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CHAPTER FOUR: ACCOMMODATION AND SUPPORT SERVICES

INTRODUCTION

4.1 We have now explored the circumstances and support needs of intentionally homeless households and concluded that these are similar to those of homeless households more generally. Key problems that emerged for intentionally homeless households related to deficits in assessment of their support needs and to a lack of pro-active and comprehensive homelessness prevention. In this chapter we review aspects of the current accommodation and support arrangements for intentionally homeless and other homeless people. Key themes covered will include models of provision, patterns of access, and service users' experience of services.

4.2 The research findings are presented under 3 main themes:

1. Accommodation provision that promotes routes out of homelessness - temporary accommodation, transitional, often supported, services, permanent/longer-term accommodation
2. Support to resettle following homelessness which may be linked with, or interconnected with, particular types of accommodation provision
3. The role of partnerships and joint work in addressing homelessness, with particular reference to households with multiple and/or complex needs.

4.3 Joint working and prevention are viewed as cross-cutting themes that are relevant to all services, as is the importance of service user involvement.

CLASSIFICATION OF ACCOMMODATION TYPES

4.4 Below we identify firstly, accommodation models identified in this and previous research (see, for example, Fitzpatrick, 2001, Edgar et al 1999), before going on to consider provision used across Scotland.

Crisis/ temporary accommodation

4.5 Crisis/temporary accommodation is generally interpreted as accommodation to meet the needs of homeless people. It includes:

Mainstream dispersed housing: This is generally furnished and provided either from a within the local authority stock or by other social housing providers allocated to homeless applicants on a temporary basis. Such accommodation is likely to be used to provide short SSTs where these are required for intentionally homeless households. At present it is used to accommodate both unintentionally homeless households as well as intentionally homeless households, with access through the homelessness service.

Self contained furnished accommodation in a complex or block of flats: These are generally staffed either by wardens and/or support staff. They are increasingly being used to accommodate homeless households as a preferred option to hostels as they provide greater privacy and seek to maximise tenants' rights. Such accommodation could be used as short SSTs.

Hostels: These are provided by local authorities, RSLs or the voluntary sector to accommodate homeless people (again both unintentional and intentional) either on a temporary or longer term basis. ¹¹ Hostel provision is generally viewed as a likely model of section 7 provision, owing to the fact that it does not confer tenancy rights. Access is generally through being assessed as homeless, regardless of priority need status or intentionality decision. Some hostels however do offer direct access, on a first come first served basis.

Bed and Breakfast (B&B): These are usually private sector establishments and the sector is known to vary notably in its standards. B&B would meet the criteria for use as section 7 accommodation provided that if there are children or a pregnant woman in the household, it meets the requirement of The Homeless Persons (Unsuitable Temporary Accommodation) (Scotland) Order (Scottish statutory instrument 2004). These require a speedy move on from B&B accommodation for households with children and those containing pregnant women. B&B may similarly be used regardless of priority need status and assessed intentionality.

Supported accommodation

4.6 Supported accommodation provides accommodation and support services. Some supported accommodation services are targeted at specific groups of homeless people, or those at risk of homelessness, such as vulnerable young people. More generally however, supported accommodation is targeted at a wide range of people with particular support needs, such as older people, people with mental health problems or with addictions for example. Such provision may accommodate homeless households in the short, medium or long term, regardless of any assessment of intentionality. Homeless people may access such accommodation either though the homelessness route or via other means, such as social work assessment, depending on services' access criteria.

Transitional supported accommodation: Supported accommodation is 'transitional' where its explicit aim is to help people move on from the circumstances associated with their homelessness, towards a more positive life stage and social and economic integration. As with hostels, there is a trend of increasing specialisation, with major expansion in the provision of specialist supported accommodation over the past 20 years, either provided by local authorities themselves or in partnership (Anderson & Tulloch, 2000, ODPM 2003). (See paras 4.52 to 4.108 for a more detailed discussion of support services).

Other forms of transitional supported accommodation include:

Supported tenancies: This may involve the provision of accommodation and support by the same provider, or by an accommodation provider in partnership with a support provider. Support is tied to residence. This model developed from the early phases of institutional reprovisioning and resettlement programmes (for example, learning disability, mental health).

Cluster flats/houses: This latter model is sometimes referred to as a core (unit) and cluster service. They offer the opportunity for transitional accommodation and support within mainstream community settings, usually for client groups with particular needs.

Longer-term and settled accommodation

4.7 There are 2 longer-term supported options - longer-term supported accommodation and independent tenancies with support.

Longer-term supported accommodation: Most homeless households need only decent, safe housing, suitably located, with perhaps some initial support to get settled. Others however may have longer term support needs. Needs may vary both in intensity and in duration, and will impact on the type of accommodation desired or assessed as suitable. Health issues may also define the most suitable accommodation and support option. Some people will have an ongoing need for long term accommodation with support. Examples of models that may play a role for those for whom independent living is not a viable option and who may have intensive needs, include small specialist hostels, residential care and nursing homes (Quilgars 2000, Petch et al 2000, Crane 1999 and ODPM 2003).

Independent tenancies with specialist floating support: In terms of the changing balance of provision, this model has risen in significance alongside the impact of institutional closures and contractions, community-based criminal justice strategies and the associated rise in targeted funding, such as Homelessness Strategies monies, Supporting People funding and Mental Health monies. The model aims to enable people with particular support needs, for example for specialist mental health services, to live independently in the community.

Specialist supported accommodation for homeless people: Various supported accommodation models have been developed to meet the particular needs of some homeless people, usually in response to the identification of unmet need. Examples include dedicated provision for rough sleepers and people with alcohol problems. It can be either transitional or longer term accommodation. Such provision is accessible to homeless people both through the homeless service and other service routes, regardless of assessed intentionality.

USE OF PARTICULAR MODELS OF ACCOMMODATION

4.8 Below we report on models of temporary accommodation identified Scotland wide, based on the survey returns from 31 of the 32 Scottish local authorities.

Crisis and Temporary accommodation

4.9 The Survey found that the most common temporary accommodation resources used were:

• local authority owned temporary accommodation was used by 30 Scottish local authority respondents
• B&B was used by 28 respondent authorities. Most noted that B&B is used only as a last resort for families, whose length of stay is kept as short as possible
• hostels were used by 25 respondent authorities.

4.10 Other accommodation types or models used by those local authorities that reported such provision in their area included: housing associations' self contained temporary furnished accommodation (19 authorities); private sector dwellings (16); other local authority dwellings (14) and voluntary sector non hostel accommodation (14).

4.11 Also identified were: Women's Aid scatter flats/refuge accommodation, shared accommodation for people with mental health problems and learning disabilities, and accommodation for rough sleepers.

Targeted provision for particular client groups

4.12 The survey sought to clarify the types and extent of accommodation provision (and related gaps) for homeless people with particular and complex/ multiple needs, including people with drug and/or alcohol issues and those with a history of anti social behaviour. Local authorities were asked whether they provided any dedicated accommodation resources for specified client groups directly, and if so, to specify the type of provision ( i.e. hostel, supported tenancy, independent tenancy with floating support or core and cluster). Additionally, they were asked to identify such targeted accommodation resources provided by other agencies.

Use of hostels

4.13 The survey identified a limited stock of mainly small-scale hostels (under 25 places) that were targeted by local authorities to meet particular needs. ¹² This reflects a more general trend of reductions in hostel size, as demonstrated by the ongoing hostel contraction programme in Glasgow. Additionally, the overall total of 100 hostels identified by this survey points to a significant reduction in the number of hostels in Scotland, compared with the 126 hostels that had been identified in 2000 (Ann Rosengard Associates with Scottish Health Feedback, 2001). It should be noted however that this reduction may in part be due to some reclassification of provision.

