Specialist social workers are helping improve outcomes for homeless people but their role remains rare, often isolated and usually temporarily funded.
That was the message from a study launched this week that called for greater recognition and secure funding of the role.
The publication of the paper, by the National Institute for Health Research Policy Research Unit in Health and Social Care Workforce, follows the establishment a peer support network for practitioners working with homeless people.
The study was a follow-up to previous research into safeguarding responses to self-neglect by people experiencing homelessness.
Importance of social work for homeless people
A central finding of that research was the importance of having specialist social workers as part of outreach services for people experiencing multiple exclusion homelessness (MEH).
MEH refers to the intersection of homelessness – particularly street homelessness – with other forms of exclusion, such as substance use, mental illness, adverse childhood experiences and time spent in institutional care.
The latest study was based on interviews with 17 social workers who were working in specialist homelessness roles or had done so recently; were supervisors of specialist practitioners, or were in non-specialist roles that informally led on homelessness.
It also drew on interviews with three elected members or line managers responsible for homelessness services, with 17 of the 20 interviewees employed by councils, one by the NHS and two by third sector providers.
Author Jess Harris, a research fellow at the King’s College London-based unit, found that the specialist role involved therapeutic direct work with people, multi-agency co-ordination and statutory functions, under the Mental Capacity Act 2005 or Care Act 2014.
Opening the door to Care Act support
Interviewees reported that, prior to the role’s introduction, it was difficult to carry out Care Act needs assessments of people with MEH, with one saying that they were classified as “not engaging”.
“For those particular individuals it opened the doors … you were then able to do assessments at street level, say literally just sat on the pavement,” the social worker added.
Practitioners also highlighted the importance of identifying and addressing care and support needs in helping people maintain a tenancy.
Helping people maintain tenancies
The study found that this was helping prevent repeat referrals to services and people’s needs escalating to crisis point.
One social worker cited a man with learning difficulties who had been on and off the streets for 20 years and had been unable to keep a tenancy because he repeatedly fell victim to exploitation.
“This time round I moved him into sheltered accommodation [with a]… small package of six hours a week … He’s been in it four and a half years, no issues,” the practitioner said.
Specialist social workers also helped improve the appropriateness of safeguarding referrals regarding homeless people, by sharing knowledge with other practitioners and agencies.
Job satisfaction
As well as the role’s impact, the study found that it also brought significant job satisfaction for practitioners, who saw it as an opportunity to practise creatively, therapeutically and in a rights-based way.
“It’s about being flexible … meet people in fields, meet people anywhere … sometimes it’s going to take weeks to build
that trust,” said one practitioner.
Another mentioned taking a man who had been on the streets since he was 18 bowling as part of a Care Act assessment, and later stayed involved with his case “so that he could have someone…that cares about what happens”.
Reflecting this, participants highlighted legal literacy, a strong value base and tenacity as key attributes of specialist practitioners.
Role is rare and isolated
However, despite its impact, the study found that, nationally, the role was “rare and often isolated”. Practitioners reported lacking peer support which, in the context of the significant pressures the role entailed, led to burnout.
Social workers also said there was a lack of understanding of their responsibilities and practice approaches from adult social care colleagues, while third sector-employed specialists said they were sometimes left out of decision making.
Very few of the specialists were in permanent employment, with the rest in a mixture of secondments or positions reliant on temporary funding pots.
Lack of adult social care ownership
Ownership of the role varied widely, across council homelessness teams, complex care or mental health teams, NHS outreach teams or third sector provider services.
It appeared to be rare to secure long-term adult social care funding for the role, which participants said was a key concern.
Harris said the study findings indicated that the role needed “greater national recognition and training for the specialist knowledge and practice approaches required”.
Ring-fenced adult social care or pooled funding would be needed if it were to be rolled out across England, “to address inequalities in access to services for a profoundly socially excluded population,” she added.
Launch of network for specialist social workers
The publication of the paper follows the first meeting last month of a national peer network for social workers specialising in homelessness and rough sleeping, which is being supported by the NIHR unit.
The network was set up by Ellie Atkins, manager of the rough sleepers social work team at Manchester council.
She said its purpose was to “nationally galvanise the collective knowledge resources and skills of this area of social work to become a formidable force for impact and change, for people sleeping rough, to have better outcomes and better lives”.
Atkins added that the role was “the epitome of social work ethics and values”.
“People sleeping rough are some of the most severely disadvantaged, multi-excluded, traumatised citizens in our society. This is not a lifestyle choice.
