difficult to get through to GP surgeries, and if so, many of our experts by experience report difficulties ‘getting past’ receptionists who can appear to act as gatekeepers.

We welcome the life course approach of the vision document but feel that links between services are missing, especially when it comes to some of the potential links between the Mental Health Act, Mental Capacity Act, the VAWG Strategy and the Women’s Health strategy. We would like to see resource being directed to link us these strategies at a national level.

Our recently published mortality report shows that our clients experience on average at least 7 long-term health conditions which can lead to early deaths. We need policies that are fit for purpose and interconnected. We also call for a joined-up approach between support services within primary and secondary healthcare but also the third sector.

C) Information and Education

In our experience, women experiencing MCN are linked in with a variety of systems and services: the prison system, alcohol and substance misuse services, adult social care, domestic abuse and the physical and mental health services. The one commonality though is women are left feeling that these systems operate in isolation and information is not being shared.

This is two-fold:

  • Information about the clients is not being shared across services effectively and our clients need to consistently repeat their stories which can be re-traumatising;
  • Health information is not being shared between services and systems. Trusted relationships, such as key workers, might be outside of the clinical healthcare system but are crucial to provide support, information and education to clients.

We appreciate that there is an acknowledgement of education and training for healthcare professionals on specific physical and mental health issues being needed in the Vision, but we would also like to see training on trauma informed approached and a less siloed approach between physical and mental health as well as the wider NHS services, adult social care and the third sector.

D) Health in the workplace

FLSE has employed a total of 41 individuals with lived experience of MCN, through its employment programme. You can read our findings from the employees’ perspective here and the employers’ point of view here.  

We would encourage greater attention on supporting the health and wellbeing of those with experiences of multiple and complex needs in the workplace and see this support as an enabling factor, helping people with lived experiences re-enter the workplace as well as supporting their health and wellbeing.

E) Research, evidence and data

Due to the high complexity of clients, we call for an open-ended, tailored and individualised approach. We believe that the healthcare system unfortunately is not always prepared to support women who experience multiple and complex needs or reach out and include them in research studies. FLSE would welcome a new, more collaborative and inclusive way of working to enhance the reach of research because historically women experiencing MCN have been under-represented in data and research.

Our project’s Research and Evaluation Officer has produced a toolkit to support researchers with practical advice and tips on applying the principles of trauma-informed practice to their research activities, specifically running focus groups, one-to-one interviews, and service observations. It is suitable for evaluators, researchers, service leads, commissioners, or anyone who would like to find out more about the experiences of people who may have been affected by trauma. This can be found here.

  1. OUR CONCLUSION AND BEST HOPES

In our experience, the key to providing better healthcare to women experiencing MCN is accessibility and flexibility. This is also supported by the King’s Fund ‘Interventions to tackle health inequalities need to reflect the complexity of how health inequalities are created and perpetuated, otherwise they could be ineffective or even counterproductive.’

FLSE is based in Brighton and East Sussex which means that our clients have worse health outcomes due to coastal inequalities, than in other areas as explained by Chief Medical Officer Prof.Chris Whitty’s annual report 2021.

Nonetheless, we hope that our contribution to the call for evidence for the Women’s Health Strategy will contribute to a better system for women experiencing multiple and complex needs.

That is why our best hopes for the Women’s Health Strategy are that:

  • Multiple and complex needs is recognised as a population category in itself, alongside disabilities and minorities.
  • There is recognition that some of the listed priorities (such as gynaecological health) can be traumatising or re-traumatising for women who have experienced certain forms of abuse and women experiencing/who have experienced MCN. As a result, high quality trauma informed training needs to be provided to all healthcare staff (incl.GP receptionists) and that the training includes the voices of lived experience.
  • The different strategies (such as VAWG, Mental Health Act, Mental Capacity Act) are linked together and find a systemic way to collaborate more efficiently.
  • The life course approach to include social determinants of health, as well as more joined up working, so that we move away from a focus on singular health issues, towards more joined up approaches to complex health conditions such as coexisting conditions mental ill health and substance use.

With kind regards,

The Fulfilling Lives South East team


Authors:

Michaela Rossmann, 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  

michaela.rossmann@sefulfillinglives.org.uk

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Reflecting on women’s health on International Women’s Day  


Working alongside clients with multiple and complex needs (MCN) / multiple disadvantage has shown us that the vast majority have a physical health problem or problems. Many have a combination of long-term chronic conditions such as liver cirrhosis, hepatitis C, diabetes and circulatory diseases. The female clients we have worked with have more complex and chronic conditions compared to men. A number of factors contribute to this, including the impact of domestic abuse and violence, as well as the stress on the body from rough sleeping. The average life expectancy nationally of homeless people is low – for men this is 47 years of age, for women this is 43 years of age.