4.14 Where hostel provision was identified as meeting particular needs, this related primarily to young people and women who experience domestic abuse, as shown in Chart 4.1 below. These findings reflect those of earlier research (Kennedy and Lynch, 2001).

Chart 4.1 Small scale hostels provided by local authorities, by client group

Hostel provision by client group

Note: the client group "more than one group" includes those who may have multiple and/or complex needs.

Use of supported tenancies

4.15 The survey identified limited use of local authority provided supported tenancies to meet particular needs. The most common client group targeted in this accommodation type was people with mental health problems followed by young people, as shown in Chart 4.2 below.

Chart 4.2 Supported tenancies provided by local authorities, by client group

Supported tenancies by client group

*The other service recorded in the table was one for high risk offenders.

4.16 The survey also sought to gather information on the extent to which the model of independent accommodation with floating support is used in different local authority areas. In the event, little information was supplied, perhaps because this information is not systematically collected or held by homelessness services.

4.17 In relation to the survey responses on accommodation provided by other agencies to meet particular needs, the most significant target client group was women who have experienced domestic violence. Twenty nine authorities reported they used such provision, with the remaining 2 respondents saying that they were developing such provision. However, no clear model of service delivery was identified, since accommodation and related support models included refuge provision and mainstream accommodation with specialist support. The second most significant group for whom there was targeted provision was young people.

4.18 Few authorities reported that they used targeted provision for people with problematic alcohol or drug use, or for those with a history of anti social behaviour, as shown in Table 4.1 below.

Table 4.1 The number of local authorities with targeted provision by client groups

Gaps in accommodation services

4.19 The most commonly mentioned accommodation related gap identified was the lack of sufficient temporary furnished accommodation and permanent move on accommodation to meet demand. This was particularly evident for rural areas. Gaps were also noted in services to meet particular client group needs, with 9 of the respondent authorities highlighting gaps in accommodation related services for those with addictions, and 8 respondents highlighting gaps in such services for people with multiple/complex needs.

4.20 Other gaps identified included:

• emergency respite for young people
• a highly supported unit (24 hour cover) for young people including care leavers
• short stay /respite accommodation staffed on a 24 hour basis for people with mental health problems/in crisis
• direct access accommodation and accommodation for particularly chaotic applicants - those with challenging behaviour - people who are very difficult to place and very difficult to support. One interviewee commented, "generally support services are not experienced in dealing with people in these circumstances"
• supported lodgings for a variety of groups
• accommodation for women, including for women experiencing domestic violence and those who have alcohol problems
• accommodation for people with mental health problems (4 authorities in the survey) while health interviewees in the case studies identified the need for short term mental health crisis accommodation and transitional accommodation for people with serious mental health problems
• drug and alcohol services, such as an addiction service for young people; a residential rehabilitation unit for chaotic drug users and services for people with problems of alcohol misuse. In one case study authority, staff stressed the need for, "24-hour support or tapping in on a day to day basis"
• specialist accommodation to meet chaotic/complex needs of some families.

4.21 These findings reflect conclusions of other research such as a Shelter Report (October 2004 p.7) which states:

"There is striking consensus that more supported accommodation is needed, with 26 out of the 34 regarding it as "crucial". 20 (respondents) also saw more self-contained accommodation ( e.g. furnished flats) as crucial. The consensus around more supported accommodation is consistent with the reported problems people face getting access to temporary accommodation because of past conduct: their behaviour might pose challenges to service providers. It is also consistent with the view that the biggest barrier to meeting the temporary accommodation needs of homeless people is lack of suitable accommodation".

4.22 Overall, the responses indicated that:

• Local authorities themselves provide little by way of targeted accommodation resources for client groups whose accommodation and support needs were a particular research focus
• While many local authorities are working in partnership to provide services for such client groups it is likely that the extent to which other providers such as the voluntary sector and RSLs meet the needs of these client groups has been under reported. This may have been because such services are not classified specifically as resources for homeless people. Examples of services provided in partnership are given in the section on joint working below
• Beyond the need for an increased supply of temporary and permanent move on accommodation in the social rented sector, critical deficits were identified in accommodation and support services for people with particular needs (including alcohol or drug issues) as well as for people with complex and multiple needs
• No discernable patterns emerged in respect of the models of accommodation and related support used to meet the needs of particular client groups.

Temporary accommodation in the case study areas

4.23 Having focused on the national picture, we shall now explore patterns in the case study areas. First it is clear that all 4 case study areas provide a range of types of temporary accommodation, including hostels and non hostel accommodation. (Further information on the temporary accommodation in the case study areas is shown in Appendix Three). Affirming the pro-forma findings, none of the case study areas designated any temporary accommodation specifically for intentionally homeless households.

4.24 The range, type and numbers of crisis/ temporary accommodation on offer in the case study areas varied significantly. Unsurprisingly, the urban case study area (B) has the largest stock, both in terms of the number and range of provision, as illustrated below. (See Appendix Three for further information on accommodation available in the case study areas).

Area C, a rural area with 8 administrative areas provides a mix of hostels, B&Bs, supported accommodation, 'group' homes, refuges and temporary furnished flats sourced from within their own stock, from RSLs and the private sector. Some of the temporary accommodation is restricted to particular client groups, such as single people, women, men or young people. Temporary furnished accommodation in the mainstream stock is concentrated in 2 of the 8 administrative areas (50 and 27 units respectively).

By contrast in a city Authority area (area B) a very wide range of temporary accommodation is on offer, including: 490 local authority provided furnished flats, mainly for households with children and 18 RSL provided flats. Additionally, targeted specialist provision includes:
- A block of 30 self-contained Council flats with 24-hour staff for very vulnerable and/or chaotic households (occasionally including households with children) and a further 6 supported accommodation units with the management and support service contracted out to external providers for vulnerable people with various support needs
- Two local authority hostels used for single people and couples with various needs
- Six voluntary sector direct access hostels - 2 of which offer single gender accommodation, used for people with varying needs
- Two voluntary sector hostels for women and women with children
- One private development leased by the local authority
- Bed and breakfast accommodation (220 places of which 90 are supported) restricted to single people and couples, but very occasionally used for households with children.

4.25 In all the case study areas local authorities have striven to increase the stock, range and quality of accommodation available to homeless households. All now have rent deposit schemes, for example, provided in partnership with voluntary agencies to enable homeless priority and non-priority households to access private rented sector housing. In Area A, a Rent Deposit Scheme rehoused 43 households into private sector tenancies in 2004 and has proved very popular. Plans are underway to develop a private sector leasing scheme for use as additional temporary accommodation, as has been progressed in other areas. A voluntary sector interviewee commented on how this has benefited women in the area.

"The council is pretty good with women generally. A number of women have had decent housing from the rent deposit scheme. Because of the non-availability of certain areas or people's aspirations, they have gone to the private sector for suitable housing. Tenancy support has also been offered."

4.26 Overall, in terms of the balance of provision, the emerging picture is one of an expanding range of service models, alongside a movement towards an increasing separation of accommodation and support services, an increase in the supply of temporary furnished flats and the development of floating support services.

Intentionally homeless households' access to emergency/ temporary accommodation

4.27 The pro-forma exercise illuminated accommodation and support outcomes further. It showed that although most applicants (58 of the 98) gained access to temporary accommodation as a result of their homeless application ¹³, almost one third (32 households) did not obtain such accommodation, for reasons of choice or refusal, or because they were not yet homeless.

4.28 Some service users who were interviewed confirmed the role of choice: they had sought other accommodation options, such as staying 'care of' or renting privately, rather than take up an offer of temporary accommodation by the local authority. Only in one case of a repeat application, did the pro-forma returns indicate that there was no temporary accommodation secured due to a lack of available options.

