By Dr Andy Taylor and Tony Maguire “ Help to Move on”: An Evaluation Of Exeter’s No Second Night Out Project November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Contents Acknowledgments 3 Executive Summary 4 11 Findings (1) Quantitative Data 17 Findings (2) Qualitative Data: Client Interviews Findings (3) Qualitative Data: Professionals’ Interviews 31 Background and Methodological Approach 22 Conclusion 49 References 52 2 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Acknowledgments The authors would like to thank all of those who generously gave u p their time to be interviewed for the study, both clients and p rofessionals. Thank you also to Janet Bardsley, Senior Lecturer, Open University for help in gaining ethical approval with the evaluation. About the Authors: Dr Andy Taylor is an independent researcher and academic. He is also an Associate Lecturer with the Open University and a research associate with Research In Practice. He has worked in p robation, social work and other related fields and in p articular has researched extensively in the area of parental substance misuse and its impact on children. Tony Maguire works for St Petrock’s as a Senior Project Worker and is a qualified Social Worker with 10 years’ experience in the homelessness sector. Alongside this role Tony has carried out another evaluation for St Petrock’s in partnership with the Probation service and a p iece of qualitative research (Shelter from the Storm) with Dr Taylor exploring the links between long term homelessness and alcohol use; details of both are available through the St Petrock’s website. 3 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Executive Summary No Second Night Out (NSNO) is a nationwide initiative aimed at making a significant impact on rough sleeping. It represents part of the Devon and Cornwall Rough Sleeper Partnership’s vision “that by 2012 no individual will have the need to rough sleep in Devon and no individual arriving on the streets for the first time will sleep out for more than one night (Devon and Cornwall No Second Night Standard no date). The NSNO project aims to prevent rough sleepers spending a second night on the streets by providing a rapid identification and response to ‘new’ rough sleepers, assessing their needs and providing them with a ‘Single Service Offer’ (SSO). Ideally the offer should be ‘credible, realistic and sustainable and include the support required to ensure that the individual will avoid further rough sleeping’ (Devon and Cornwall Rough Sleeper Partnership Group 2012). The project is supported by the principle of reconnection-­‐ to reconnect rough sleepers (where feasible and realistic), especially new arrivals in the area, to an area where they have accommodation, support networks or other links which offer them the best hope of preventing continued rough sleeping. The Exeter NSNO project commenced on 1st April 2012. This evaluation reviews the second year of this initiative from 1st April 2013 until 31st March 2014. Both quantitative and qualitative data were collected. Quantitative data focused on an analysis of agency figures/monitoring audit during the relevant period. Qualitative data focused on interviews with both people who used the service and professionals involved in implementation and delivery. 4 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Summary of Findings Data monitoring audit •
NSNO Exeter appears to have been very successful in meeting its aim of supporting new rough sleepers more quickly. In total, 215 were supported to move off the streets and into accommodation. This exceeded the original target of 173. •
174 out of the 215 seen avoided a second night out. Although the monitoring data (as with other projects) does not indicate sustainability of outcomes, 81% of rough sleepers either accessed emergency accommodation or accepted an offer of reconnection . •
Out of 215 clients that were assessed, 92% (198) received an initial assessment within 24 hours and 98% received an initial assessment within 72 hours. •
A high percentage of Single Service Offers were both made and accepted. Of the 174 offers made (81% of the total seen), 198 (92%) were accepted. This is made up of 99 (62%) of offers of accommodation, and 61( 38%) offers of reconnection. 14 ( 8%) offers were declined, 8 of which related to an offer of re-­‐
connection. •
61 clients were reconnected -­‐ 15 in the South West region, the remainder to other areas within the UK. Two individuals were re-­‐connected twice and two other individuals were known to have returned. The original target was for 90% of reconnections to be ‘successful’, measured by them not returning to the project, with at least 45 of these being from outside the local area. This target was based on the idea that reconnections should be credible and realistic and therefore an acceptable option for clients, hence the high target of 90%. By this measure, the Exeter project can be seen to have met its target. •
In assessing and placing rough sleepers, the Exeter NSNO aimed to improve choice and support for clients in finding and retaining accommodation. As above, data on clients sustaining accommodation is limited. The target here was for 110 clients to sustain accommodation for a minimum of 6 months. In the event, 83% of individuals qualifying through the ESOP (Exeter Support Options Panel) component of the project maintained their accommodation for over 6 months. This was verified through the individual support providers on completion of the support. •
An area with good data about sustainability is for those NSNO clients who were placed via the Private Rented Scheme. Figures for this support project for those in private rented accommodation, albeit aimed at clients with less complex needs than other NSNO clients, indicated that 60% (23) had sustained accommodation and were reported as ‘doing well’ 18 months from being placed. This suggests a high level 5 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT of sustainability. Significant factors influencing this outcome include an individualised and supportive service, taking into account individual need regarding health and social problems. Clients’ experience of the service •
The assessment process was seen by all as productive, beneficial and timely, with respondents commenting on the value of opening up about their situation. This was seen as especially important at the point of initial contact. •
The basic survival service had a significant impact on the success/completion of assessments. •
The assessment process was seen by clients to be speedy and efficient and provided what for many was a significant opportunity to talk about difficulties and engage with an interested professional. This had an impact on motivation. •
Qualitative interviews suggest the Single Service Offer was accepted willingly and that the process was undertaken inclusively in all but one case. This is reflected in 10 out of the 11 interviews undertaken. •
A number of those interviewed had negative preconceptions about St Petrock’s, perhaps reflecting negative perceptions of homelessness. However these were quickly dispelled once they physically entered the centre. While there may be a risk that this perception deters those new to rough sleeping, the advantages of having an established homeless resource centre with a high profile hosting the NSNO service would seem to outweigh these concerns. •
In terms of emergency accommodation, client interviews revealed an uneasy balance between the benefits of providing basic short-­‐term accommodation and the potential risk of up to four strangers sharing a room through the night and the issues of shared space for clients with differing levels of complex need. The fact that the accommodation was located in a fully 24 hour staffed hostel with CCTV and there were no serious incidents mitigates some of these concerns. •
In one case where NSNO has a strong reliance on reconnection and local connections it was perceived as negative intervention. This illustrates a ‘grey’ area in terms of when a SSO offer can be ‘undermined’ by other offers of accommodation locally. In such cases there may be a risk of leaving rough sleepers without a service for too long and this time period between SSO and new approach needs to be reviewed regularly on an individual needs led basis. This may also indicate that not enough is known about the impact of reconnection on the lives of rough sleepers and its use needs to be carefully managed and monitored. 6 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT •
The support offered around longer term accommodation provided through the St Petrock’s Private Rented Service was very positive and highlights the benefits of having a specialist worker who can focus on this level of support. However it is worth noting that this resource was only suitable for those clients who had the skills and confidence to engage with and manage low levels of support. Of the three interviewees who did not meet these thresholds two are currently rough sleeping. This may illustrate one critique of the NSNO service as positive for those with low support needs and the ability to engage with support but less so for those with more chaotic behaviours -­‐ particularly around drug and alcohol use and mental health, where services are at best overstretched. •
In discussing routes to rough sleeping clients revealed significant reliance on informal or social support networks, which in reality proved to be tenuous as relationships were often strained. This offers some insight into the concept of the ‘hidden homeless’ with individuals staying on sofas, in sheds and tents in gardens and the routes into rough sleeping. •
Relationship breakdowns were the trigger for rough sleeping for over half the clients interviewed, with most approaching services at the point of crisis. This may have some implications for more proactive prevention work with this group before the onset of rough sleeping. Inter-­‐agency working • Good levels of collaboration were identified by a range of professionals and seen as a key factor in avoiding overlaps in working with other agencies. The NSNO Project was viewed as having evolved well locally, using the NSNO principles to clarify lines of communication with other relevant partners. • Factors which aided engagement with this high number of individuals included good inter-­‐agency collaboration, particularly between the Street Homeless Outreach Team and St Petrock’s services, plus St Petrock’s high profile and status in supporting homeless people. • Good relationships with other partner agencies, including the council, helped the identification and flow of people to early assessment. • Working together was clearly enhanced by the ‘Common Assessment Approach’ which had also led to a better understanding of agencies’ roles and the challenges they faced. • Good inter-­‐agency communication was important in establishing eligibility criteria or verification and helped reduce duplication. However, it was felt by some that inter-­‐agency meetings had worked better at the start of the project and that it was important to try and sustain these throughout, as they helped resolve complex challenges and led to increased knowledge and learning in the area of rough sleeping. 7 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT • Inter-­‐agency communication was highlighted positively as a way of implementing NSNO principles effectively but holistically. • Good joint work was identified between the Response Team and the SHOT Team and with St Petrock’s Housing Team at Exeter Prison. Some identified that more support was needed from mental health services and drug and alcohol agencies. Applying eligibility criteria and service delivery •
The way in which Exeter NSNO has managed and adapted the NSNO principles can be seen to offer important and creative approaches to the challenges of working with this group in relation to issues of assessment, working with clients to maximize choice where resources are limited, inter-­‐agency collaboration and issues of reconnection. •
The criteria for establishing eligibility raises some key issues in terms of selection of some and exclusion of other groups. It also presents challenges regarding how ‘rough sleeping’ or ‘settled accommodation’ is defined. Professionals differed about how some of these criteria were defined and applied. Whilst at least one agency felt that physical verification on the streets would have more clearly helped target actual rough sleepers, most felt that that good signposting, and inter-­‐agency liaison mitigated any drawbacks of relying on assessment alone. •
It was felt that established criteria using a checklist and experienced staff enabled a balance between consistency and rigidity. •
Despite the potential for being a divisive use of limited resources, most professionals interviewed felt there were key benefits in the NSNO criteria in that they helped to establish new rough sleepers, target those who might be amenable to change and resulted in quicker assessments to prevent a culture of rough sleeping developing. Approaches to assessment and assessment tools •
The use of the assessment tool was seen to aid comprehensive assessments, which included accommodation history, assessment of risk and support needs. Whilst professionals welcomed the structured nature of the tool, some felt it was too long, concentrated too much on negative aspects and was too proceduralised and at least one felt it could encourage a risk averse outcome. •
Findings suggest that professionals adapted this tool in a constructive, creative, holistic, staged way, using knowledge in order to verify key information at speed -­‐ a particular challenge. This enabled a better 8 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT engagement with clients, leading to better information. This translated very positively to client experience, as the respondent interviews confirm. Single service offers and reconnection •
The impact of emergency accommodation and the service it has provided is a significant finding from this report. The ability to provide immediate accommodation, albeit at a basic level, and at the first point of contact with a rough sleeper while options are explored was key to the success of this pilot. It was commented as the one thing that really made a difference, giving the Response Team the opportunity to make powerful interventions into the lives of rough sleepers who were often in crisis •
Professionals identified both opportunities and challenges in relation to implementing Single Service Offers. Positives included the elements of focus and encouraging motivation to move clients forward. At least one professional felt that the use of written agreements and inter-­‐agency consultation may have been implemented more consistently. Others felt that this approach would have been too rigid. •
