Five tips for working across services to support people who are homeless

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Part of Health and care services for people sleeping rough

People who are experiencing homelessness often have multiple and overlapping health, care, social and housing needs. Addressing these needs requires effective joint working across the full range of relevant services, but a number of barriers exist that can make this challenging. These include differing priorities, constraints and terminology, and a lack of familiarity with how things work on ‘the other side’.

We spoke with staff working across services to support people who are homeless. Here, we set out some key lessons and practical tips that they shared on joint working.

1. Build personal relationships with key individuals

Informal relationships with staff in other services, who you know on a first-name basis and can contact directly, enable you to address issues quickly and work together with a foundation of trust, understanding and flexibility. Having a ‘go to’ person in other services can be invaluable. Interviewees shared the following tips about building these relationships.

  • Start small – exchange telephone numbers and make time to introduce yourselves.
  • Find reasons to spend time together. 
  • Identify common objectives and barriers, and ways you can help each other.

A common frustration is finding a link person. That’s largely to do with the amount of turnover in hospitals. One of the key things we share with housing is that nurses tend to stick around, so build a relationship with a ward sister or the senior nurse in A&E, find someone with ‘matron’ or ‘nurse practitioner’ in their title. (GP)

Relationships develop at the speed of trust. Create a shared vision and celebrate small wins. (Drug and alcohol treatment service manager)

Formal mechanisms for people to connect across services, such as those outlined below, can help sustain cross-service links even when individuals leave their roles. We also heard that regular cross-team reviews can help people explore differences and develop the way they work together. 

2. Get to know each other’s constraints and priorities

People working in different services work within different sets of constraints, which have an impact on what they are able to deliver. These can include the eligibility criteria for accessing their services and the priorities that their team is working towards. 

Investing time in understanding others’ constraints can shed light on how best to work with them, as well as the ways in which they are and aren’t able to flex their approach to meet service user needs. 

An acute health need isn’t always the same as an acute housing need. Those sorts of issues bring people into conflict. That’s why spending time working on relationships is so important: you can explain what seems incongruous or unfair. (Homelessness service manager)

A letter from a doctor won’t automatically open doors. There’s no point writing a letter about someone’s overall vulnerability. You have to show they are more vulnerable than the hypothetical average person would be if made homeless and what their clinical condition means for the harm they would face on the street. (GP)

3. Make it easy for people to work with you

Some organisations share simple resources that set out how to make referrals to their service, what their eligibility criteria are and the information they need, with simple process guides and contact details. Others recommended regularly sharing information and engaging other services early on, to draw on their expertise and give them time to prepare for referrals.  

Keep things simple – give people simple forms, don’t use jargon or assume people know what acronyms mean. (Nurse)

4. Create a directory of key local services

Having a directory of relevant services in your area enables you to quickly work out what support is available and how to access it. Carrying out this mapping exercise can itself be an opportunity to build relationships. Interviewees stressed the value of sharing the directory with others and the importance of keeping it up to date.

Key information to gather about each service in your area might include:

  • Contact information for key individuals
  • Services offered
  • Eligibility criteria
  • Which client groups they serve
  • How to make referrals to them
  • What information they need about service users

We developed a profile for each hostel. I went to each hostel and filled those out. We’ve given them to the discharge teams, the occupational therapists and the hostels. The hope is that when they’re discharging, they can flick through and see which placement will be appropriate. (Occupational therapist)

Hostels vary in terms of clientele, eligibility requirements and facilities. There’s lots of assumptions about the level of care that a hostel can provide. A discharging team might think ‘There’s staff 24 hours a day, therefore they can do things like medication’, but that isn’t the role of staff there. If people need that then they need a care package. (Housing support worker)

5. Language and acronyms

Terminology differs across services, which can often create a barrier to effective communication. Interviewees recommended keeping a ‘glossary’ of terms used in other services. We’ve provided a example glossary below with a few key terms used in health and housing services. We encourage you to adapt this to suit your own working relationships. Keep it up to date, because new terms often emerge and definitions can shift over time.

Don’t be afraid to ask what someone means. And watch out for cases where you’re using the same word to mean different things. (Clinical psychologist)

Housing sector terms 

Emergency and temporary accommodation

Emergency accommodation is provided by councils while they assess applications for homelessness support. Temporary accommodation is provided to people who qualify for longer-term housing but have not been given a final housing offer.

Homelessness 

People are homeless if they lack suitable and secure accommodation. This includes people sleeping rough, who sleep outside or somewhere not designed for accommodation.

The housing support that people are entitled to varies according to whether they meet various conditions: being legally homeless, meeting immigration conditions (also called ‘eligibility for assistance’), being in ‘priority need’, being homeless through no fault of their own (‘unintentionally homeless’) and having a ‘local connection’.

Hostel 

Non-permanent accommodation for people experiencing homelessness. Can be short-term or long-term stay. Hostels vary in terms of types of and levels of support offered.

Local connection 

A link to a local housing authority area, such as working or having family there. Councils can refer people without a local connection to councils where they do have one, unless they are at risk of domestic abuse or violence there.

No recourse to public funds (NRPF) 

People with no recourse to public funds are not entitled to a range of welfare benefits and housing support. Click here to see what counts as ‘public funds’.  

Priority need 

People in a priority need category are entitled to specific kinds of homelessness support. These include young people leaving care, 16- and 17-year olds, people who are pregnant, people assessed by the council as being vulnerable and people who have children living with them.

Health sector terms 

Duty to refer (DTR) 

Some health services have a legal duty to refer people who are, or are at risk of becoming, homeless to their local housing authority for support. This includes emergency departments, urgent treatment centres and inpatient wards. 

Delayed transfer of care (DTOC) 

A delayed transfer of care can occur when someone is medically fit for discharge (MFFD) but unable to be discharged for some other reason, for example due to accommodation issues.  

Stranded patient 

Patients staying in hospital for seven days or more. Those staying for 21 days or more are sometimes described as ‘super-stranded’. 

For more health and care terms, see the King’s Fund jargon buster.

Care Act Assessment Toolkit – Voices of Stoke
Guidance on completing Care Act assessments for people with multiple needs.

Creating Effective Partnerships – Homeless Link
Tools to support cross-agency joint working.

Mental Health Service Assessments – Pathway
Guidance on assessing mental health needs, accessing services, the Mental Health Act, Mental Capacity Act and raising adult safeguarding alerts.

Homeless Palliative Care Toolkit
Toolkit with sections on person-centred care and multi-agency working.

‘My rights to healthcare cards’ – Groundswell
Cards that support people to register with a GP practice.

Joining a network
Being part of a network can give you access to training, resources, meetings and opportunities to share learning. Examples include the Faculty for Homeless and Inclusion HealthQueen’s Nursing Institute Homeless Health Programme and the London Network of Nurses and Midwives

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