"The applicant has been provided with numerous accommodation options over a number of years. These include 3 private lets, 2 placements in supported interim accommodation, a supported dispersed temporary, and placements in B&B and hotels, totalling 26 days. On each occasion, he was either asked to leave because of ASB, has been arrested and incarcerated or has abandoned the accommodation. The applicant has exhausted available options. Providers are unwilling to accommodate."

Types of temporary accommodation secured

4.29 The types of temporary accommodation secured following the homelessness presentation were noted for 66% of households covered by the pro-formas. Overall, this confirmed local authorities' continuing reliance on B&B as emergency/ initial temporary accommodation, as illustrated by the local authority survey.

• B&B was provided for 17 households, 6 of which had children. Two of the 6 families moved on to other temporary accommodation in the 3 month period, including a furnished flat and an accommodation unit.
• Accommodation unit or hostel places were provided for 15 applicants, more than half of whom had children (8), so confirming that both families with children and single person households are placed in hostel-type provision.
• Temporary furnished flats were provided for 14 applicants with children. It should be noted that only one of these households would have been likely to be entitled to section 7 accommodation only when the 2003 Act is enforced.

4.30 Other types of temporary accommodation noted as being used for the immediate placement of homeless applicants, were an accommodation unit or hostel managed by an RSL (one case) and a House in Multiple Occupation (one case).

Lengths of stay in temporary accommodation

4.31 Variations emerged in terms of intentionally homeless applicants' length of stay in temporary accommodation. The pro-forma exercise indicated general patterns, while the case studies indicated the influence of procedures, processes (including discretion) and the availability of accommodation, on length of stay outcomes.

4.32 Information on applicants' length of stay in temporary accommodation was only provided in 29 pro-forma applicant cases, with this varying from 10 days to six weeks. Three of the 29 households were still in the temporary accommodation when the pro-forma was returned, illustrating the limitations of the 3 month pilot period on examining longer term outcomes. For the service users interviewed, it appeared that lengths of stay in temporary accommodation varied even more sharply, with some households having been in temporary accommodation for more than a year, and particularly those staying in 'care of' arrangements.

4.33 In the case study areas, local authorities' procedural frameworks varied in terms of time-limits applied and the scope for staff discretion and flexible responses. Therefore overall, local policies and practices appear to interact with resource capacity to influence intentionally homeless households lengths of stay in temporary accommodation.

4.34 Specifically, 2 of the 4 authorities (an urban and urban-rural) only offered intentionally homeless households temporary accommodation for up to 28 days. In the urban authority staff reported that the 28-day time limit is treated as a minimum period for assessment, the decision on homelessness, and for discharging the relevant duty by providing advice and information. After this 28 days notice is given to leave, so in fact the process may take up to 2 months overall. Additionally, staff stressed that there is further flexibility, quoting the example that if a household is waiting to obtain a deposit on a flat, case officers may extend the period further. It was reported that some homeless people have been allowed to remain in temporary accommodation for up to 6 months to enable them to seek follow on accommodation. In the other area, the time limit appeared to be treated more exactly.

4.35 By contrast, in the other 2 areas there is even more scope for discretion and flexibility. In a rural area there was no set period of stay, although housing staff commented that intentionally homeless households are likely to stay longer in temporary accommodation than others. In the fourth area, these households similarly appear to have lengthy stays in temporary accommodation, but this can lead to permanent housing, as the authority frequently offers short SSTs with support to intentionally homeless households.

Views on models of temporary accommodation

4.36 Professionals interviewed felt that there is no ideal model of temporary accommodation given the diversity of needs amongst intentionally homeless households, just as is the case for the homeless population more generally. Instead, professional interviewees stressed that the full range of temporary accommodation on offer is potentially available to such households. Access to specific types of provision is influenced by household composition; by particular needs; by the intensity of needs, and to a significant extent, by the availability of accommodation. Professionals further stressed that where support was needed, the appropriateness and quality of the support on offer was more important than the specific type of accommodation. Such findings correspond with those of an earlier study considering models of intermediate accommodation ¹⁴ which concluded that:

"Given the extent to which the needs of many homeless people are seen to be complex and inter-related, the value of making an assessment on the role played by a model of accommodation in isolation of the broader context of a homeless person's additional needs is arguably limited" (Kennedy and Lynch, 2001 p47).

4.37 Divergent views emerged on the appropriateness of different accommodation models from the perspectives of service user and professionals. There was a consistent perspective on standards however, namely that temporary accommodation varies significantly in quality in terms of internal facilities, location and environment and the supervision and support on offer. This applied both within and across local authority areas and it cut across accommodation models.

4.38 The intentionally homeless households interviewed raised the following issues:

• offers of temporary accommodation had been turned down in some instances because the location would have disconnected them from established supports, community facilities and schools
• a lack of play facilities required families to go out of the premises more than they would have chosen
• having to share facilities caused problems for some households
• some households appeared to have split up when going into temporary accommodation, and some parents' chose to have their children looked after by relatives, rather than take them to the temporary accommodation offered
• one interviewee stated that he could not afford to stay in a hostel because of his reduced income.

Comment made by service users and staff in relation to particular models are covered below. These indicate considerable common ground as well as some divergences of opinion.

Hostel/accommodation unit accommodation

4.39 Service users were somewhat ambivalent on hostels. Some were happy with the quality of the accommodation and the human environment. One said, "I get on really well with the residents and staff" and another commented that compared with B&B, "the hostels were quite good and I liked the support". Others however, criticised the lack of amenity, the downsides of shared living arrangements and the stresses that resulted from the social mix:

"It's alright, I feel safe. The facilities are Ok…kept clean and tidy and the staff are great."

"It's ok to be in here, they treat you with respect. They only let the goody goody ones in here."

"The workers are great…they try to help you. They let the children use the staff-room to study in until we moved.

"My partner sees his kids at his ex-partners house but it costs him £20 in fares to take them out and back home again and he's on benefit. He can't have the kids to visit in here."

"I don't smoke so I can't sit in the TV lounge, there should be smoke free areas. There's not many people my age, mostly younger".

4.40 Staff were also ambivalent about hostel type accommodation and stressed its tendency to promote institutionalisation and dependence. Comments on such institutional tendencies included: "there's no pressure, it's all done for you" and " children don't learn about boundaries".

4.41 Some staff felt that a minority of people liked communal living with one housing officer for example commenting that "section 7 accommodation may suit some people".

"They're institutionalised and don't want a tenancy. The hostel is like a community, with breakfast in the morning."

4.42 Both service users and staff questioned the suitability of accommodation units or hostels for vulnerable homeless households, and particularly because of the mix of needs that these accommodate:

"Families tend to get the furnished flats with single people getting accommodated in the accommodation unit. There seems to be little recognition that single people can be as vulnerable (there) as families."

"Households accommodated in the accommodation unit generally have higher support needs than those who get temporary furnished flats. Stays can be up to 2 years before households can then move onto accommodation with support. However, there can be problems in the unit because of the mix of households with different needs. Some people might for example be using drugs, while others are trying to come off. There are also problems with sharing facilities such as some people leaving kitchens in a mess."

Bed & Breakfast

4.43 Staff were generally committed to minimising the use of B&B and some referred to targets to phase out its use. Problems highlighted reflected those identified through studies of temporary accommodation and by various local authorities' Homelessness Assessment reports:

• conditions are cramped for families
• cooking facilities are restricted ( e.g. microwave ovens in the rooms) or shared by people with varying standards of cleanliness
• limited facilities tend to increase the costs and limit the nutritional value of food
• water for babies bottles may have to be taken from a bathroom tap
• children lack play facilities and there is pressure to go out during the day.

4.44 By contrast, service users' views indicated some ambivalence. Many service users raised the issue of poor standards, and one said: "The B&B, paid for by the council, was dirty". However, some were positively disposed towards B&B where this was well-managed.

"My landlord was the greatest help…he understood what we were going through…he gave advice about jobs, he provided everything but food."