Problems in relation to Single Service Offers were mainly related to limited accommodation at various stages in the process, which impacted on the offers and limited the matching of assessment and delivery in relation to need. This related to first stage accommodation and its appropriateness for clients placed there. The issue was exacerbated by there being no NSNO worker on-­‐site through the night. •
Problems with lack of ‘move on’ accommodation impacted on the overall aim of moving people in a staged way from the initial Single Service Offer. •
The PRS scheme run by St Petrock’s, to which a percentage of NSNO clients were referred, appeared a highly successful resource. •
There were different views about the wider principle of reconnection. One key issue that emerged was that, however successful one area may be at implementing NSNO principles, the system can only operate if other areas are implementing similar policies and have other professionals to manage NSNO from their end. •
Professionals adapted reconnection principles in a humane and positive way utilizing the scope and discretion within this, but skilled assessment was required to understand complex disconnections and negotiate outcomes within the limited options and life situations presented. •
It was clear that all the professionals involved in different agencies interpreted the principle in the most flexible way to ensure that, as far as was possible, vulnerable clients were not ‘persuaded’ to return to an area where they had experienced violence or threats. However, there was some concern that, despite the issue of discretion, the principle could in some circumstances lead to returning people to risky situations due 9 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT to the limits on being able to verify their vulnerability. However all agencies demonstrated acute awareness of this issue and employed tactics to prevent this where possible. Challenges •
Availability of accommodation impacted at times on the length of time between an initial offer being made and the availability of more permanent accommodation. As a consequence, there were times when clients remained in assessment accommodation for longer periods than was envisaged or desirable. •
Complex issues were identified in terms of vulnerable groups. These included an increase in vulnerable young people, an emerging, albeit partly hidden increase in women rough sleepers and a large number of clients with mental health and addiction problems. All of these groups were seen to benefit from faster removal from a risky rough sleeping environment. There was also concern at the increased use of legal highs by rough sleepers as an alternative to other drugs. •
Changes in benefits and housing shortages in the city were seen to increase the pressure on resources and limit available accommodation both in the immediate and long term. This raises issues about the need for the project to continue at a time when funding is becoming more limited. •
There were identified problems with Bed and Breakfast provision and the support offered – more suitable accommodation accompanied by more worker availability and support would have made a significant difference. Both factors were seen to result from limited resources but some learning was identified in relation to how the response team was best employed. People identified as suitable for private rented accommodation also found this limited by wider housing shortages. •
Other suggestions included that provision might be improved by a separate hub, better resources for those released from prison and that those being released from hospital should be automatically eligible for NSNO support. 10 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Background and Methodological Approach Background. How The Project Operates : The ethos and history of St Petrock’s of providing a service on a very basic human level to those affected by homelessness alongside a more structured assessment service places it at the centre of Exeter’s local homelessness strategy. This status means that the majority of rough sleepers will access the centre and significantly it is where new rough sleepers will be quickly signposted both by other relevant agencies and the public. For this reason it is where the NSNO Response Team has been based throughout this pilot. The Response Team is formed of three workers who (each working four days a week) work closely with the established St Petrock’s project team. Their primary focus is to make contact with new rough sleepers as soon as possible and begin the assessment process. This will often initially be an informal conversation within the centre to establish relevant details around the individual’s eligibility for a NSNO service before the more formalised assessment process commences in a confidential interview room. The team uses a common assessment tool or form shared by all relevant services within Exeter. Once an individual is assessed to meet the criteria for NSNO there is an intensive assessment period for up to 72 hours before a credible offer of support is made. The priority is to end that period of rough sleeping so providing a form of emergency accommodation immediately is crucial. In order to achieve this effectively, the Response Team has to liaise with all relevant agencies and be constantly aware of the availability of emergency accommodation. This can be a challenge during particularly busy periods. This role entails an ability to communicate with a range of individuals, carry out quick and effective assessments and have a clear awareness of the local homelessness strategy and various agencies roles within it. The Response Team operates a front line service and their role is proactive in terms of contacting new rough sleepers. The idea of ‘No Second Night Out’ (NSNO) was developed to ensure that rough sleepers were helped off the streets as quickly as possible and to sustain this with appropriate support, thus breaking patterns of rough sleeping. A key rationale for this initiative was that the longer someone is sleeping rough on the streets, the 11 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT more susceptible they are to a range of problems, including substance dependency, physical and mental health problems, being a victim of crime and, in some cases, anti-­‐social activity (Homeless Link 2014). Following the Government’s policy document ‘Vision to End Rough Sleeping: No Second Night Out’ (2011) local authorities adopted the NSNO principles. These are as follows: •
New rough sleepers should be identified and helped off the streets immediately so that they do not fall into a dangerous rough sleeping lifestyle •
Rough sleepers should be helped to a place of safety where their needs can be quickly assessed and they can receive advice on their options •
If people come from another area and find themselves sleeping rough, the aim should be to reconnect them with their local community unless there is a good reason why they cannot return. There they will be able to access housing and recovery services and have support from family and friends •
Members of the public should be able to play an active role by supporting and referring people sleeping rough This report evaluates Exeter’s unique response to this initiative. The evaluation focuses on the effectiveness of an innovative and holistic response to rough sleepers and the extent to which core aims have been met. In particular, the evaluation team sought to gather data on outcomes, in line with the project’s aims which are as follows: •
To improve response times to all new rough sleepers and minimize the need for a second night out. •
To improve co-­‐ordination and partnership working. •
To improve advice and choice for clients in relation to both accommodation and support. The scale of the problem: estimates of the rough sleeping population in Exeter Establishing rough sleeping figures is difficult as there are different approaches to establishing this. Approaches include an annual count, providing a “snapshot” at a particular time, or estimates of the number of people being worked with by the SHOT team, for example. Another complication is the definition of what constitutes ‘sleeping rough’. Devon and Cornwall’s ‘No Second Night Out Standard’ (no date) uses the definition from the Local Government Document: ‘ No One left Out’ (2008) : 12 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT ‘People sleeping, about to bed down (sitting on/in or standing next to their bedding) or actually bedded down in the open air such as on streets, in tents (inappropriate use of tents), doorways, parks, bus shelters or encampments. People in buildings or other places not designed for habitation (such as stairwells, barns, sheds, car parks, cars, derelict boats, stations, or “bashes”). Another element of complexity is related to how ‘rough sleeping’ is established. This is open to some difference of opinion and interpretation. Whilst some may base this on an assessment of a person’s situation, others see this as only clearly established on the basis of visual observation of the above circumstances. It is important to bear these differences in mind when considering data on the rough sleeping population as it is often interpreted in different ways. The official rough sleeper count estimates suggest that there are between 25-­‐29 rough sleepers in Exeter at any one time. According to the Report on Devon and Cornwall’s Rough Sleeper Partnership (Report on Devon and Cornwall Rough Sleeper Partnership 2014), the autumn count for the last 4 years was as follows : 2010 -­‐ 21 2011 -­‐ 29 2012 -­‐ 30 2013 -­‐ 23 Further data is provided by The Devon and Cornwall Rough Sleeper Partnership figures relating to the number of clients Outreach Teams have worked with in areas in Devon and Cornwall. Here the number of rough sleepers worked with were estimated over 12 month and 6 month periods as follows; 155 (April 2012-­‐April 2013) and 144 for the 6 months from April 2013. The Council report on the Devon and Cornwall rough sleeper project 2012-­‐2014 comments: ‘Outreach teams have worked with many more individuals during 2012/13 and 2013 to date, than are seen during the annual autumn count, which has become more sophisticated in its methodology since it started in 2010, but is still a snapshot in time’. (Page 4) Many people who are homeless do not show up in official figures. This includes those who become homeless but find a temporary solution by staying with family/friends, living in squats or other insecure accommodation. 13 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Research by the charity Crisis indicates that about 62% of single homeless people are hidden and may not show up in official figures. The Methodology and approach to the Evaluation The project covers the period from the 1st April 2012 until 31st March 2014. However the period of evaluation focuses predominantly on year two of the project, that is from 1st April 2013 until 31st March 2014 . The evaluation is based on ; •
An analysis of monitoring data produced by St Petrock’s between 1st April 2013 and 31st March 2014. •
11 semi-­‐structured interviews with clients who received the service •
11 semi-­‐structured interviews with a range of professionals who delivered the service or were involved in partnership working with the project. Due to the fact that the evaluation involved discussions with clients of the service who, by definition, were likely to be vulnerable in some way, ethical approval was required. The evaluation team used the Open University ethical procedure protocol. The detail of the methodology was considered by a senior academic who considered the appropriateness of the issues of informed consent and the feasibility of the project. The project was deemed sound from an ethical point of view. Quantitative Data This was obtained from St Petrock’s team who provided the researchers with extensive monitoring data and reports provided by The Devon and Cornwall Rough Sleeper Partnership. The figures in this report are drawn from these sources. Qualitative Data Interviews with clients 11 interviews were undertaken with clients who had experiences of the NSNO initiative in Exeter. Access to this sample was gained by professionals at the project and Tony Maguire, a senior project worker at St Petrock’s and joint author of the evaluation. As far as possible the evaluation team aimed to interview clients at different stages of the project. At the time of interview, the clients were at the following stages of accommodation: Four 14 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT were in the St. Petrock’s Private Rent and Support Project accommodation; two were in supported accommodation, with an emphasis on move on; two were in temporary B&B accommodation; one was in independent, private rented accommodation; one was in the local hostel and one was rough sleeping. A semi-­‐structured interview schedule was employed, based around the core themes of the evaluation. Clients were taken through an information sheet and a consent form to ensure that they understood the purpose of the research and the control they had over the process. Issues of informed consent and confidentiality were highlighted to respondents and they were assured that their answers would not affect their use of services in any way. Eleven people were approached and all participated. Interviews lasted between 45 minutes and 1 hour. Interviews with professionals 11 interviews were undertaken with professionals involved in providing the Exeter NSNO response. The sample consisted of: •
Project Worker •
Senior Project Worker •
NSNO Link Worker •
Two NSNO Response Team Workers •
Manager of the Project •
Street Homeless Outreach Team Worker •
Street Homeless Outreach Team Manager •
Exeter HMP Housing Officer •
Exeter City Council Strategic Move on Co-­‐ordinator •
PRS Project Co-­‐ordinator Once again, a semi-­‐structured interview schedule was used. Questions focused on the key area of the evaluation, including the opportunities and challenges that the project presented. Interviews were conducted at the respondents’ places of work. Interviews lasted between 1 hour and 1 hour and 15 minutes. 15 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Data analysis Detailed notes were taken during the interviews and analysed both in terms of responses to exploratory questions as well as new emerging insights into the operation and experience of the service. Both researchers interviewed a mixture of clients and professionals and shared their data, discussing themes and findings as they emerged. 16 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Findings (1) Quantitative Quantitative Data Monitoring Audit This section focuses on the analysis of project data against the stated outcomes of the project as whole Demographic Profile of the 215 NSNO clients in the evaluation year. •