Our recent research into the deaths of people facing multiple disadvantage who were supported by Fulfilling Lives South East (FLSE) over the past seven years, supported national research findings that individuals facing multiple disadvantage are more likely to experience premature death compared with the general population (Aldridge, 2018). With some of the most complex cases, FLSE had the highest mortality rate across the national programme. Restricted access to healthcare is a recurring theme in our casework.

This recent research captured in our How can we avoid treatable or preventable deaths of people facing multiple disadvantage? found that:

• Of all the Fulfilling Lives South East clients who died in hospital of preventable or treatable conditions; 75% were women (6 clients), compared with 25% who were men (one client).

• Of all the FLSE female clients who died, 100% were from preventable or treatable causes in hospital, without inquest or further investigation.

• The average age when clients died was slightly higher for women (42 years), compared with men (41 years)

What does this mean about healthcare for women who face multiple disadvantage? As women, do they experience additional levels of health inequalities?

Our project believes that women facing multiple disadvantage are more likely to have more complex health issues and are more at risk of premature death. Our client work suggests the healthcare system struggles to meet their needs even more so than men facing multiple disadvantage. Our case studies highlight the complex trauma experienced by women who received support from across FLSE, culminating in very complex health needs. This evidence clearly illustrates why women’s specific healthcare services are paramount and could ultimately reduce or prevent premature deaths of women facing multiple disadvantage.

The National Women’s Health Strategy

In June 2021 FLSE fed into the government’s ‘Women’s Health Strategy Review’. It was recognised by the Secretary of State for Health and Social Care that, “For generations, women have lived with a health and care system that is mostly designed by men, for men.”

In response, we recommended support for:

• Women only spaces in healthcare settings, such as sexual health clinics.

• Specialised healthcare services for women with MCN.

• Making appointments should be flexible (not only online or phone) and offer walk-in clinics.

• The frailty score should be used for women (and men) with MCN to offer healthcare services more quickly, using the ‘Edmonton Frail Scale’ (Rolfson et al., 2000).

• Making trauma-informed approaches training compulsory to all healthcare professionals.

• Improved coordination of support services for those with comorbid mental health and substance misuse conditions.

We have further fed into the discussion about the future Women’s Health Strategy. At the end of 2021, the Government released details of its Vision for the Women’s Health Strategy for England, informed by feedback received in the call for evidence.

We have reflected on this Vision as a team and welcome some of its strategic intentions, particularly to shape services by taking a ‘life course approach’. However, there are some areas we feel need strengthening to better meet the needs of women with MCN. We have shared these reflections with the Maria Caulfield MP for Lewes who is leading the development of the Women’s Health Strategy.

Key reflections on the Vision for Women’s Health Strategy include:

Women’s Voices: We are happy to see the acknowledgement of stigma and taboo in the new Vision document but we strongly feel that trauma informed training needs to be rolled out across the healthcare system, not only in connection with Violence Against Women and Girls specific services/aspects of the healthcare system.

Healthcare Policies and Services: We welcome the life course approach of the vision document but feel that links between services are missing, especially when it comes to some of the potential links between the Mental Health Act, Mental Capacity Act, the VAWG Strategy and the Women’s Health strategy. We would like to see resource being directed to link us these strategies at a national level.

Information and Education: In our experience, women experiencing MCN are linked in with a variety of systems and services: the prison system, alcohol and substance misuse services, adult social care, domestic abuse and the physical and mental health services. The one commonality though is women are left feeling that these systems operate in isolation and information is not being shared. We would like to see training on trauma informed approaches to promote shared language and approach to healthcare services that could enable a less siloed approach between physical and mental health as well as the wider NHS services, adult social care and the third sector.

Health in the workplace: We would encourage greater attention on supporting the health and wellbeing of those with experiences of MCN in the workplace and see this support as an enabling factor, helping people with lived experiences re-enter the workplace as well as supporting their health and wellbeing.

Research, evidence and data: Due to the high complexity of clients, we call for an open-ended, tailored and individualised approach. We believe that the healthcare system unfortunately is not always prepared to support women who experience MCN or reach out and include them in research studies. FLSE would welcome a new, more collaborative and inclusive way of working to enhance the reach of research because historically women experiencing MCN have been under-represented in data and research as such are often missed out of policies and strategies.