Temporary furnished flats

4.45 Critical comment by service users related to poor maintenance standards, location and threatening internal or external environments.

"It's costing a fortune in bus fares to get my son to school (there is no help given with this)."

"It's okay although some things aren't working in the flat."

"We hate it…the kids are terrified. Its in a big block of flats and there are people outside drinking etc. It's a daunting place to be. The inside is okay but basic."

Others however felt very positive about their temporary accommodation:

"I'd recommend the accommodation to anyone. There is plenty of space and (child) can play in the garden."

"I like it very much as it has a back and front garden. I would like to stay there in the long term as my children are settled there now but I have been told this will not happen."

Short SSTs

4.46 Three service user interviewees were accommodated in short SSTs at the time of interview - one household who had had their intentionality decision overturned and 2 who had not. Satisfaction with such accommodation appeared to be largely related to the location. One interviewee said:

"The house is good but the area is poor…it's all junkies and not good for the kids."

One interviewee's dissatisfaction was related to their uncertainty about their future housing prospects and the fact that neighbours know that the house was allocated as "a homeless house".

Longer term accommodation outcomes highlighted through the research

4.47 Information on longer-term accommodation (final) outcomes is partial. According to Scottish Executive statistics (2003-04) accommodation outcomes were unknown for a significant minority of cases (44%). The pro-forma analysis similarly highlighted lack of knowledge of rehousing outcomes following discharge of duty or case closure. While 'outcome unknown' was recorded for 16 cases only, this section was left blank in 20 cases.

Overall, the research found that intentionality assessment in itself is no clear indicator of particular longer term housing outcomes as shown in Chart 4.3 below.

Chart 4.3 Rehousing outcomes following discharge of duty - the pro-forma analysis

Rehousing outcomes following discharge of duty

4.48 In one case study area (A) the majority of service user interviewees had been offered a short SST or were awaiting such an offer.

4.49 In other case study areas, some intentionally homeless households had been allocated permanent accommodation in the social rented sector, through the waiting list. This reflects good practice identified in the Code of Guidance on Homelessness (Scottish Executive, 2005b) that,

"Local authorities and Registered Social Landlords have a duty under section 20 of the 1987 Act to give reasonable preference in the selection of their tenants to people assessed as being homeless. It should be noted that this reasonable preference extends to all those who are assessed as homeless, regardless of the outcome of further assessment into priority need or intentionality. Homeless people should always be included in local authorities' mainstream allocation system as from the date of their application, rather than at a later date.

4.50 Some interviewees had found private rented accommodation through rent deposit schemes. Some had been assisted to resolve longer-term accommodation through advocacy which led to a revised homelessness assessment, and so improved their options. Other interviewees however, remained in temporary accommodation with little indication of what would happen to them next or of how long they were likely to remain there.

4.51 Both the case studies and the survey findings indicated that even when appropriate advice and resettlement assistance is available, it can be extremely difficult to obtain good quality accommodation. Moreover, where appropriate accommodation is obtained, there can be problems in sustaining this - so realerting us to the role for support and preventing repeat homelessness after rehousing.

"It's got a back and front garden and we got a shower put in. There are a lot of bought houses round about. The only bad things are that the neighbours complain about the wee laddie and the council tell Social Work about the complaints before they tell us."

SUPPORT SERVICE MODELS

Support models and patterns of provision

4.52 Having considered the role of particular types of accommodation in responding to homelessness in general and intentionally homeless households in particular, we now focus in on models and patterns of support provision, as a basis for considering good practice. We then consider the extent to which intentionally homeless households have been provided with support, the extent to which support is provided through joint work and partnerships, particularly to address multiple and/or complex needs, and finally we consider aspects of non-engagement with support.

4.53 Support may be classified in different ways. One criterion would be the role of support in relation to stages in homelessness: emergency/ crisis response; while resident in temporary accommodation; moving on/ resettlement; follow on/ medium-term and longer-term. A second is to classify support according to its methodology - for example, approach, delivery method and location. In addressing support services the local authority survey classified support by its methodology, focusing on support tied to particular accommodation; floating support and a mixture of these types. Before discussing the research findings we define these terms.

1 On site support tied to particular types of accommodation

4.54 In this model people live in accommodation within which there may be varying levels of support to address residents' general or particular needs. Support may involve 24 hour support and supervision and/or key worker support for agreed time periods. Overall this model includes "short and medium stay supported housing services, which are designed to resettle homeless households into independent housing, including direct access services, hostel services, transitional housing and supported lodgings services" ( ODPM 2003).

2 Floating support

4.55 Floating support responds to individual or household needs that may fluctuate in scope or intensity, rather than being tied to, or a condition of, occupancy. Forms of floating support, may include resettlement support, tenancy sustainment and stand alone support services ( ODPM, 2003). The term floating support is used here to describe services that employ support workers to travel to where clients are to provide support, whether to their accommodation, or through outreach work at locations to help people resettle from rough sleeping, for example.

4.56 Floating support originated in resettlement support services in the 1970s that were targeted to respond to the needs of people sleeping rough, hostel dwellers and formerly homeless people, regardless of the 'route out' of homelessness followed (Douglas et al, 1998). In the homelessness context it may be practical, time-limited and resettlement-focused and it may be provided either by housing, social work or voluntary agencies. It may be generalist (housing support teams) or specialist ( e.g. targeting people sleeping rough, or people with health problems or addictions). Additionally it may vary in intensity in accordance with needs. Most recently the model of floating support has characterised housing-related support with a longer-term orientation and a tenancy sustainability/ preventative focus, and this has increasingly been funded through Supporting People ( ODPM, 2003).

3 A mix of on site support and floating support services

4.57 Local authorities and other housing providers are increasingly using combinations of floating support and supported housing services. Apart from on-site support teams in hostels and supported accommodation services, there are outreach support services working within hostels that are generalist and resettlement focused, advising and assisting people to move on or to tackle benefits issues; or they may be specialist services that target particular needs, such as addictions, mental health or the needs of homeless women or young people.

4.58 The survey found that 'on site support only' was most prevalent in hostels (29% of those identified in the survey). This was less evident in non hostel types of provision, with only 8 instances reported in this category.

4.59 Floating support, on the other hand was the most commonly provided support to homeless households staying in non hostel provision. Floating support constituted 87% of the services identified for B&B residents; 82% of the support services targeted to meet the needs of homeless people staying in private sector dwellings and 68% of services for people staying in self contained furnished accommodation.

4.60 The case studies further illustrated the rise of the floating support model in responding to homelessness in the 4 local authority areas with all the case study areas employing tenancy support teams or neighbour support teams.

The funding of support services

4.61 While the survey data on support related funding was partial ¹⁵, the case studies and the survey jointly identified that a variety of funding sources play a role in relation to different types of provision, that Supporting People grant has become a key funding source for supporting homeless people since 2003, and that mixed funding packages often prevailed.

4.62 Chart 4.4 below shows that, on the basis of the information supplied, hostel provision was more dependent on Supporting People funding only, than for non hostel temporary accommodation.

Chart 4.4 Source of support funding in hostel accommodation

Source of support funding in hostels

Other funding sources identified included:

• Social Work and Health funding
• Social Work funding
• Local authority's general funds
• 'Top up' funding by the voluntary service provider, housing benefit and the service user
• Supporting People grant as well as s10 funding and housing benefit (voluntary sector hostel)
• Hostel Support Grant and RSI funding were both used in some instances.

4.63 In contrast with hostels, the information supplied suggested that support in non hostel accommodation was less likely to be fully funded by Supporting People grant as shown in Chart 4.5 below.