“Social work has an integral role to level up the equity gap, advocate, challenge unconscious bias, use legal literacy and sow seeds of hope for change and promote dignity and self-worth.”
The research paper mentioned in this article is: Harris, J (2023) ‘Evidencing the social work role within responses to multiple exclusion homelessness’ NIHR Policy Research Unit in Health and Social Care Workforce
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Hello, the experience in Scotland, specifically Glasgow seems very different. Glasgow City Council over a decade ago withdrew social workers from front line contact with homeless people and families amalgamating homeless local authority housing casework services with social work services. Unqualified housing staff assess homeless referrals signposting vulnerable homeless people to qualified colleagues where appropriate but most often finding that mainstream professionals have lost specialist knowledge of this unique service user group. In any event statutory services are unable to respond as qualified staff are swamped by demand from the settled and permanent accommodated community in Glasgow.
Yesterday, 30th November 2023 Glasgow City Council followed Edinburgh declaring homelessness in the city a ‘crisis’.
separate and separated specialist services have empirically speaking, and since Cathy Come Home, and long before, always been seen as the most effective way to help; but are they? For example, the use of words in, say, teir 3 drug and alcohol modalities is called ‘structured day care’ a term coined at the Maudsley by Edward Griffiths, whose work with life threatening liver damaged patients used the treatment routines and structure as a form of therapy.
this continues today in Q3 and Q4, ie between the beginning of October and the end of March, within which vulnerable populations access to otherwise universal services are monitored more closely.
whether the presentation of problems are about social and personal inadequatacy or are structural deficiencies brought into sharp focus.
but here’s a more recent consideration ~ CANDI, an NHS Foundation Trust, had in the mid-noughties developed a dedicated team for such work; the number of inpatient admissions using the provisions of the mha went up. This was anticipated and CANDI had, then, both the physical bed spaces and staffing to do the work.
what’s less visible though is that the Supporting People allocation for direct work within these populations amounted to about a sixth of the total allocated spend ~ the rest and like tens of millions went towards CANDI having a sufficiency robust operating surplus needed for Foundation Trust status.
this isn’t odd though as since Cathy Come Home ‘the homeless’ have been treated as homogenous, and the means by which to a cool million or so. the generalised assumptions of personal inadequacy as being root cause facilitates and encourages cherry picking ~ and on a scale that’s so normal that one would have to be the ‘right kind of homeless’ to get help.
in this environment separate and separated specialist services flourish ~ it’s not new and goes back a while capturing the attention of researchers as happened within the early Detox Centres, and the discourse on symbolic interactionism of Peter Archard in his work The Mad, Sad or Bad: Societies Confused Response to Homelessness.
today though requires that a leap forward, as is made in the doctoral work of Josh Burraway titled ‘Intoxicating Ethics’ circa 2016 (josh had given me an early draft of his work so the publication date of his PhD will come later).
there aren’t many voluntary organisations, nor indeed NHS Foundation Trusts, that haven’t gained financially from their own advocacy for the population(s) of people comprising ‘the homeless’.
They are homogenised cash cows.
I would urge anyone genuinely interested in taking this initiative forward to speak directly with Josh ~ I think at UCL but am not entirely sure. His contribution is as brave as it is challenging ~ it does though refreshly reframe the issues.
Also see the work done, as part of the early Quality Protects initiatives of the, late, Frank Dobson, then SofS for Health in 1997. Frank, then MP for St Pancras North had previously in January 1987, sponsored a Parliamentary Lobby by 111 London homeless comprising rough sleepers, and those in B&Bs, and travellers were represented by Leo McGir. Neither Chris Holmes, of then CHAR nor, the now late and great, Sheila McKechnie supported the Lobby. It was the UN International Year of for the Homeless and also the year of the ‘Big Freeze’ as temperatures didn’t rise above 3-5 degrees in the daytime and plummeted to minus 11 at night.
The very early Quality Protects Projects highlighted the significance of what was called ‘conviviality’ or it’s absence as a societal root cause ~ outcasts must be outcasted and championed ‘estate based’ work resulting in such things as ‘2nd Chance Schools’ a, then, EU initiative tackling intergenerational deprivation at the geographical level of where people lived before becoming homeless and heading-it-off. David Blunkett was, then, SofS for Education and George Mudie MP, Minister for Youth ~ they both put the money where it was very much needed and crucially brought Ministerial power to those directly impacted as their constituents.
Is this an illustration of Buurtzorg?