Male: 183 (85%) •
Female: 32 (15%) •
UK clients: 204 •
EEA Nationals: 10 ( EEA ) •
Non EEA: 1 •
Under 26: 56 (26%) •
Over 50: 30 (14%) •
56% of individuals presented with more than one health need and 45% with a diagnosed or undiagnosed mental health need. The Devon Homeless Risk Impact Assessment snapshot of those rough sleeping or sofa surfing in May 2013 offered the following demographic breakdown by age, across the whole of Devon as: •
Under 18-­‐ 2.5% •
18-­‐24-­‐ 29% •
25-­‐54-­‐ 55% •
Over 55-­‐ 6% (figures rounded up) Outcome: Numbers of rough sleepers worked with The total number of clients worked with under NSNO during the evaluation period was 215. The original target set was to work with 170 individuals, although the rough sleeping criteria was later extended. By comparison, 173 people were worked with in the first year (over a 10 month period) of the project. The official rough sleeper count for Exeter recorded 23 individuals in November 2013 and 29 in April 2014. It is estimated that there are approximately 5 new rough sleepers on average in the city every week. Of the 215 people seen, the breakdown in terms of the NSNO criteria was as follows: 17 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT •
40% of these were new to rough sleeping •
30% were new to Exeter (but had previously slept rough elsewhere) •
30% were returning to rough sleeping after 6 months or more in accommodation. The number of new rough sleepers was higher than anticipated. As can be seen from these figures the project was highly successful in targeting and attracting rough sleepers over this period. This was achieved by professionals working purposefully but flexibly with the criteria and is reflected in the qualitative data from client interviews. The project’s success here in working with this high number of clients appears related to good inter-­‐agency collaboration with the SHOT team and St Petrock’s high profile and track record for helping the homeless within the area. Although it is difficult to establish a percentage of the overall numbers of rough sleepers that were worked with in the city, it would appear that the project was very successful in offering a service to a high proportion of rough sleepers under NSNO and a significant proportion of new rough sleepers. Outcome: avoiding a second night out In total, 174 of these 215 individuals avoided a second night out, representing 81% of the individuals approaching the service. One comparison here is with the data from the first 6 months of the London Project, where 70% of rough sleepers avoided a second night out (Hough et al 2011). As with data from other projects, monitoring does not shed light on long-­‐term sustainability, as the figure is based on clients not returning to the project. It does, however, show that 81% of rough sleepers either accessed emergency accommodation and/ or accepted an offer of reconnection, thereby avoiding further rough sleeping. Data from the PRS scheme, in which a number of NSNO referrals were placed, also offers harder data on sustainability for this group. Outcome: Improved response time to the rough sleeping population As discussed above, a key element in the NSNO projects is the timeliness with which rough sleepers are seen, assessed and offered a single service offer. This process is judged as important in helping people off the streets before riskier behaviours and /or longer term rough sleeping is established. 18 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Of the 215 clients that were assessed, 92% (198) received an initial assessment within 24 hours and 98% (210) received an initial assessment within 72 hours. This exceeded the original target of 160 rough sleepers receiving an initial assessment within 24 hours of arrival on the streets. Later in this report more detail will be provided about the challenges of making timely whilst purposeful assessments within this time frame and how the team responded to these challenges by adapting the assessment process and utilised their assessment skills. (See section on findings from professionals’ data) Outcome: The effectiveness of Single Service Offers (SSOs) ‘A “Single Service Offer” is an offer judged to be the most appropriate for an individual after an initial assessment of their needs is made. Once this offer has been identified, the aim is to make this consistently by all services coming into contact with this individual. Once a Single Service Offer is made, alternative offers are not made unless a reassessment finds that another service is more appropriate’ ( Hough et al 2011, page 10) A key element for the potential success of the NSNO initiative is the provision of a Single Service Offer, as this links to a key aim in assisting clients to get off the streets by connecting or re-­‐connecting them with accommodation. For individuals presenting with no local connection, the SSO is usually reconnection 174 Single Service Offers were made with 92% of these (160) being accepted. 62% (99) were offers of accommodation, and 38% (61) offers of re-­‐connection. 8% (14) of SSO offers were declined, 8 of these being in response to an offer of reconnection. This appears to represent a significantly high percentage of offers both made and accepted. In comparison, data from the first 6 months of the London project indicates that 44% of hub clients were made Single Service Offers and that 76% of “hub clients” who were given a Single Service Offer accepted this (Hough et al 2011). 76% of all SSO offers were made in less than 72 hours. It was difficult to ascertain the length of time between an initial offer being made and when an offer of permanent accommodation was made available, as this was affected by waiting lists for local supported accommodation. As a consequence, clients sometimes remained in assessment accommodation for longer periods than was envisaged or was seen as desirable. 19 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Outcome: The success of reconnections The target here was for 90% of reconnections made to be successful, measured by the clients not returning to the project, with at least 45 outside the local area. In all 61 clients in the NSNO project were reconnected. 15 of these individuals were reconnected within the South West region, the remainder being reconnected to other areas within the UK. 2 individuals were reconnected twice (in other words, the first attempt failed and a further attempt was made) and 2 further individuals were known to have returned. Consequently, by this measure, the Exeter project was very successful in meeting its target. However, in common with other projects, there are significant limitations in relation to the measurement of the effectiveness of long-­‐term reconnection and how this is assessed. There is little follow up data on how or whether such clients sustained their reconnection or indeed if they arrived at their intended destination at all. This is clearly an area where further research is required as without this, the robustness of this aspect of the service remains unclear. ( ‘No second Night Out-­‐:The Lancet : no date) Outcome: Improved advice and choice for accommodation and support services The target here was for 110 people to receive improved advice and choice regarding accommodation support services. It was also an aim that 80% of clients sustained their accommodation for a minimum of 6 months. The figures show that 83% of individuals supported through the Exeter Support Options Panel (ESOP) component of the project maintained their accommodation. 102 clients were supported through this service with a total of 3750 support hours provided. As indicated above in relation to reconnection, measuring sustained accommodation outcomes is very difficult, as reflected in the evaluations of similar projects. For example, in the first 6 months of the London Project, whilst follow up telephone calls to clients showed just under a quarter (24%) were known to be still in their accommodation and only 1% were found to be returned to rough sleeping, data was missing for 75% of clients who had not been contacted. (Broadway Lodge, p 201 page 5) However, one aspect of accommodation follow-­‐up does enable very good verification and gives some confidence about overall sustainability. This was data from the clients placed in private rented accommodation. 20 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Here, 27% (38) of NSNO clients were accommodated in the private rented sector and of these, 60% (23) had sustained accommodation and were reported as ‘doing well’ 18 months after having been initially placed. This suggests a highly successful outcome for this client group, given their prior history of rough sleeping, and a variety of problems linked to physical and mental health and substance misuse issues, even taking into account that this grouping is considered to have lower needs than the majority of NSNO clients. Significant factors influencing these outcomes include a highly individualised and supportive PRS service (see later in report for details) in addition to a range of support options, including specialized support for those with drug, alcohol and mental health difficulties and for those clients new to independent living. 21 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Findings (2) Qualitative Data-­‐ Client Interviews Overview: This section provides an analysis of the interviews carried out with eleven clients supported by the NSNO project. It focuses on the key findings that emerged from the data in relation to their experiences of accessing the NSNO project; their perceptions of the support they received; and its impact. Please note that pseudonyms have been used to protect the anonymity of the respondents. Characteristics of interviewees: Eleven interviews were undertaken: ten males and one female; ten self-­‐defined as either white English or British; one white Irish; age range 26-­‐53. Four heard of St Petrock’s through ‘word of mouth’; three from previous contact; two were signposted from the local council; one was referred from hospital and one from the Citizens Advice Bureau. All were offered emergency accommodation on initial assessment; one did not accept. Six were offered G8 (emergency sit up accommodation) and five emergency Bed and Breakfast. All but one accepted their SSOs (Single Service Offers) at the end of the assessment process. Breakdowns of the SSOs are as follows: one was referred into the local hostel; three were referred into temporary supported accommodation; six were referred into the supported private rented scheme run through St Petrock’s. One client refused to access the emergency accommodation and refused their Single Service Offer (SSO) and slept rough. Routes into homelessness: While all clients who accessed NSNO through St Petrock’s were rough sleeping at point of contact, their routes into homelessness varied. Neal sofa surfed with friends or family for 5 years before this resource was no longer available. He never, in this time, had his own long term accommodation or tenancy agreement and funded it through intermittent periods of employment. Once this resource was exhausted, Neal ended up on the streets-­‐ “in a bush in the middle of a roundabout”-­‐ and rough slept for about 3 weeks before accessing St Petrock’s. Neal was taken by a friend to the local council and then was signposted to St Petrock’s in order to access the NSNO service. •
Kirk had his own accommodation with family in the Kent area but lost this due to relationship difficulties and spent time staying with friends and family. Kirk came to Exeter to get “away from the drug scene in 22 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Kent” and spent time (3-­‐4 months) living in a caravan in a friend’s garden until the council intervened. Kirk heard about St Petrock’s through “the grapevine”. •
Alan was accommodated locally with his young family but, due to “constant arguments and stress”, left feeling it was having a negative impact on “the kids”. Alan stayed for a period with a relative for two weeks in Exeter (she was expecting a baby) and then rough slept for three nights. Alan then approached the local council and was signposted to St Petrock’s. •
Mike had a long (15 year) history of travelling with no settled accommodation, staying in various traveller sites. He came to Exeter after being threatened at a local site and was rough sleeping in the city. Mike heard about St Petrock’s from other rough sleepers and was attracted by the basic survival service. •
Ron was homeless in London and had been “for some time” before coming to Exeter and accessing the St Petrock’s survival service while he rough slept in the city. Ron had rough slept in Exeter “a few years ago” and said he was aware of the services on offer. Initially Ron was “just happy to have somewhere to eat and keep warm”. •
Dave was evicted from his own flat for rent arrears in the Mid-­‐Devon area. Despite some support to help with these debts, he “ended up rough sleeping in Exeter for about five weeks” before ending up in the local hospital with a fractured leg. Dave was referred to St Petrock’s NSNO team by Bay 6 (specialist team for patients with accommodation issues). •
Brian was living and working in the Bristol area as a fundraiser but two weeks into a new job he was “let go for not meeting my targets”. He could no longer afford the rent and became homeless. Brian found Bristol to be “dangerous” and came to Exeter to stay with a friend. This did not work out and, after a brief stay in a local youth hostel, he approached the council for help and was signposted to St Petrock’s. •
Eric relied on his father for accommodation and work after his divorce. Unfortunately, this ended when his father died suddenly. This had a massive impact on Eric practically and emotionally and led to his homelessness as his personal finances ran out. He rough slept for 4 nights before being referred to St Petrock’s by the Citizens Advice Bureau. •
Bob was accommodated through a support agency providing low level floating support but ended up becoming “completely withdrawn”. He lost his benefit and housing benefit claim which led to his eviction for arrears. He was aware of St Petrock’s from a previous contact and eventually re-­‐approached. However, he found this difficult and was reluctant to “ask for help again”. •
Anna had a relationship breakdown which involved Child Social Services and a court order. This led to her no longer being able to live in the family home and, as a result, she became homeless. Anna used a 23 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT train pass (from her time as an employee) to travel the country during the night to avoid the perils of rough sleeping. Two and a half weeks later, she accessed St Petrock’s. •