Chart 4.5 Support funding in non hostel provision

Support funding in non hostel accommodation

4.64 Where Supporting People did not fund services in full for non hostel temporary accommodation a number of other sources were used to supplement revenue. While not all respondent authorities supplied information on other funding sources, those that did identified the following sources:

• homeless strategy/grant monies (9 authorities)
• mainstream or general services funds (4 authorities)
• a mixed package of Housing Revenue Account, Rough Sleepers Initiative ( RSI) funding and Children Change Fund (one authority)
• top up funding from client group specific sources such as Mental Health Specific Grant ( MHSG) (one authority)
• other funding sources mentioned included Health, RSI, Social and Health Care.

It should be noted that Appendix Five contains information and comment on indicative costs.

The support on offer in the case study areas

4.65 As with the temporary accommodation options, none of the 4 case study areas used any form of dedicated support service for intentionally homeless households; nor did any local authority suggest that this would address their needs better. The professionals interviewed stressed that the support offered would and should depend on the particular needs of the household and on the support options available in the area. This confirms the findings of earlier research in Scotland (Kennedy and Lynch, 2001). Overall, the range and number of support services on offer varied across the case study areas, with the city authority (B) again having the widest range of services.

Tenancy support

4.66 All case study areas had floating support / tenancy support teams of varying size and remits. The teams in turn varied in scope in terms of the range/coverage of temporary accommodation/ locations and the diversity of their clientele. These and other variables influenced whether or not intentionally homeless households might be excluded from access to such support, as shown in the case study examples below.

Intentionally homeless households' access to floating support / tenancy support services
Only one case study local authority (A), routinely offered support to all homeless households, including those assessed as intentionally homeless, regardless of where the household was currently living, through its tenancy support team.

Another local authority (D), provided tenancy support as a matter of course where applicants were placed in temporary accommodation by the local authority, but not where they had secured their own accommodation, such as households staying 'care of'.

A third local authority (C) offered support to intentionally homeless households as considered appropriate, following an assessment.

In the fourth case study area (B) however, service user interviewees reported that support was not provided to such households as a matter of course, although they may have accessed such services through other routes, such as social work assessments.

4.67 The case studies indicated that access to support for both intentionally homeless and unintentionally homeless households, just as with access to accommodation, reflects policy, practice and funding differences, which jointly and variably influence local patterns of rationing access to support. For example, case study areas A and D are both rural/urban areas with housing support services. Area D had more than 3 times as many households assessed as priority homeless than had area A in 2003-04 (1,163 compared to 349 (Scottish Executive Statistical Bulletin, 2005). The size of housing support teams did not vary in proportion to the potential need identified, with area A having a larger number of support workers than area D. Although the reasons for such differences are unclear, relevant influences may include strategic choices, the local supply of support services and funding opportunities.

4.68 Support teams appeared to have variable access to the particular specialist services that service users required. In area A, the senior support workers link directly into local addictions services, Community Mental Health Teams, and the hostels. The ability of the area A support team to draw on such specialist skills when required was seen by staff as a success factor. By contrast, problematic delays in accessing particular specialist services were highlighted by support workers in other areas. Support for particular needs is discussed further below.

Support for particular needs

4.69 Beyond the housing support teams that they managed themselves, some of the case study authorities also commissioned support services provided by the voluntary and private sectors, such as specialist families projects. Additionally, Social Work also provided and/or funded dedicated services for particular clients, as highlighted in Area C, for example. This reflects the fact that some households with particular needs require support beyond that which can be provided by generalist tenancy support teams, both in terms of their particular need and the intensity of the support that may be required. Further information on the support on offer in the case study areas is supplied in Appendix Three, while examples of jointly developed specialist support services are outlined later in this Chapter.

Help with furniture and making the house habitable

4.70 In case study A, eligible homeless applicants are assisted to buy furniture through a furniture grant scheme and this is greatly appreciated by service users (see below for service user views). The authority also tries to bring any housing allocated up to a suitable standard wherever possible. In case study D, a specialist service for stabilised drug users similarly assists with property refurbishment and furnishings, amounting to some £5,000 per property. This compares with something in the region of £1,500 for furnishings through the Communities Scotland scheme.

4.71 Reflecting on these findings we can identify a complex range of factors that influence homeless people's access to support services. These may include:

• local patterns of homelessness which shape client groups and support needs
• local homelessness strategies
• local policies and practices on homelessness assessment
• policies and practices relevant to joint working
• policies on the scope and access criteria of the support services
• logistics of service delivery ( e.g. where there is geographic spread)
• resources (housing support team scale, capacity and funding)
• service users' histories, situations and choices.

Perspectives on housing support

4.72 Interviewees who were receiving, or had received tenancy support, mostly spoke positively about the help received. This was mainly described in terms of advice and support on practical matters, and this was the type of support that most people felt they needed. The types of help that service users referred to most positively are broadly consistent with 'low level' or 'resettlement' housing support as described in the wider literature.

Support while in temporary accommodation:

"We got a support worker two days after we moved into the hostel. She gave us advice, told us she'd support us, phoned to chase up our allocation and helped with forms. She got (the child) into a nursery for 3 days a week. They practically do everything for you."

Support to move on:

"It was brilliant. We got carpets, beds, curtains, fridge and £60 for decorating. And they kept in touch until we got the house, every 2 weeks. Now we see her every 2-3 weeks, but we've to ring if we need anything."

"We got information about where to get furniture, and we can get free swimming tickets and ice skating if we wanted it. We've both always worked and the support worker is finding out about childcare for us so now we know that we can get work."

"I'm getting help with furniture. I can look after myself."

On the overall value of housing support, one service user commented, reflecting the views generally expressed by staff on tenancy support:

"Don't do away with the tenancy support…it's a great thing…don't know where we would be without it."

Continuity of support was also valued, for example where support workers followed households as they moved on from a hostel to temporary or permanent flats.

"It's good that it's the same person. I wouldn't have liked a different person each week."

4.73 Staff also stressed the value of continuity of contact. However in one case study area (area D), staff pointed out that such continuity was not on offer. When people leave the temporary accommodation unit they are allocated a different support worker (from tenancy support). It was noted that service users say at times that they have lost a good working relationship with their (floating support) worker in the accommodation unit.

4.74 There were also some pointers by service users and staff to potential areas for improvement. Some service users commented that they would have liked to have had more staff contact time, although they recognised the constraints on the service, and particularly that staff are very busy. Staff similarly commented that pressures of caseload at certain stages required prioritisation of needs and reduced flexibility. This was seen to be a matter requiring regular and focused review.

Gaps identified in support services

4.75 Eleven authorities responding to the survey identified support gaps, and these included support for people with mental health problems; people with addictions and for refugees. Support gaps were covered in greater depth in the case studies. Key gaps identified included:

• Preventative support to avoid tenancy breakdown, including low level housing support for those who require minimal assistance. In some areas housing support teams are at capacity and are reviewing priorities
• Crisis and short term support services, including support for B&B residents and those staying 'care of'
• More resettlement support services
• Befriending services
• More help to address anti social behaviour issues
• More support to address particular needs including those of: families with children; older homeless people (especially women); 16 & 17 year olds and care leavers, who some professionals consider generally need support to avoid tenancy failures and high need/high assessed risk groups. The latter may include offenders, individuals with substance misuse issues, and those with a history of tenancy breakdown including on the grounds of anti social behaviour.

4.76 Health staff emphasised that the needs of homeless children may be overlooked while their parents try to sort out the homelessness problem - "the focus is on the parents, who are wound up in their own issues". Similarly they stressed that the psychological needs of children whose mothers have suffered domestic abuse need to be carefully addressed

Gaps in provision of health services

4.77 It was notable that despite increasing joint planning and joint working, the health problems of homeless households continue to be a significant source of concern. In general, priorities for action identified in this study were similar to those emphasised in many Health and Homelessness Action Plans and subsequent Homelessness Assessments. Notably, substance misuse and mental health services appear to lag behind the prevailing needs, while access to primary and specialist care can both be problematic. There were indications of a growing attention to the health needs of children and the needs of families.

