Five tips for working across services to support people who are homeless
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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.
Formal mechanisms for building relationships across services
Shadowing each other: ‘When you immerse yourself you start to really get a sense of it all. If you’re in the discharge team, shadow a housing team for a day, see how requests come in and how they prioritise. And people from housing, go into the wards to see the numbers and types of clients they’re dealing with.’ (Homelessness services manager)
Multi-disciplinary hospital teams: ‘We embed a housing worker in the discharge team to do that housing work and link with housing services.’ (Emergency care practitioner)
Co-location: ‘Co-located teams from different agencies have lots of daily contact. Being around each other helps us stay abreast of new developments and rules.’ (Housing support worker)
Multi-agency street outreach: ‘Having that two-hour walk around the city together gives us lots of time to share ideas and knowledge.’ (Clinical psychologist)
Shared training: ‘We identified issues we all need to understand: safeguarding, the Care Act, No Recourse to Public Funds.’ (Social work practitioner)
Multi-agency meetings: ‘We learn from each other about what’s available to support people. And we support each other to flex the system.' (Housing liaison officer)
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