Enzo had past contact with St Petrock’s but eventually accessed services and accommodation in the Birmingham area where he had a local connection. He stayed in supported (mental health) accommodation in Birmingham when he experienced a “total breakdown”. Enzo decided not to “talk to anyone but just run away”. He came to Exeter as he knew about St Petrock’s and the survival service and felt Exeter to be a “safer city” and began accessing the centre again. Summary: In terms of routes into homelessness, family or relationship breakdown would seem to be a significant factor and, in three cases, led directly to episodes of rough sleeping. While six of the interviewees relied on their friends’ and families’ support, this proved to be risky and when it was exhausted, led to rough sleeping. Financial difficulties in terms of rent arrears, caused by either loss of employment or benefits, led directly to three episodes of rough sleeping. Two interviewees had longer term experience of homelessness and appeared to be relatively self-­‐sufficient in managing this lifestyle. Significantly, in all but three interviews, there seems to have been some form of negative emotional impact from relationships or loss which compounded the practical realities of rough sleeping. Accessing the NSNO service: The process by which people accessed the NSNO service based at St Petrock’s varied. Two were referred or signposted via the local council; four heard of the general support available through St Petrock’s through ‘word of mouth’ and three had previous contact with the centre; one was referred by the local hospital and one by the Citizens Advice Bureau. Of the two interviewees signposted from the council, both felt this contact with the council had been a negative experience: Neal felt, “they just did not seem interested”; Kirk commented “It was obvious from the start they were not really going to help -­‐ there was nothing they could do”. However, it needs to be noted that these decisions would have been made after a period of assessment and presumably based on individuals’ lack of ‘priority need’ and were therefore in line with council policy. A number of clients had preconceived negative ideas about St Petrock’s and its client group, which would seem to reflect some of the prejudices within the city around homelessness. However, all those interviewed 24 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT commented on how welcoming and safe they found the centre once they actually accessed it. This negative reputation may have an impact on ‘hidden homelessness’; for example, how many of those signposted to St Petrock’s did not access it? However, it would appear from the quantitative data that a considerable number of new rough sleepers did access St Petrock’s. This point is illustrated by the experience of Anna. Anna was aware of the St Petrock’s service after being told about it from various people. She was ‘frightened’ about the prospect of going to St Petrock’s, due to the perceived behaviour of service users. “Some of the people who hung around outside the building looked a bit scary”. Anna said she felt particularly vulnerable as a single female entering what appeared to be male dominated service. However she eventually plucked up the courage to approach the centre. On entering the centre Anna felt “a bit fazed” by the whole experience but felt that everyone was “welcoming and friendly and willing to listen and help”. She was quickly reassured and felt “I was in the right place”. This was backed up by a number of comments from the client interviews: Mike felt he was treated ‘respectfully’; Ron “found everyone great on all levels”; Eric said “it was fantastic every step of the way” and Neal, who had serious misconceptions about accessing the centre in line with those described above, questioned why he had not come in “years ago”. These comments reflect the efforts of the St Petrock’s team to ensure that the environment is a safe place for all. The data from the interviews indicates that the process of assessment and services available at the centre were explained on arrival clearly and accurately. It also seems the basic survival element of the service allowed clients opportunity to counter the negative impact of rough sleeping, adding to feelings of the environment being safe and welcoming. As Enzo put it “it really made a difference to have somewhere to go to get hot food and a shower; you don’t know how much you will miss these small things when you are out”. This basic survival service appears to be a key element of the service provided and in line with the Maslow Hierarchy of Human Needs ethos that St Petrock’s has developed over the last 10 years. This was illustrated again by Enzo who was aware of the service from past contact and felt it was a place “you can get a hot, sugary drink in the morning”. For Enzo, this was, and is, a major attraction. This would appear to highlight the importance of having an appropriate venue for the assessment hub and in this case one that is geared up ethically and practically to provide an effective NSNO service. 25 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Assessment: The data demonstrates that in eight cases the assessment occurred on the same day; of the others two were within a ‘few days’ and only one was over two weeks. The assessment process was seen by all as a productive and beneficial experience. It was noted in the interviews that they were prompt; offered an opportunity to exchange information and were inclusive, with the purpose clearly explained. It was also clear from the interviews that the opportunity to talk and engage with a professional about their situation was of huge value to those accessing the service. These impressions of the assessment process are evidenced in the interviews: Brian seeing it “as an opportunity to tell my story”; Bob was “not made to feel bad or that I was in the wrong for messing up my accommodation” and “felt this was a new start”. Anna saw the assessment as not only an opportunity to “tell my story” but, more significantly, with someone who was actually “interested in me”. This process appears to have reinforced the initial positive impression of St Petrock’s and tapped into levels of motivation and for Kirk, “gave real hope for the future”. This approach to the assessment process is key to the success of NSNO and to developing rapport and trust between the worker and client. Anna was assessed on the same day she arrived at St Petrock’s and saw the process as a way of the Response Team “ascertaining my situation”; and it was reassuring that “I was listened to and no one doubted what was actually happening to me”. Anna could not recall if NSNO was actually mentioned by name, but was clear that the Response Team would be actively looking to accommodate her quickly before exploring her “longer term options”. However, for the first couple of nights there was no space in any emergency bed or breakfast or female hostel so she had to “stay out” before a space at the local female hostel became available. Alan waited “around five minutes” before being assessed. He felt that the purpose was laid out clearly and he understood why information was being taken. During the assessment Alan felt that he not only had the chance to tell his story, but felt that the person assessing was actually interested, which was important to him. He felt that “All staff members made time for me.” Eric also describes having a very timely assessment interview and says this was completed the same day he attended. “All staff (he had contact with) were very helpful -­‐ nothing but calm seas”. For Ron, the assessment was clear and an action plan was agreed with his full involvement. He was also clear about a shared responsibility. “I knew that I would need to fully engage with the process and in practice this would mean attending meetings with the Response Team, making a claim for benefits, getting personal 26 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT identification and a birth certificate”. Ron also felt he had a lot of the skills and confidence to deal with these independently and accepted that the onus was on him to “help himself” as much as possible. Emergency accommodation: A combination of G8 and emergency bed and breakfast was available as initial accommodation. The former was seen as at best ‘uncomfortable’ and by one client as a dangerous environment and Brian actually chose to rough sleep rather than access it. Neal felt it was definitely not ideal and a number of the clients mentioned it was a concern that they would not know who else would be accessing the room. Alan felt some of the other residents were a “bit scary”. However, Brian’s concerns were potentially more serious: “The first two nights were fine if a little uncomfortable. However, on the third night a new person moved in. This changed everything. This guy was a total nightmare and was jacking up (I.V. using heroin) in the room in front of us”. Brian found this experience ‘traumatic’ and was placed in a dilemma as how best to deal with it -­‐ “I did not want to grass this guy up (to the NSNO staff) and put myself at risk”. As a result, Brian decided” I would rather live in a ditch”. Brian did leave the G8 for a short period and spent time with a friend before rough sleeping again “for a few days”. He was then re-­‐ offered G8 with assurances about safety and accessed it for a further week before being placed in a bed and breakfast. This illustrates some of the problems with the use of emergency ‘sit up’ accommodation that G8 offers. In contrast, Mike, Alan and Dave felt the G8 was a good idea but the lack of a TV or radio increased levels of boredom. However Mike added that he thinks his mobile was stolen from G8, so the experience of G8 for him “really depends who is in there”. It appears that concerns around the unknown, in terms of other residents, were a source of anxiety -­‐ albeit at different levels -­‐ for all those who accessed G8. This may be an issue exacerbated by the fact that no committed NSNO staff were available through the night as modeled in larger areas/cities. However, it was noted by SHOT that in the pilot period no serious incidents were recorded and the hostel has 24 hour staff cover. Anna accessed a space at the local hostel while waiting for a room in a B & B to become available. However, Anna had two nights before a space in the hostel became available when she had “nowhere to stay”. Anna was resourceful and used her train pass to avoid actually having to rough sleep during those two nights. Prior to the establishment of G8, the first stage of accommodation was B & B and this accounts for the remainder of the interviewees’ first stage access accommodation. 27 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Single Service Offers and reconnection: All but one of the interviewees accepted their SSOs. However, there was some reticence about the emergency ‘sit up’ accommodation provided by G8 described in the previous section. This high level of acceptance of SSOs reflects the skills of the NSNO assessors, their commitment to a fully inclusive process, identifying appropriate options and working in partnership with individual clients. This was evidenced by the client interviews, illustrated by Eric who felt he was “brought along every step of the way”. The breakdown SSOs for the interviewees were as follows: Eric, Bob, Neal, Alan, Ron and Kirk were all referred into the St Petrock’s supported accommodation within the private sector; Dave, Brian and Anna were all put forward for low level supported accommodation with an emphasis on moving on into more settled accommodation and Enzo was offered a reconnection. The fact that the clients felt they were part of the assessment process and that SSOs were ‘negotiated’ is a crucial aspect of the NSNO service, as is the fact that the SSOs were, in essence, agreed in stages. Neal was happy with his offer of accommodation in a B & B initially and a referral to the supported private rented scheme and accepted. Kirk felt the action plan was clear and negotiated from “A to B” and felt well supported “all the way”. However, Enzo did not follow this pattern and describes a negative response to the NSNO service. Enzo was assessed under NSNO and offered G8 initially. This was refused as he felt this environment would be bad for his mental health and continued to rough sleep. He was eventually given an SSO of reconnection back to Birmingham where there was a local connection and services and accommodation available. Enzo refused this offer, categorically seeing it as a “backward step” and counterproductive in relation to his mental health and general well-­‐being. The continual referring back to this offer became a cause of frustration and upset for Enzo when he tried to explore options in Exeter. Enzo explained he “felt settled and safe in Exeter”. He was spending a lot of time “doing the issue” (Big Issue vending) which he really enjoyed in terms of “meeting and chatting to people” as well as “making a bit of money”. Enzo was adamant in the interview that he would not leave until “he gets what he wants” namely “accommodation with my own door”. He felt a reconnection was a “bad thing” and therefore NSNO was not a way of “helping or meeting my need” and actually “made life a lot more difficult for me”. 