4.78 Beyond this, the critical need to acknowledge that mental health issues may underlie homelessness risks was stressed in urban case study area (B):

"Support is more important than other measures as a longer-term solution to antisocial behaviour. We're trying to address the causes of behaviour. It's not a matter of enforcement as it's not appropriate, for example, where someone has mental health problems."

Future funding of support services

4.79 Concerns about the complexity of, the constraints on, and the uncertainties associated with, the revenue funding of support services emerged in the case study areas. This was especially so in regard to Supporting People funding, which since 2003 has enabled the growth and targeting of support services for homeless people, but has more recently been constrained following UK wide and Scottish level reviews (Pricewaterhouse Coopers ( PWC), 2004). While these uncertainties are not specific in their impact on the opportunities for intentionally homeless applicants, they serve to limit the responsiveness, effectiveness and continuity of support services for homeless people.

4.80 Beyond housing support, the research findings have highlighted that some intentionally homeless households had received support from a range of sources that include generic social work support, and the input of specialist teams (health and social work). The following section now focuses on patterns and implications of joint working.

JOINT WORK, INCLUDING ADDRESSING MULTIPLE AND COMPLEX NEEDS

The key role of joint work

4.81 The Homelessness Task Force (Scottish Executive 2001) and its research agenda have affirmed the need for homelessness to be tackled holistically and stressed the role of joint work between housing and related services in achieving this.

"We take as our starting point the principle that everyone in Scotland should have dry, warm, affordable and secure housing. Not only is this desirable in itself, but good housing is also crucial to family life, physical and mental health. However housing is not the only dimension which needs to be addressed. In many instances, homelessness is the result of wider needs which have not been recognised, or have not been met effectively. All the varying needs of people affected by homelessness must be assessed and addressed individually and flexibly. If they are not, purely housing solutions are unlikely to be sustainable."

4.82 Following the Task Force's Report, Scottish Executive guidance further stressed the need for joint work to prevent and resolve homelessness. These include: Homelessness Strategies (Scottish Executive 2001a); Health and Homelessness Guidance (Scottish Executive 2001b) and Health and Homelessness Standards (Scottish Executive 2005c).

4.83 The housing, health and care professionals interviewed in this study presented a consensus that addressing complex needs requires joint strategy development and systematic frameworks for collaborative working. This viewpoint reflects the findings of various reviews of support services and of service users views (for example, Rosengard and Jackson 2005). Reid identifies a pattern of 'parallel' actions "designed to tackle the underlying problem that provide the backdrop for the crises experienced by vulnerable individuals and households" (Reid, 2001). Overall collaborative and partnership working is essential where organisations pursue complex and holistic aims, where services are fragmented but inter-dependent and where no single agency controls all the required resources, such as skills, funding and personnel (Balloch and Taylor, 2001; Alter and Hage, 1993; Dean et al, 1999).

4.84 We now draw on the research findings on good practice in partnership working and its role in improving opportunities for both intentionally and unintentionally homeless households in Scotland.

Joint work in homelessness prevention

4.85 The case study areas evidenced developments in joint working to co-ordinate and improve the effectiveness of homelessness prevention and the professionals interviewed expressed positive views on these.

• Case study Area B was one of the first Scottish authorities to develop a Housing Information and Advice Strategy in 2003. The Strategy promoted culture change in the service from one that fulfils statutory duties to preventing homelessness by: "providing advice before the points of crisis". Within the council's one-stop homelessness advice service, case workers can usually consult a social worker, mental health officer, community psychiatric nurse and nurse for information.
• In Case Study Area A, a dedicated housing education post has enabled the educational needs and aspirations of service users to be identified and addressed as part of a wider prevention strategy. Also an education forum has been established for service users to discuss feelings about being homeless, gaps in literacy skills, and ways of meeting particular needs. A schools education programme is underway to raise awareness of leaving home issues.
• In one of Council C's administrative areas a multi agency youth liaison group was formed to bring together staff from housing, social work services, a housing association and the voluntary sector. Participants feel it provides an opportunity for partners to "sing from the same hymn sheet" in regard to complex cases.
• In Case study Area D a Sub Group is working to link the Homelessness Strategy and the Children Service Planning Framework to develop and implement protocols relating to looked after young people and people being discharged from long stay institutions. Other joint protocols are also being revised such as in relation to anti social behaviour and rent arrears, with plans to extend protocols to cover all housing providers, including RSLs. Additionally, joint policies are being developed and implemented to deal with families who have been evicted.

Services provided in partnership to meet particular needs

4.86 This research has confirmed that intentionally homeless households (like homeless households in general) have diverse needs and that a variety of services have a positive role to play following appropriate needs assessment. The survey indicated a pattern of service development that is broadly consistent with this context. In sum there is a widening range of accommodation and support services targeted to meet particular and complex needs that are either currently being delivered or under development by local authorities working in partnership. To maximise development and access opportunities for example, there has been increasing joint work between local authorities and RSLs on section 5 protocols (under the 2001 Act) and between RSLs as landlords and voluntary organisations providing support services.

4.87 The examples highlighted below, present a mesh of service strands for improving options and outcomes for those assessed as intentionally homeless, as well as for unintentionally homeless applicants.

• In the case study areas floating specialist support services, provided in partnership between housing and support providers, were on offer to people in temporary and longer-term accommodation, including families, young people, people with addictions, people with disabilities and mental health problems and offenders, including Schedule 1 offenders.
• A rolling programme of training on mental illness and awareness has been introduced in case study area (A). Additionally it is intended that housing support team staff will be able to access training that is made available from partner agencies. Such inter-agency training is highly valued.
• In an urban rural area, Housing and Criminal Justice plan to fund a new post to offer support to young homeless people. It is intended that the post holder will take homelessness applications while the young person is in custody. In a large urban area the local authority contracts voluntary sector organisations to provide support for offenders for up to 12 months after release.
• Three local authorities described supported accommodation services for people with multiple/complex needs, including:
  • an interim unit for 10 single adults with drug, alcohol and/or mental health problems
  • an assessment centre with on site and floating support provided by Social Work and Health staff, with funding through Supporting People and mainstream funding
  • two flats provided in partnership for people with alcohol related brain damage in one area.

4.88 More detailed information was obtained on certain specialist support services/services to meet particular needs in the case study areas, where these were regarded positively by service users and/or staff and the information on the services reflected good practice criteria. Some had been accessed by intentionally homeless clients, such as a families service covered below.

Specialist support for families

4.89 Designated Families Projects operate in 2 of the case study areas (B and D) as well as in 2 other areas in Scotland. All provide a transitional support model oriented to the resettlement of homeless families, including services for children. Having developed on the basis of varying funding packages, all now use Supporting People funding as well as other local authority and charitable funding. One service is based on a residential-based core and cluster model, whereas the others provide floating support. All these services provide strategic and intensive household-centred support to homeless households that ranges across practical, emotional and resettlement, including linking to other appropriate services. Working in partnership with local authorities (their key referrers) they may also play a role in preventing homelessness.

4.90 One service user interviewee receiving support from one such project was particularly appreciative of the emotional support she received both for herself and for her children.

"They have given me a lot of emotional support and have found services for both me and my children."

Dedicated support for households with mental health needs

4.91 While no intentionally homeless households had accessed this particular service, it is representative of many support services that work in partnership with housing providers and health services across Scotland. Service reviews generally find that such services are valued by service users, although they may be varyingly clear about measurable outcomes (Quilgars, 2000).

In a rural case study area (area C), a Community Mental Health Team appointed an accommodation officer having recognised the importance of housing issues for those with mental health problems. Part of her work is to assist with benefits and form filling. Many clients are currently homeless or threatened with becoming homeless. Some lose their accommodation after being admitted to hospital; some people's families are not able to cope when they return home; and some cannot sustain their accommodation after their mental health deteriorates. Accessing temporary accommodation can be difficult. Staff reported that some young men with drug related psychosis are especially hard to place. The service was reported to be working well with both housing and the criminal justice services.