Our best hopes for women’s health  

In our experience, the key to providing better healthcare to women experiencing MCN is accessibility and flexibility. This is also supported by the King’s Fund ‘Interventions to tackle health inequalities need to reflect the complexity of how health inequalities are created and perpetuated, otherwise they could be ineffective or even counterproductive.’

FLSE is based in Brighton and East Sussex which means that our clients have worse health outcomes due to coastal inequalities, than in other areas as explained by Chief Medical Officer Prof.Chris Whitty’s annual report 2021.

Nonetheless, we hope that our recent contribution to the call for evidence for the Women’s Health Strategy will contribute to a better system for women experiencing MCN.

That is why our best hopes for the Women’s Health Strategy are that:

  • MCN is recognised as a population category in itself, alongside disabilities and minorities.
  • There is recognition that some of the listed priorities (such as gynaecological health) can be traumatising or re-traumatising for women who have experienced certain forms of abuse and women experiencing/who have experienced MCN. As a result, high quality trauma informed training needs to be provided to all healthcare staff (incl.GP receptionists) and that the training includes the voices of lived experience.
  • The different strategies (such as VAWG, Mental Health Act, Mental Capacity Act) are linked together and find a systemic way to collaborate more efficiently.
  • The life course approach to include social determinants of health, as well as more joined up working, so that we move away from a focus on singular health issues, towards more joined up approaches to complex health conditions such as coexisting conditions mental ill health and substance use.

Authors:

Rebecca Rieley, Systems Change Lead

Michaela Rossmann, Systems Change Officer

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

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

For more information sign up to our newsletter:

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A New Approach: The Trauma Stabilisation Pilot  

Gemma Harfleet shares her thoughts on the first few months of the new Trauma Stabilisation pilot; Outreach support for women who want to go to rehab but their trauma experience has made it difficult to get there or stay for as long as they need…  


The Problem

For years I have seen and felt the frustration of women with complex trauma and addiction being told they are too complex to access a service or they need to stop using substances to receive any support – as if they should somehow have held things together a bit better if they really wanted help. As a Specialist Women’s Worker with Fulfilling Lives, I’ve seen how tailored trauma stabilisation work in an outreach model can really make a difference and help those who’ve been all but written off. Training in trauma stabilisation shifted the way I was able to work by talking about the present symptoms of trauma and ways of managing this, so it doesn’t get in the way of achieving recovery goals. Now I’m excited to see what happens with a focus on trauma for women who want to go to rehab in Brighton. 

We have fewer women going into rehab but they are accessing community support. There isn’t much research on why this is and what can be done to improve women’s experiences in recovery. We’ve known for a long time that men seem more likely to need the support of rehab. However, not a lot of attention has been paid to voices questioning if this might also be because women’s needs are often different. We know men and women survive addiction and homelessness differently – which often leads to more complex trauma because of domestic abuse and sexual exploitation.  

The Complexity

Since the start of the pilot, I’ve been meeting with women in rehab, those with lived experience, with services that have supported them and those who work in rehabs. I wanted to know what preparation women had before going into rehab, what was their experience when they were there and what they thought was missing. Yes, I had this idea. But I wanted to check that it would meet the needs of women right from start. These women have been so generous with their experiences of addiction and rehab, sharing with the kind of infectious courage you get from people in recovery. We know more trauma support needs to be done with women in addiction but doing this survey made this even clearer. Particularly we are hearing how those supporting women can be understandably cautious about giving space to talk about trauma for fear of making things worse. However, I’ve experienced how building a sense of safety and having the training to talk about trauma (but not asking about specific experiences) can equip women with the understanding they need to start their recovery journeys. What women want is to understand their trauma, how it impacts them and those closest to them, to know it’s not because they’re broken and have a space to think about what they want to do about it. 

The Pilot

Of course, we learnt so much more from these journeys and we will be bringing that together in a report to help guide the pilot. I’m also reaching out to other services in the city that support women – to work together, share resources and show the strength of the networks of women they can be a part of. We are not alone. 

My thanks and appreciation go out to the BHT detox and recovery projects, CGL, Oasis, the Rita Project, Cascade Recovery, Nelson Trust, Jen at the Africa House café, Move-On, RISE and Threshold. None of them needed convincing, all of them have given their time and thoughts and many have also nominated women to the pilot. 


Author: Gemma Harfleet

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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

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