28 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Support beyond emergency accommodation: The specialist private rented housing worker’s role with the six clients who were referred into her service was significant and the time and levels of support she offered were integral to the success of this longer term accommodation. Her approach was based on a person centered model and a considerable amount of her time was taken up with advocacy, particularly around benefit and rent arrear issues. The benefits of this role were evidenced in the interviews: Kirk “it was brilliant to have someone there for those day to day things that can get out of hand”; Neal “she was always flexible and easily contactable”. Ron felt she provided a “light touch and allowed me to use my own coping skills” while Alan felt he was given the information he needed but was never “bombarded”. In contrast, both Dave and Eric had more intensive support around issues related to loss and depression which proved for Eric “invaluable and gave me the strength to move on”. This support was not available to all those assessed under NSNO and targeted those most likely to manage more independent levels of accommodation. Likewise, the private rented support worker (S) was able, with Transition Funding, to access support for issues around mental health and related substance misuse where appropriate. This is clearly illustrated by Eric’s interview where he stated that after a period of time he started to go “downhill” (as the period of shock wore off). At this stage he was referred to specialist one to one support. He estimates that altogether he saw the specialist worker on about 10-­‐15 occasions, starting weekly and then less often and is still seeing him. “He helped me deal with big changes… I was in a totally different environment… it was a dark place and getting harder.” “I would go into mourning when I was attending St Petrock’s… they picked up on that and referred me to a specialist worker.” This would appear to encapsulate the level of support provided by S in terms of time, access to funding and available resources and its benefit in maintaining accommodation on both a practical and emotional level. Ron had the skills and confidence to engage with the available support and is now living fully independently in private rented accommodation. He is the only one of the eleven interviewees to do so at the time of writing. Of the others, Mike continued to experience issues around his mental health, in particular depression, a condition that he has had for some time. He says that he gets a lot of nightmares which he says is related to what is going on inside his head and his depression -­‐ there is also a history of alcohol use. Mike also has poor levels of literacy, which is a cause of stress and anxiety, particularly dealing with any letters and his benefits 29 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT claims. This history, alongside long periods of transience, meant he was seen as unsuitable for the support from S; Mike was referred and moved into the local hostel which provides relatively high levels of support. In Anna’s experience, initially there was lots to “investigate about what was going on for me” particularly around her children, social services and court proceedings. This took up a lot of time while it was established that a return to the family home was not an immediate option. Anna received a lot of practical advocacy and emotional support around these proceedings. She felt low in mood as her children’s social worker had requested a mental health assessment. However, this was seen as not necessary by her G.P. Anna went on to do some training around Numeracy and English in order to find employment. Anna was referred and moved into temporary supported accommodation, which is aimed at providing the support to move into more settled accommodation. While Brian, as we have seen, had a mixed experience of the initial emergency accommodation, he was eventually referred and moved into low level supported accommodation while he considers more settled accommodation. Dave was referred into low level supported accommodation by the Response Team and maintained this for about 9 months before leaving and returning to rough sleeping. The reasons for this are complex and were touched on in Dave’s interview. This may indicate an underlying inability to deal with responsibilities around his accommodation, which leads to periods of homelessness. Enzo, as we have discussed, refused his SSO and rough slept. 30 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Findings (3) Qualitative Data – Professionals’ Interviews The Following Section is based on 11 interviews with professionals representing key players in the NSNO project. •
Project worker •
Senior project worker •
NSNO Link worker •
Two NSNO Response Team Workers •
Manager of the Project •
Street Homeless Outreach Team Worker •
Street Homeless Outreach Team Coordinator •
Exeter HMP Housing Officer •
Exeter City Council Strategic ‘Move On’ Coordinator •
PRS Project Co-­‐ordinator Coping with the number of referrals As the quantitative data confirms, staff assessed significant numbers of clients over this 12-­‐month period, 215 in all. Numbers fluctuated, perhaps as a result of seasonal pressures but one professional estimated that the project was working with between 20 and 30 rough sleepers at any one time. The official rough sleeper spot count for Exeter recorded 23 individuals in November 2013 and 29 in April 2014. But professionals identified an overall increase in numbers, with one professional from the Street Homeless Outreach Team identifying an average of 30 and identifying a fairly consistent group, despite slight variations. The volume of individuals encountered at any one time was stressful and impacted on how staff managed the flow of referrals, especially in the light of less accommodation being available both at both the assessment and move on stages than was originally envisaged. Trends in rough sleeping and the role of NSNO 31 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Increases in certain groups on the street underlined the potential importance and significance of the NSNO initiative. Mental health problems and addictions remained key issues, seen as being exacerbated by a more difficult employment market and the bedroom tax. A higher percentage of those with complex needs was also identified and one professional described a core entrenched group of rough sleepers who were either resistant to offers of accommodation or too high risk to refer into accommodation. The combination of different complex needs meant that making inroads into rough sleeping was particularly challenging. Another identified trend linked to the wider housing market was the increase in accommodation for people in work. An increase in young people and women as rough sleepers was identified as significant almost universally by those interviewed. Young rough sleepers were identified as potentially more at risk and vulnerable. The reduction in the supported housing fund and the lack of provision for young care leavers was also seen as having limited the options for this group. One professional explained the importance of diverting this group speedily from the streets, given what was known about the culture of older, more established groups of rough sleepers and the risks of younger people easily becoming entrenched in this -­‐ “They can quite quickly be negatively influenced by others -­‐ older and more entrenched rough sleepers-­‐ into a negative culture with implications for their vulnerability”. This problem is reflected in other research into rough sleeping where people may be seen to ‘learn to become homeless’ by inculcation into a particular rough sleeping sub culture. For example, Ravenhill (2008) suggests that it can take an individual living on the streets only two or three days to become acclimatized to parts of the homeless culture. One professional gave an example of a young person with learning disabilities who had been helped off the streets, consistent with one of the key aims of the NSNO project, to prevent rough sleeping habits developing. Another professional gave examples of how skillful work and negotiation with young people who may have left home after a minor disagreement helped establish a home reconnection, illustrating the value of helping them home in order to prevent a more damaging long term engagement with a rough sleeping culture. One professional summed up this aspect of the work: “An important aspect is how it moves people on quickly… which might never happen otherwise… a key aspect of working within NSNO is that, by picking up people quickly, it often prevents more exposure to those who are vulnerable.” The increase in female rough sleepers was also an issue. Women represented 15% of the 215 sample and this is a figure echoed across the other NSNO projects in Devon (Report on Devon and Cornwall rough sleeper project 32 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT 2012-­‐2014). However, a number of professionals felt that this did not represent the true picture of a potentially ‘hidden group’, who may often ‘hide’ themselves when sleeping rough, and may not be picked up in official counts. This view is substantiated by recent research, which also links their vulnerability and history of being victims of violence to a determination to stay hidden (St Mungo’s 2013). As other studies suggest, such as the follow up report into entrenched rough sleepers, whilst being a minority numerically, women may have experienced a greater number of stressful life experiences, compared to men, and have different needs (Teixeria 2010). One professional explained that she had aimed to develop a ‘women’s space facility’ within the NSNO project. Another challenge were very heavy drinkers, described by one of the professionals as a “hard group to help” and one professional commented that wet house facilities for both men and women was a badly needed resource in this regard -­‐ an issue that has been flagged up for some time as a local need. The problem of entrenched drug and alcohol users in the city was also an area of concern, as was the issue of begging which was identified by one professional as being consistently correlated with those supporting their addictions. Another key trend identified was the increase of the use of legal highs amongst the rough sleeping population. Many rough sleepers were seen to be using these as a cheaper alternative to heroin and crack, including the older or more established rough sleeping population. This was resulting in more problematic behaviors as a result of the impact on the mental health of those rough sleepers and was an emerging problem in the city. Two other identified causes of people leaving accommodation and becoming homeless were those with involvement in drug debts, with subsequent threats against them, and those fleeing from situations of domestic violence. Both presented significant challenges in terms of assessment and accommodation as discussed below. The housing officer from the local prison identified a significant issue in terms of mental health problems amongst those in prison who would be rough sleepers on discharge. In terms of the overall profile of rough sleepers dealt with, there were a higher number of first time rough sleepers than had been anticipated. 40% were new to rough sleeping, 30% were new to Exeter (but had previously slept rough elsewhere) and 30% were returning to rough sleeping (after 6 months in accommodation). Running the scheme: Issues of fairness and eligibility : A key challenge in implementing NSNO is the way in which eligibility criteria are applied. Some elements of the NSNO principles are potentially controversial in their aim to target certain groups whilst potentially excluding 33 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT others and, some would argue, by suggesting there are choices, which in fact are very limited as a result of resource constraints (see for example Hill, 2012; Kinsella 2011). Interviews with professionals highlighted some differences in the way that rough sleeping is established, how consistently Single Service/reconnection offers are made and with what degree of discretion this is done. One project worker felt that establishing whether a client was eligible was the area that had resulted in most differences and discussion between agencies in terms of how this was interpreted. Another felt that this was anything but “a straightforward process”. One professional thought that, whilst the criteria were largely clear, there was a difference in terms of how these were perceived and interpreted by different professionals and there was room to be ‘creative’ in the clients’ best interests. Another acknowledged these challenges whilst suggesting that the more formal NSNO criteria had been developed and adapted with local issues in mind. In essence, the team “who through their experience had developed a good knowledge of what might be effective, whilst leaving more entrenched groups to be dealt with by another part of the service” aimed to work with a wide range of clients. The majority of professionals interviewed saw the importance of some key aspects of the criteria in establishing fairness of resources. At the same time, they faced the demands of working with those with a variety of complex needs. These included the multi-­‐layered behaviour patterns of rough sleepers. One professional pointed out that sleeping patterns are affected by both personal and often traumatic events and seasonal differences. Consequently, such individuals might be in and out of accommodation for variable periods. As a result, many of them would fall outside of the NSNO criteria. Potentially this had implications for some of the more established rough sleeping population who fell into this category. Some of this group might have viewed their exclusion as arbitrary and unfair. Fortunately, this professional said the staff team had managed this issue with thought and flexibility in ways that had contained this issue within the wider group, using the centre in a way that did not undermine its wider brief and reputation amongst the homeless population. Another example of the need for flexibility related to the initial identification and assessment of rough sleepers. An original aim was to undertake initial assessments directly with rough sleepers on the streets, in order to pick up people quickly. However the approach to this changed for two main reasons. Firstly there was concern that staff making the first assessment on another person’s territory might be seen as being potentially provocative under certain circumstances, and therefore might place staff at risk, especially if assessments were conducted in the evenings. 34 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Secondly, it became clear that because St Petrock’s was so well established and signposted as the first point of call for rough sleepers, visual assessment was unnecessary and could be sought when needed if there was unclear status. One professional explained that there were a number of potential routes for clients into the NSNO service through other agencies, including Exeter City Council, the Prison and other voluntary agencies. At least one professional felt, however, that it was difficult to establish actual rough sleeping status if there was not physical identification of this, as there was a distinction between problems with homelessness and actual rough sleeping. In terms of verification, another worker from a different agency felt there was some ambiguity in relation to the verification process and that a ‘prediction’ of rough sleeping status is normally accepted. There was some development in the process in that a standardised checklist was adopted. One professional summed up some of the key issues from his perspective, saying that there can be some ambiguity about what constitutes ‘settled accommodation’ but that skilled discretion and assessment meant that the correct people are being targeted and that rough sleeping could be validated via good liaison between the Street Homeless Outreach Team (SHOT) and the NSNO Response Team if status was uncertain. Another felt that this issue was a good example of the project adapting a way of working with this issue in a way that best served the interests of the client group. One professional said that originally the focus was more strictly on those who were verified and new to rough sleeping. However, over time, the approach had less emphasis on physical verification and more on the assessment itself. This caused tension at times with the council, who took a more literal interpretation, but could be seen as a positive aspect of a ‘preventative’ approach to clients who may otherwise have been ‘under the radar’, such as sofa surfers, and those living in sheds and tents in gardens. Consequently, it was felt by this professional as helping to highlight a number of the hidden homeless even though it might be “ only scratching the surface”. The use of emergency accommodation could in itself be seen as a way of establishing validity, as one professional commented that use of this accommodation could be a good indicator of who is actually ‘genuinely in need’ and in this way may be preferable to bed and breakfast in the first instance -­‐ “ Just acceptable enough that if someone does not need it they will not access it”. Finally, as one professional explained:“ When used well, the criteria can be very good as a means of support for this group, rather than as a means of control”. 35 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Assessment in NSNO: Challenges and developments Key themes emerged : •