Assertive outreach

4.92 In Area B, one very personalised and flexible assertive outreach voluntary sector housing support service for people who find it difficult to engage with support, is widely regarded as an example of good practice.

The housing support service was started as a pilot service for 10 people by 2 voluntary organisations. Funded by Supporting People, the service now supports 160 clients using an assertive outreach model. It offers general counselling, practical help to maintain tenancies and, where clients are vulnerable, assistance with communicating needs to the housing department e.g. writing letters about a mental health problem or addiction, or domestic violence. It works mainly with 2 groups of clients. The first is people with difficult behaviour. The second group includes vulnerable people, e.g. those with serious depression, or who are at great risk from domestic violence.

Housing support is provided to lone parents but there are no services provided specifically for children. Clients with children are linked to community services and to statutory services if there are concerns about children. Housing support is provided for up to 2 years overall and levels range from 4.5 hours to 60 hours per person per week. The service has to secure agreement from the SP Officers Panel for a more intensive support package (over 5 hours) and such cases require a Carenap (or integrated assessment) to be carried out by a social worker or a caseworker with the centralised assessment team.

Each client's needs are reviewed quarterly. Clients may also be linked into other specialist housing support services, e.g. for young people or people with mental health problems. When another service gets involved, there are handover meetings/ visits and workers take care not to 'swamp' the client. If clients have to wait for a long-term provider, the service can press for an extension for 5 or 6 months. The most chaotic clients are unable to move on to more permanent accommodation and other forms of support. Staff stressed that people need a "reach out" support service.

Dedicated support services for households with addiction issues

4.93 An innovative service was developed by Housing Authority D in partnership with Social Work and Health services to bridge an identified gap in intensive resettlement support services for households who have children living with them at the time of the referral, or who are working towards having their children living with them, who are stabilised drug mis-users and have been through the Criminal Justice system. A comprehensive needs assessment is carried out and the sole project worker acts as the case manager, co-ordinating other services as necessary. Service users sign up to a support plan.

Dedicated support for people with personality disorders

4.94 One example of joint work identified in Area B focuses on the needs of people who are assessed as having a personality disorder which is "untreatable" medically. Often such people are accommodated in hostels, but are regularly evicted due to behaviour that is found too challenging and difficult. Homelessness and support services experienced difficulties in obtaining a positive service for this group, and it was commented that "No-one will take on people with a personality disorder - they are in a 'no-man's land". Against this background a study was conducted on the prevalence of personality disorder and this estimated that 80% of the surveyed population had 1 or 2 characteristics of personality disorder. As a result a pilot service was developed in a day centre to identify interpersonal difficulties and methods of delivering housing support. This led to better targeting of services to identified needs and it increased people's length of stay from 5 days to 2-3 months in temporary accommodation. The project is due to restart in September 2005, applying models that promote a better quality of life. The project is funded by Supporting People, RSI/Homelessness Task Force, housing and the NHS.

Individualised, flexible high support

4.95 Demonstrating the potential flexibility of floating support to meet complex needs, an individualised support package was established for a very vulnerable young woman who had recognised behavioural problems, including a lack of 'control of the door' that made shared accommodation inappropriate. A self contained flat was accessed and initially 126 hours support was provided per week. This was reduced to 90, then to between 50 and 60 hours a week. Support was provided through the day and for concentrated periods on weekend nights (6-8 hours) and for 2 hours per night through the week. Social work funded approximately 76% of the support package and Supporting People the remainder (24%). It was commented that this arrangement was working well.

Joint work to meet health and homelessness needs

4.96 A number of services in the case study areas sought to address the health needs of homeless people. These included:

• In area A the health authority has worked extensively with the local authority to identify and respond to the needs of homeless people. In conjunction with the Council, service users and a specialist health worker from a voluntary sector housing support project, a comprehensive needs assessment of health and homelessness in the area was conducted.
• A council managed day centre in area C has significant health input in the shape of: a practice nurse for 18 hours a week who provides health education and access to mainstream services; a CPN for 18 hours a week; a GP for 3 sessions - 1.5 days a week; and a substance misuse worker for those unable or unwilling to access the addictions service worker - 2 afternoons a week. The centre is about to set up a needle exchange and has begun an immunisation programme.
• Action to meet the health and social needs of children in hostels and temporary accommodation. In area A this began with links between health visitors and the hostels, when children were previously accommodated there. Families have now been moved on to furnished accommodation. A dedicated Health Visitor post has been developed. Its remit is to link homeless families and single people in to the local health services.
• Providing inter-disciplinary dedicated health services for homeless households in the local authority area. In Area D this includes: a health visitor; two mental health and addiction workers; a community nurse; a podiatrist and a lead nurse. In Area B, staff working in the council's one stop homelessness service for people sleeping rough or with a history of rough sleeping, can usually consult with a social worker, mental health officer, community psychiatric nurse and nurse.
• In one city case study area, there are dedicated health practices for homeless households offering: GP; Nursing care; Dentistry; Chiropody and a Community Psychiatric Nurse. Additionally, there are a number of outreach clinics for homeless people with mental health or drug or alcohol problems that can enable much faster access to health services for homeless people.

Addressing social and economic inclusion objectives

4.97 The fact that many households assessed as intentionally homeless are unemployed and have financial and debt problems means that like other homeless people they require access to support to take up social opportunities, as well as literacy, education, training and employment promotion opportunities. Both the case studies and the survey highlighted examples of the positive role of housing support staff in promoting inclusion, and often by working in partnership to enable access to education, training and employment options.

Joint work in addressing anti social behaviour

4.98 Other approaches that play a positive role in preventing homelessness for households who may have had histories involving anti-social behaviour or rent arrears are supported accommodation services for homeless families, including those threatened by homelessness. Only one area reported in the local authority survey that they have developed a specifically targeted supported accommodation service for homeless families (based on a core and cluster model) while others had been engaged in developing joint protocols and training on this front. Earlier we saw (para 4.90) that designated Families Projects in 2 of the case study areas as well as in 2 other areas in Scotland play a key role in providing transitional support. Such services appeared to be appreciated by interviewees who valued the emotional support on offer.

4.99 A new Scottish Executive Initiative is that of the "Breaking the Cycle" pilot projects, which to date mainly involve the floating support model. It will be important that these consider the fact that children affected by ASBOs may have learning difficulties such as autism or Attention Deficit Hyperactivity Disorder ( ADHD), as has been highlighted by Bibic (British Institute for Children with Brain Injuries), a group that supports families of children with brain injuries in England ¹⁶.

Joint work/involving service users

4.100 Involving service users in decision making was broadly seen by service providers as a core aspect of support needs assessment and support planning, just as is stressed in the Supporting People good practice standards. While the service user interviewees who had been in supported accommodation services appeared to have experienced such participation, others did not indicate much experience of consultation and user involvement.

4.101 Additionally, involving and consulting service users in the strategic planning of services is now recognised good practice. Few examples of collective involvement emerged in this study, although nationally and locally a range of initiatives have emerged in recent years, supported by national and regional co-ordinating bodies ( SCSH, Glasgow Homeless Network, Homeless Alliance) and good practice bodies (Scottish Housing Quality Network).

4.102 One example of user involvement was found in case study area (A) where the local authority had developed a forum for hostel residents to discuss the support services provided and to enable residents to address their needs and preferences, such as to access education or training opportunities. Transport is provided and it was reported that 20 service users attended the first group meeting at which food was on offer. The meeting was fully noted. Other ways in which agencies had involved service users in informing service planning was by consulting service users, when conducting Homelessness Assessments or Supporting People reviews, for example.

