1. Introduction
Rough sleepers and the Multiple Exclusion Homeless people are at an increased risk of abuse, neglect and exploitation. ‘Multiple Exclusion Homelessness' is defined as people who have been homeless and have also experienced one or more of the following:
- institutional care, or
- substance misuse (drug problems, alcohol problems, abuse of solvents), or
- participation in street culture activities’ (begging, street drinking, ‘survival’, shoplifting or sex work')
2. Things that work: Assertive Engagement
Take every opportunity to meet or talk to the person.
Do not assume the person will keep to appointments. Their understanding of time might be different to yours.
Take refusal to meet or work with you at ‘face value’, try a different strategy.
Involve family and friends when appropriate, with the person's consent.
3. Things that work: Building Relationships
Get to know the whole person in the environment you see them in.
Removing strategies that they use to cope with their own situation may lead to broken relationships.
Plan and revisit the risk assessment around their lifestyle and environment, it will frequently change.
Agreed interventions should be personal to them.
4. Things that work: Professional Curiosity
Listen to their concerns.
Ask questions and repeat those questions using different phrases: ask ‘why’, ‘how’ and ‘what’.
Support them to agree on ways to reduce ‘Risk and ‘Harm’, and judge the level of intervention required.
Think ‘Family’ - consider their past history as this is important to them.
Roll with resistance - be creative and flexible.
5. Things that work: Mental Capacity
When assessing capacity, consider fluctuating capacity and executive functioning.
Capacity may change with factors influencing their lifestyle.
A large number of homeless people have mental disorders.
Substance misuse, adverse childhood experiences, brain injury and brain trauma may all impact decision making.
Focus on decisional and executive capacity.
6. Things that work: Multi Agency Working
Clear leadership and resources to support. Consider using the MARM (Multi Agency Risk Management) Framework to help communication between agencies.
Clear and agreed engagement with other agencies needs to be identified and actioned.
Integrated ‘wrap around care’ is essential.
Confidently challenge decisions you feel don’t support the person.
7. Things that don't work
Poor communications internally and across agencies.
Failure to follow policies and guidance on ‘Non engagement and Discharge’.
Failure to notice patterns in the person’s behaviour.
‘The problem is not the problem, it is the solution that is the problem’. Michael Preston Shoot - Poor communications internally and across agencies.