Assessment at such speed presents many challenges in making an assessment of risk. •
The use of the assessment tool was seen to aid identification of key issues. •
Some professionals felt that the standardized form was too proceduralised and militated against enabling the clients to tell their stories. •
Professionals adapted the best elements within their own style and used assessment skills to balance more holistic interviewing with the requirements to gain harder information. •
Particular skills were needed to establish verified information at earlier points of the process. •
The speed of assessments, if there are particularly high numbers, could mean that some may get missed, without sufficient resources. •
There was a potential gap between initial contact on outreach and assessment by the Response Team and this might be addressed by having a dedicated NSNO worker as part of the Street Homeless Outreach Team. •
A “staged process” of assessment was a way of managing the challenge of making comprehensive assessments at such speed. •
Some risk assessment could be too risk averse. There are a number of challenges in relation to providing speedy but accurate assessments given the time frame in which such assessments are undertaken in terms of the NSNO aims. As one professional explained: “ There can be a pressure to obtain an accurate assessment within the time constraints otherwise you might be placing people with behaviour problems in unsuitable accommodation.” A key objective, in terms of the assessment process, was the reduction of bureaucracy and the improvement of joint working, particularly given the fact that up to ten different agencies can be involved in the intervention with one client. In order to achieve this, there is one assessment form (which is common to all agencies). A key aim, as one professional explained, is : “To cut down on multiple assessments whilst providing important factual information”. It includes boxes that indicate the assessment criteria, key areas to consider (for example health, mental health, substance misuse) and history of homelessness, including an assessment of risk. 36 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Professionals discussed both the positives and negatives of this tool. Many of those interviewed commented on the value of the structured nature of the form, which assisted in helping to consider and keep key areas of assessment in focus. This included the important consideration of risk assessment factors such as mental health, suicide and self-­‐harm. The tool was also viewed by many as “comprehensive”, enabling a potentially better matching of need and resources. The main identified disadvantages linked to what some saw as “the over structured nature” of the tool, which were seen as allowing “ little room for the client’s story”. Despite adapting this flexibly, others too saw it as over proceduralised and likely to encourage more of a ‘question and answer’ approach, rather than a dialogue -­‐ “ It can take the exchange element out of assessment by requiring too many questions to be asked. It does not really work as a way of getting to complexity of need”. Another felt that it was over focused on negative elements of a client’s life. In a similar vein another professional said: “ I would like it to be a bit more holistic and to include something a bit more positive about the client, say their interests or work. Some of the questions can feel very intrusive”. One professional felt that the approach could lead to ‘risk averse’ decisions, where levels of risk on the form could be used to deny services or support to clients. Another, from a different setting, echoed this, adding that the lack of emergency accommodation left the NSNO team ‘holding clients before referrals were accepted and that more accommodation was needed for riskier clients’. Two other issues raised were in relation to speed of assessments; particularly high numbers could mean that some may get missed, without sufficient resources. Secondly, there was a potential gap between initial contact on outreach and assessment by the Response Team. This might be addressed by having a dedicated NSNO worker as part of the SHOT team . It was clear that all professionals adapted the assessment tool in different ways to suit their style by matching skilled questioning with getting the required information. Some would fill it in as they went along but others would do so after the main interview. For example, one commented:“ There is also the issue of personalisation, including the voice of the client which is important. There is allowance for this in terms of how each worker uses the form, which is not written in stone”. Balancing accuracy and verification of information, given the pressure to undertake assessments, was a particular challenge. One respondent said that, when placing people, some agencies required more verified information than others and that this could be challenging to obtain quickly. This can mean that workers might 37 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT have to rely on their intuition, in focusing on crucial areas first, and then gain key information from the most informed sources (such as a key worker). Professionals talked about how they managed the process of making assessments in stages, using their expertise to make judgments about what information needed to be sought or verified at an early stage, and adding to assessments as they were able to obtain or verify more information about clients’ circumstances. This clearly involved a high level of skill in interviewing and negotiating with others and finding information from key players and other agencies. A key issue in assessment was the availability of accommodation to which to refer clients. This links to the whole issue of the Single Service Offers made. A clear finding from most of the professionals interviewed was the comparative lack of suitable accommodation available that clients could access -­‐ “Not having (the expected amount of accommodation) has made the initiative much more difficult to run and is also affected by the volume of people the project works with”. The lack of emergency accommodation at the start of the project was also raised as a key issue. Others said that the already limited accommodation had worsened as a result of further cut backs, causing greater pressure on NSNO accommodation. This was seen to link directly to the assessment process, as one person said: “Offers (that follow from assessment) are only as good as the offer it’s possible to make”. A number of professionals commented that clients had to be kept in assessment accommodation longer than was envisaged and that there were consequent blockages in the flow of people into follow on accommodation at various points. This shortage of accommodation also caused pressure on workers making assessments and attempting to match needs to limited resources. Another professional commented that such pressure could impact on the dynamics of the team making such assessments, which in turn could affect the appropriateness and suitability of the referrals made. They gave an example of one client with mental health problems who was in what she considered unsuitable emergency accommodation as a result. (One professional felt that, although there could never be enough, generally speaking such accommodation had proved to be available when it was needed, saw it as a good resource and that access to emergency accommodation mirrored aspects of a direct hostel approach). 38 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Single Service Offers: How do they work in practice? “A Single Service Offer is the offer of one service which is judged to be the most appropriate for an individual after assessment of their needs. Once a single service offer has been identified, it is made consistently by all services coming into contact with the individual. Once a single service offer has been made, alternative offers are not available unless a reassessment finds that another offer is more appropriate” (Hough et al 2011). The concept of a ‘ Single Service Offer’ is key to the NSNO initiative as one professional explained: “The aim is to offer an assessment quickly, within 72 hours, via an intense period of engagement and assessment so that people can be helped off the streets quickly”. Professionals identified both opportunities and challenges in implementing this principle in their work with rough sleepers. At least two professionals felt that clients did not always fully understand the concept and its implications and consequently emphasised the importance of working through this process. Another felt that, despite some challenges, it had worked well, stressing the importance of explaining the process very clearly to clients, why it has been offered and the consequences of refusal. The importance of adopting a person centered approach, negotiating SSOs where possible and ensuring that no options are closed down too early were stressed as key practice issues here. Offers were generally made verbally, rather than in writing. One professional said that offers in writing suggested a contractual arrangement that was over formalized in such a setting and the important thing was that the client was actually clear about expectations. However, another professional felt that there might have been more consistent use of more formal validation of offers by putting these in writing and greater sharing of these between agencies would have aided a more uniform approach, thereby reducing the risk of an individual sleeping rough with the expectation of a getting a better offer. A number of aspects were identified about the process which linked to the need to avoid rough sleeping becoming an entrenched lifestyle. Many professionals interviewed felt the initiative had valuable aspects, despite the constraints of lack of resources needed to underpin the principle. Key positives here were the way that a concrete offer, rather than a promise of one, could help clients focus on issues and consequently increase the potential for motivating them to change : “It’s good for clients to have a focus, something concrete to help them move on. It has elements of being time and solution focused”. As one professional observed: “Where it 39 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT worked well in practice it was part of a staged process, linking to the aim of working intensely with someone through this period to avoid rough sleeping patterns developing”. One project worker said that an offer might increase motivation, and provide a period off the streets quickly, so that the person could move to the next stage. Offering clients something real and concrete within such a short period of time was seen to help stabilise people who may be on the slide towards inculcation into more problematic behaviours. Another felt that it formed part of a clear line from assessment through investigation to identification of need to making a concrete offer of support. Challenges related to issues of limited accommodation at various stages in the process. Shortages of accommodation impacted on what offers professionals were able to make and how this matched need. For example, one respondent talked about the way that limited accommodation impacted on the type of Single Service Offers that staff were able to make. Because of demand on Gabriel House from other sources and the closure of Esther, the only women’s hostel, types of suitable accommodation were limited. Another added that lack of emergency accommodation for women was a particular concern, as this was not safe. He also commented on the lack of suitable accommodation available for those discharged from hospital. Another professional explained that the original aim was for two houses that would have allowed for dedicated space for intensive work with clients during the assessment period. However, due to very limited emergency accommodation, in practice some people had to remain in this first stage accommodation for too long, as there were waiting lists to move on. One worker commented that this can lessen motivation and the client may be more vulnerable to a return to drug or alcohol misuse. Another commented that emergency accommodation was often viewed poorly by clients, was a “hard sell” and that some would prefer to be left to their own devices, i.e. friends/tents. The problems related to the scope of ‘first stage’ accommodation was a significant issue raised by a number of professionals, as the original idea was that workers might have more hands on contact with clients if the initial accommodation was more centrally based. Another theme was that both G8 emergency accommodation and bed and breakfast had been used more than was initially planned, due to the fact that two initial assessment ‘move on’ properties had not materialised as envisaged. Access to clients in move on bed and breakfast accommodation was also an issue as a number of professionals felt that this limited opportunities to work intensively with this group. One said that this was, in part, due to the 40 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT fact that it was not possible to keep tabs on clients placed there, as there was no point of contact via