4.103 It will be important to assess the potential to involve service users more systematically in the monitoring and evaluation of homelessness services, drawing on the experience of developments such as the recent pilot project of the Scottish Housing Best Value Network in involving service users in peer reviews of homelessness services, the Glasgow Simon Community's longitudinal evaluation and the Glasgow Homeless Partnerships involvement of a service user forum in informing the assessment process.

The scope for innovation and partnerships in tackling complex needs

4.104 Two ways forward in addressing complex needs have been proposed by Rankin and Regan (2004) - those of Connected Care Centres and a "service navigator" role.

• Connected Care Centres is the title given to a community based 24 hour service that aims to respond to and prevent crises and to link people who have "breadth and depth of need" appropriately in to relevant services. The approach that underpins this model is both a community development and a partnership one and Rankin and Regan suggest that these should be piloted in deprived neighbourhoods. Local residents should be involved in planning and in managing the service. Potential service users should be able to self-refer, rather than rely on professionals. The actual service specification should be determined through a local needs audit and joint planning, and such services would typically involve:
  • co-location of a variety of health, social care and voluntary professionals
  • a single point of entry
  • common assessment procedures
  • procedures for information sharing
  • round clock support
  • links with all relevant services
  • managed transitions and continued support.
• A service navigator or service adviser would be a new type of lead professional with knowledge of "all mainstream and specialist services, and who would work with the service user" to develop a sustainable pathway of accommodation, support or care, in the case of homeless people. This would be similar to the role of care management, but would have a more diverse remit, being required to know about a very wide range of presenting problems and their interconnections - e.g. particular needs, housing, benefits and employment law, cultural impacts, offending and homelessness issues. Advocacy would comprise part of their remit and the role would therefore have to broker the person's interests across roles and agencies. Rankin and Regan stress that this type of role will not resolve required changes in services, but will be essential during a period that agencies and professionals are moving towards a "whole needs" approach.

4.105 The community development, partnership and preventative approach of Connected Care Centres and the strategic linking and advocacy role of service navigators as suggested by Rankin and Regan (2003) should be considered. No blueprint is offered here for these models; rather the position taken is that any interested local authority partnership would need to adapt these to fit with local needs and the network of local accommodation and support services in the context of their Homelessness Strategies.

Influences on the effectiveness of joint working

4.106 A variety of factors were identified in the interview programme as influencing the effectiveness of joint working and these are summarised below:

• Senior level and inter-agency commitment to a holistic, comprehensive approach to tackling homelessness, and to the aims of joint working and integrated services, were seen as key to improvements in joint working across the sectors.
• Corporate prioritisation of support for joint working with a view to maximising resources. Such a commitment is essential to progress needed matters such as: joint training, joint planning, joint budgets, staff commitment to and time for networking, shared service premises and investment in compatible IT.
• Effective communications based on shared understanding and trust.
• Joint protocols, including on information sharing/ data protection.
• Fewer rather than more partners: In one large urban area some of the best examples of good joint work were identified as being where a small number of organisations work together that meet regularly. Examples related to throughcare and aftercare, work with offenders, people with mental health needs and addictions. This would imply that in smaller areas, effective joint work may be relatively easier to achieve, providing there is a strategic level commitment.
• The resource capacity to engage in joint work: Joint work takes up staff time.

4.107 Some of the constraints on effective joint working were seen to include:

• Environmental constraints such as the widespread geography of the area that has implications for distance between services on the ground.
• Lack of a corporate vision that the council as a whole holds responsibility for tackling homelessness and bureaucracy leading to 'tunnel vision'. "There's a lack of joined-up thinking. It's not a housing issue - it's a Council issue."
• Divergent organisational, professional and service boundaries and approaches that create culture divides reinforced by different "languages", lack of trust and different ways of doing things alone. This can lead to a lack of appreciation of the different services' ethos, poor communications and a lack of information about each others' roles. Another consequence was a lack of shared models of joint work e.g. assertive outreach model or assessment models - "Case officers won't accept assessments carried out by voluntary sector supported accommodation staff".
• Confidentiality and data protection issues: Housing staff felt that social work and health may "hide behind patient confidentiality, so we get incomplete information and cannot do our best for the individual." This was seen as compounded by a lack of knowledge of the implications of Data Protection and Freedom of Information - "There's a general level of ignorance about data protection. We can't find out what's allowed but information is shared at case management meetings in any case".
• Competitive commissioning arrangements were seen to mitigate against trust between services, information sharing and therefore can undermine joint work.
• Resource constraints and generalist services being under pressure because conflicting priorities - some services were reportedly overstretched so that staff don't have time for joint working. In the case of social work, this was seen to concentrate energies on statutory duties, such as child protection. Case officers and voluntary organisations reported some difficulty in involving social workers where intentionally homeless households have children.
• Lack of infrastructure for priority objectives such as care management.

INHIBITORS ON ACCESS TO AND TAKE-UP OF SUPPORT

4.108 While this study stresses the need for a flexible, locally relevant range of accommodation and support services, it also illustrates that accommodation and support options may not be taken up for various reasons. We have seen that households may reject the accommodation on offer for standards or location reasons and may stay 'care of' or find private sector alternatives. Additionally, staff expressed some concerns that households may not take up or engage with the support on offer - "There is a big issue of how to engage people who refuse the support. How do we work with them?" In one case study area where homeless applicants are encouraged to take up support, it was suggested that some people may agree to support in order to be allocated a tenancy, only to disengage from it later.

4.109 Failure to engage with support may have significant implications for households assessed as intentionally homeless. Having initially been allocated a short SST, people's failure to engage with the support on offer might result in loss of their accommodation and subsequent entitlement to section 7 accommodation only.

4.110 Other professionals however, viewed people's lack of engagement with services as resulting from inflexibility and inappropriateness in the service response. One health visitor, referred to the failure of some homeless substance misusers to sustain their accommodation because they cannot locally access the medical support they need, and commented:

"They appear to fail, but they've not, it's us."

4.111 Professionals also stressed the need for support services to accept that some people will disengage from services at times, and that services must not "shut the door" in response. Some were concerned that some services do not "stay with" the person referred, but strike them off after 2 failed appointments. The approaches of assertive and intensive outreach services and of floating support were seen to represent best practice in engaging with some client groups who are typically viewed as "having complex needs" and being "hard to reach and engage".

4.112 Service users also identified reasons why they may have difficulties taking up support on offer with one saying:

"When I was homeless before, the probation service spent a lot of time trying to help, but they probed too deeply so I stopped."

Another person also stressed the need for support to be provided at their own pace and with mutual agreement:

"They are taking the pressure off me. Unless it was agreed, it didn't go down in the plan. They are thorough, they ask you questions about what's on top of you and suggest things. They're not demanding like everyone else."

SUMMARY

4.113 This chapter has identified and reviewed the role of the various accommodation and support services that comprise the system of services that may play a role in securing temporary accommodation and move on to more settled accommodation for households assessed as intentionally homeless.

4.114 It has concluded that while intentionally homeless households have no specific accommodation and support needs that are identifiably different from those of homeless households more generally, some intentionally homeless households will have a need for dedicated services to meet their assessed and individual needs in the short, medium term and possibly longer term. The study has found that local authorities are increasingly developing a broader range of both accommodation and related support services to respond to identified needs, frequently in partnership.

4.115 A trend of joint working is evident from the case studies and the survey. The overview in this Chapter emphasises that joint working is critical to effective prevention and alleviation of homelessness generally. While some intentionally homeless households will have multiple and complex needs, the research (quantitative and qualitative findings) has not indicated that the prevalence of multiple/ complex needs is greater for intentionally homeless compared with unintentionally homeless households. Without systematic assessment and monitoring of support needs for all homeless applicants, no conclusion can be derived here.

4.116 The final chapter of this report will take an overview of the study and its key findings and explore issues of service effectiveness.

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