the landlord and often clients would not be there or contactable. Another professional, whilst acknowledging that the accommodation held limitations for this client group, felt that there might have been a better way of NSNO managing contact with this group despite the challenges, so enabling better engagement with such clients more regularly. Another professional commented that there was a pattern of clients with complex needs, who had been placed in bed and breakfast accommodation, “going off the radar”, and that evictions were not uncommon. Some professionals discussed how problems with lack of ‘move on’ accommodation impacted on the overall aim of moving people, in a staged way, from the initial single service offer. For example, one respondent commented that, whilst clients were placed in bed and breakfast accommodation with the aim of eventually moving them into private rented accommodation, there were a number of challenges to this including a shortage of private rented accommodation. Landlords were reluctant to take on people on benefits, and were easily put off by perceptions of those not in work or with other problems. This problem was seen to be significantly amplified by the housing market situation. There was seen to be an acute shortage of suitable and available private rented sector accommodation, even for working local people. This presented enormous challenges for the local council, alongside additional and continual cut backs in relation to funding. One professional commented that many clients, especially those with addiction problems, often lacked the motivation to move on from bed and breakfast accommodation and that this, combined with such a shortage of options, was a very difficult problem. Another professional explained that Single Service Offers were often complicated because of the challenge of finding the right accommodation:“ You might have to make multiple referrals to different places as you don’t know whether or which one might be accepted. This had implications for holding to one offer.” Another commented that, if temporary bed and breakfast accommodation was offered whilst other referrals were in place, it was important to clarify that this is only available on the condition of the SSO being accepted. One professional also felt that, whilst SSOs worked for people with low support needs, they worked less well for those with higher support needs. They also felt that a disadvantage was that the SSO principle could lead to eviction in certain circumstances. Another commented on the term itself, feeling that this could give a misleading idea to clients, and convey an over authoritarian approach which might impact on rapport with the client. 41 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT One professional responsible for running St Petrock’s supported PRS scheme for clients a stage further on, identified core elements that she felt increased clients’ motivation and their capacity to sustain more permanent accommodation. It was often a volatile client group, where there had been issues of drug, alcohol and mental health problems, but these were often accompanied by histories of dislocation and problems of attachment as a result. This often meant that clients’ connections to places and areas had significant resonance, as a result of past broken family ties or separation from children. It was important to understand the significance of these attachments in engaging with such clients. Allowing as much choice and ownership in the process of gaining accommodation was seen as key, even when this may be limited. Discussion of what was wanted, preparation for moving, accompanying clients through this process, as well as supporting them with all the practical obstacles they encountered, were all very significant aspects. All of this contributed towards clients owning the issue and helping to “ build responsibility” . Reconnection This is a part of the project with the most potentially controversial elements -­‐ encouraging clients to return to the area they have recently left. Reconnection raises complex questions about fairness of resources, people’s entitlements to accommodation and personal issues of what constitutes home. This has particular resonance where people have traumatic histories, complex relationships and problematic behaviours. People may have very good reasons for both wanting to leave an area or to return to one. As one professional observed: “It’s hard to get away from your past as it’s part of your identity”. This was illustrated by an example of the work of one professional involving a client whose base was in Devon. Despite being separated from parents and siblings as a result of care proceedings, Devon represented a time when the family has been together and was his main claim to a “home area”. The individual had walked back to Exeter along the motorway. The idea of ‘reconnection’ may, on the other hand, assume that people do want to return to an area, when clearly there are major issues causing them to have left. As one professional said “ Whatever the reason for people leaving an area… it’s clear they do not want to go back”. One professional was opposed to the concept in principle, feeling that an individual’s needs should be met “at source” in the area they present, and in its worst manifestation, could be viewed as a form of “ extraordinary rendition”-­‐ except where it was based on an informed choice. Another felt that, although it might work in helping someone consider their best options more thoughtfully, there was a more difficult, grey area, in terms of 42 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT how long to hold to this one offer without an alternative. This highlighted the important safeguard of reviewing the situation. However, in discussing the challenges of reconnecting clients, many of the professionals interviewed identified important aspects of this principle both in terms of social justice and working pragmatically with the constraints of available resources. One illustrated the complexity of reconnection in balancing the rights of individuals and the availability of resources :“Whilst the premise is often criticized, it is only fair that local people should have some priority over local services especially if this is interpreted in a humane way”. In evaluating this element, it is also important to see the Exeter NSNO project in the context of wider structural issues and how other areas’ arrangements regarding NSNO or lack of them impacts on Exeter and Devon’s project. In other words, the extent to which other areas are adhering to similar NSNO principles or implementing NSNO was viewed as a significant factor. There is comparatively high reconnection rate from Exeter, which reflects Exeter’s attraction as an area for people moving in from other areas. However professionals gave examples of other areas that have ‘sent’ clients to Exeter with no evidence of any verifiable connection. This has significant implications for those who do have a valid local connection. This would appear to have major implications for how NSNO works where one area may be implementing this consistently and another is not or has no reciprocal project or arrangement. In the same vein, another professional felt that, in her experience, Exeter can be seen as a good option in terms of resources and services and this can make people less willing to accept reconnection away from the area. In relation to the pragmatics of managing the reconnection process, professionals spoke of the skills needed and the importance of facilitating reconnection where this was feasible: “If people do have some kind of support network and have some link with their own council, it’s generally much better that they reconnect there and the NSNO project staff can help them do that.” Another added that, if enough time was spent exploring the reasons for leaving an area, and assurances could be made about a change involving support, this can be accepted: “ Often the reality of reconnection can focus people’s mind and put things in perspective”, adding that it works when not rushed, is genuinely accepted and there is enough support at the other end. Another identified positive was that such a mechanism did potentially offer a realistic way out of a damaging engagement with an entrenched rough sleeping lifestyle by diverting those who may be at risk of becoming ‘attached’ to this way of life. As one professional, working with a young person with learning disabilities, said: 43 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT “ Especially for certain groups… mixing with others who have very problematic pasts and behaviors can be very risky”. In practice ‘reconnection’ was applied in different ways. It might involve helping people to go back to the area they had just left as a result of more minor disputes or because of rent arrears. One professional gave examples of situations where she and other workers were able to negotiate with the client, their family or the council in order to reconnect people in this way, including examples of some with mental health problems who might have left their home area prematurely because of anxiety or misunderstanding. Other examples of reconnection involved negotiations with local councils or other agencies so that workers were able to act as skilled advocates. Most clients were helped with fares to return to their area where the value of this in terms of reconnection could be established. One professional emphasised the scope and discretion within the system to use reconnection constructively, not just as a way of controlling resources. Through skilled assessment and interpersonal skills, workers were often able to establish the basis of complex disconnections, by understanding the reason for people leaving, and negotiate the best outcomes even though the available resources often limited these. As one put it: “ The system at least allows you the possibility of discussing reasons for people’s reluctance to go back”. Another commented that the more successful reconnections tend to happen quite quickly, linked to the resolution of disagreements and disputes in the home area that may have escalated, resulting in them leaving. The most controversial aspect of the idea of reconnection is that often people are fleeing from an area for reasons of risk or vulnerability. Professionals identified a variety of such reasons, which included those experiencing domestic violence, or threats emanating from drug debts, often with a history of related drug dependence. One professional estimated that about 80% of people had either relationship breakdowns of some kind or had attempted suicide: “The majority of people are fleeing something. It takes quite a lot for someone to leave their own area and access services in a strange place”. Another observed : “Whatever the reason for people leaving, they have left an area and, often, they don’t want to return. A potential problem with this NSNO principle is that it can also force people to become rough sleepers, because once an offer is made, if they refuse this may limit their chance of being further assisted”. In accordance with NSNO principles, vulnerable clients are protected from these risks, but this often hinges on the difficult issue of being able to verify reasons for clients’ vulnerability in returning, which, as one professional said, can “ ignore the reality of some people’s lives” 44 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT This verification was technically speaking done by checking that there had been a log of the situation (incident) with the police. This in turn relied on clients having contacted the police or relevant authorities. As professionals pointed out, individuals fleeing from complex, traumatic and often violent relationships or those caught up in threats relating to drug debts were usually very reluctant to report such incidents to the police. This created significant challenges for professionals working with high risk clients where it may be very difficult to assess and verify past violence or future risk, from perpetrators of domestic violence or pursing drug dealers. One professional cited an example of a case where an individual had been subsequently attacked by criminals due to his past drug debt history, despite all attempts to house him away from the area he had come from. Again, there was evidence of professionals’ flexibility and expertise in working within these constraints. For example, one talked about using the assessment period to verify someone’s previous history by liaising with other agencies or key workers. Others gave examples where reconnection, although applied, was not enforced rigidly but flexibly. It was acknowledged that this principle may be used very differently in other areas of the country, where it might be used as a way of protecting local resources by moving people on, without making a fuller assessment of vulnerability. Another identified issue was the problem of establishing a client’s actual connection to the area they have come from. A worker would try and contact other relevant professionals, but where this was not possible, it was a question of relying on phone calls to friends or relatives of the clients, without additional verification being available. This would occur when people were seeking reconnection or train fares back to a previous area. For example one professional, who estimated that about 95% were genuine, commented that it can, on occasion, be a “ very abusesable system”. This aspect is also compounded where the returnee’s local area does not have an established NSNO project or similar agreement. In these situations, it’s harder for the professional to ‘negotiate’ a more considered reconnection without established contacts in the area to which the person has to return. At least one professional commented that Exeter council was very flexible regarding the challenges of reconnection and that, although it was often criticized as an idea, it was interpreted by the project workers in a humane way. Resources As already indicated, professionals described resource challenges that the project had presented. Insufficient accommodation in particular made many of the processes discussed in the above sections far harder. 45 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Many felt that the project needed more key resources with the already limited accommodation having been cut back, causing greater pressure on the available NSNO provision. One summed up the problem with move on accommodation for more entrenched rough sleepers like this: “ For those people with complex needs and entrenched behaviors… they are very reliant on one hostel and if evicted there is nothing else for them. There has to be an increase in services for people who can’t manage their own accommodation. Other suggestions included that provision might be improved by a separate hub, better resources for those released from prison and that those being released from hospital should be automatically eligible for NSNO support. Working together Despite some of the potentially problematic principles of NSNO and the acute constraints, working arrangements were described very positively. One professional said that there was a very good working relationship between the SHOT team and the project team -­‐ a key relationship to making NSNO successful -­‐ and good relations with Exeter City Council. The prison housing officer felt that her team was a model of good practice, in terms of sharing information and liaising with other teams. In relation to inter-­‐agency working, the Council’s Strategic Move On Coordinator commented on many positives, including a generally consistent approach to NSNO from partner agencies and the fact that the initiative had clearly helped numerous very vulnerable people with housing problems. It was felt that a great deal had been learnt about rough sleepers as a group that might provide the foundation for further developing community and partnership working. Another commented that working together had been enhanced by the ‘Common Assessment’ approach which meant that there was a wider network of referrers and had also helped to establish a good working relationship between the Street Homeless Outreach Team, St Petrock’s and Exeter City Council. Additionally, it had helped increase the understanding of the challenges and tensions that other agencies experienced. The manager of the project commented on a number of aspects of inter-­‐agency collaboration and development. It was felt that there was good communication between the council, the SHOT team and St Petrock’s. Additionally it was felt that clients’ needs were acknowledged and seen as paramount and that staff worked with flexibility with these. In terms of challenges, there was a difficult balance to be struck between consistency regarding the council’s criteria and over rigidity. There was always a key challenge in assessing risk when placing 46 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT people in accommodation. However, overall it was felt that the development of common assessment procedures had been seen to make major advances and that the NSNO initiative had developed a very good “building based assessment”. Challenges to working together included the perception by some that, due to the project being based solely at St Petrock’s, this would sometimes pull resources away from NSNO work, especially when the centre was overloaded. One professional felt that the way that the project team was organised meant that there was often a lack of overall strategy and review of ongoing issues at times. For example, although the team did discuss individual referrals, there might have usefully been more discussion around key issues and procedures. Another professional felt that the team worked particularly well at the beginning of the project, resulting in appropriate referrals, but as the project proceeded, this became more difficult as lack of resources put more pressure on workers. Overall, however, the person described very good working relationships with the team. It was also noted that the project team worked very well with a good range of distinctive but complementary skills and approaches. In terms of learning, it was considered that inter-­‐agency collaboration on all sides might have been sustained better from an original start where inter-­‐agency meetings had been more frequent. It was also felt by at least one professional that there might be more support from drug and alcohol agencies and other agencies including St Petrock’s to move on some entrenched rough sleepers who proved a consistent and enduring problem. Whilst the council had done all it could to provide accommodation supporting the NSNO scheme, funding was very limited, was likely to be even more so in the future, and there needed to be more initiatives from the voluntary sector to support this group in the future. It was hoped that a new council 5 year homelessness strategy would include aims in relation to the rough sleeping population. Despite the challenges and potential problems with many of the key principles, professionals described ways of working with these flexibly and with the best outcomes of clients in mind. So, despite restrictive aspects such as the Single Service Offer and re-­‐connection, assessments had been used positively, holistically and flexibly:“ Initially the scheme was more about gatekeeping our services as well as other aims… but alongside that you can use it as a positive as long as you are aware of that and alert to the dangers of that happening”. 47 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT A professional commented that multi-­‐agency working within the NSNO scheme works well 80-­‐90% of the time as a result of good communication, an awareness of how different agencies work and the demands and challenges they face. Another commented on the many positive aspects that enabled entrenched rough sleepers to get help quickly, with hope for change as a central part of this. One highly experienced worker said that, whilst it was difficult to verify hard figures about those sustaining accommodation, in his experience :“ We know that it has stopped people sleeping rough and overall has been a very good experience.” Another felt it was important to avoid overlaps in working with other agencies and that Exeter NSNO had evolved well locally, using the NSNO principles well to clarify lines of communication with other relevant partners. A final comment reflects what was considered the huge success of Exeter NSNO, which had “seen the introduction of a variety of services, highlighted the benefits of quick and direct access to emergency accommodation and which had the potential to develop for a wider range of rough sleepers”. 48 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT Conclusion •
The Exeter NSNO project has been successful in supporting a great many new rough sleepers to move off the streets, as outlined in the executive summary. •
Whilst elements of the NSNO principles remain controversial, this project adapted them in holistic ways that enabled vulnerable rough sleepers to avoid the detrimental effects of immersion in a rough sleeping lifestyle. •
Despite expressing different views regarding some aspects of the principles behind NSNO and some feeling that inter-­‐agency working might have been sustained more regularly from an excellent beginning, the range of different agencies expressed very good levels of inter-­‐
agency communication, resulting in NSNO principles being adopted in clients’ best interests and key aspects of good practice emerging as a result. •
The qualitative interviews from both recipients of the service and those working with them confirms that a range of important practice approaches and initiatives were delivered and developed within the operation of the scheme. Many of these address what other research has indicated are key factors to consider when engaging and working with rough sleepers. These include: potential barriers including stigmatisation, fear of change, distrust based on past experiences and understanding of how complex needs or past trauma impacts on rough sleeping and motivation to move on or not (Teixeria 2010). It can be seen that many of these factors were a central ingredient of the positive relations developed by the professionals involved. •
It would appear that particular skills/approaches were developed in relation to the speed of assessments and structured tools for this were adapted. Many professionals felt there was a further need to adapt the assessment form to allow more possibility for rough sleepers’ own stories to emerge. 49 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT •
The majority of clients interviewed were very positive about the service they received. There were some key problems in relation to some issues of emergency and move on accommodation, provision for women and one example in particular illustrated the potential conflicts and risks with reconnection. •
Reconnection appears to have been adapted advisedly, with professionals keenly aware of the potential problems if this is not used carefully. However this remains a controversial and in many ways unknown area. In their research on enforcement measures on street users, Johnsen and Fitzpatrick (2007) suggest that some enforcement measures may have some beneficial outcomes if accompanied by sufficient support (a factor evident in the Exeter Project). They also suggest however, that such enforcement can be a high risk activity in relation to rough sleepers. Although their research was not specifically related to issues of reconnection (as a type of enforcement) it will be important to consider the outcome of further research into this particular aspect (Johnson et al, forthcoming). This suggests that reconnection as a policy needs to be continually reviewed against the risk of it becoming a mechanism of gate keeping access to local services, particularly at a time of reduced funding for these services. •
The impact of emergency accommodation and the service it has provided is a significant finding from this report. The ability to provide immediate accommodation, albeit at a basic level, and at the first point of contact with a rough sleeper while options are explored was key to the success of this pilot. It was commented as the one thing that really made a difference, giving the Response Team the opportunity to make powerful interventions into the lives of rough sleepers who were often in crisis. •
The qualitative data from both the client and professional interviews would validate this conclusion and as such this strongly indicates that this service in some form needs to be part of any new service if NSNO does not continue to exist as it does at present. Interestingly, comparisons can, and have, been made with this element of NSNO and the old style night shelter provision; namely emergency accommodation that can be directly accessed by clients without a lengthy period of referral. In effect this arguably casts a new light on the role of the historic night shelters or hostels that have been seen politically as part of the problem as opposed to a solution to rough sleeping. This resource would also have potential benefits for a group that did not come directly under NSNO but have been recognised as an enduring feature of the rough sleeping landscape, namely those who are consistently resistant to engagement around their accommodation. Such ‘entrenched rough sleepers’ who do access emergency weather provision (provided in St Petrock’s and the local hostel) regularly would arguably be more likely to 50 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT engage with a process combining the model of G8 and the emergency weather provision in terms of accommodation. The fact that this system negates the need to carry out lengthy referrals that require a range of commitments from individuals would be hugely beneficial with this group. While this model would not be without some risk, evidence from this report suggests it would have to at least be seriously considered as an option. The Future The future of the NSNO service is at the time of this report undecided and the lack of official dialogue around its future would suggest it is unlikely to continue in its present form. Latest figures from London suggest that, whilst the proportion of those new to the streets who spent a second night out fell from 41% in 2008/09 to 25% in 2012/13, the flow of new rough sleepers onto the streets increased over this time. As a consequence, London is proposing “a new strategic commitment to minimize the flow” including a pilot for a ‘No First Night Out’ project’ (No First Night Out Pilot project 2014). Interestingly this pilot would appear to be moving the focus from NSNO on new and verified rough sleepers to a more preventative role. This would appear to fit a pattern of shifting or tinkering with the focus of services targeted at rough sleepers without any sustained or long term approach. The NSNO Exeter project was funded by the Exeter Transition fund, which made available £250, 000 for a two year period. The ongoing support and funding for the project remains uncertain. The future is uncertain without guidance and support from the DCLG but it is hoped that the standards, partnerships and principles established with the £805,000 funding will be maintained by local councils/areas. The evidence contained within this report suggests that the NSNO service has made a real difference in the lives of rough sleepers and as such the pilot has been a success. 51 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT References Department for Communities and Local Government ( 2011) Vision to End Rough Sleeping: No Second Night Out Nationwide. London: The Stationary Office. Available at: https:www.communities.gov.uk Devon and Cornwall “ No Second Night” Standard. (no date) Devon and Cornwall Rough Sleeper Partnership Group (2012) NSNO Principles Hill, D (2012) Rough sleeping in London is soaring-­‐what was that pledge, Boris Johnson ? The Guardian, 14 December. Available at: https:// www.theguardian.com Homeless Link (2014) No Second Night Out Across England . Available at : http://www.insidehousing.co.uk/journals/2014 Hough, J Jones, A and Lewis, H (2011) No Second Night Out: An evaluation of the first six months of the project. Available at : at www.broadwaylondon.org Johnson, A, Fitzpatrick, S and Jones, A : ‘Reconnections ‘: Heriot-­‐Watt University and University of York Forthcoming. Jones and Hough (2013) No Second Night Out: A study of medium term outcomes: A summary report: at www.broadwaylondon.org Kinsella, C (2011) ‘Welfare, Exclusion and Rough Sleeping in Liverpool’, International Journal of Sociology and Social Policy, 31 (5/6). pp.240-­‐252 No First Night Out project and bidding process overview (2014) available at: No First Night out www.london.gov.uk No Second Night Out : The Lancet UK Policy Matters www/ukpolicymatters.the lancet.com/no second-­‐night-­‐out/ accessed 2/514 Ravenhill, M (2008) The Culture of Homelessness : Ashgate: Hampshire Report on Devon and Cornwall rough sleeper project 2012-­‐2014 52 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT St Mungo’s (2013 ): Rebuilding Shattered Lives : Getting the right help at the right time to women who are homeless or at risk . Available at :http//www.mungosbroadway.org.uk/documents Teixeira, J (2010) ‘Still left out? The rough sleepers ‘205’ initiative one year one.’: Crisis Available from www.crisis.org.uk (w/c 18,570) 53 November 2014 AN EVALUATION OF EXETER’S NO SECOND NIGHT OUT PROJECT 54