Housing Support Service Annual Report 2013 – 2014

Service Profile

Finance

Positive Steps is contracted by Dundee City Council to provide flexible housing support. The service is aimed at adults with housing need but it is not tied to any particular type of housing tenure. Positive Steps can engage with people with a tenancy in the social or private rented sector as well as owner occupiers.

Dundee City Council contract Positive Steps to deliver the Housing Support Service the funding coming from the Supporting People Fund.

The service is targeted to support between 80 and 120 service users with each service user receiving between 1 and 12 hours of support per week depending on identified need; the targeted hours available per week is 597. “I like my support because I get a good laugh. ‘A’ helps me with paperwork because it confuses me and she lifts my spirit”. Service User A Comment

Aims and Objectives Positive Steps is committed to promoting independence and provides support to assist service users to reach the point where they feel ready to live without housing related support after 18 months to 2 years.

Prior to 2013 -2014 the funding had not received any cost of living increase for the last five years. During this year the contract was reduced by 5% in line with the Council’s cost saving requirements. This resulted in a reduction in staffing but Positive Steps has worked hard to limit the impact on service delivery. Care Inspectorate Report The Housing Support Service was inspected in January 2014. The report was extremely positive about the work of the service. Summary of grades: Quality of Care and Support - 5 Very Good Statement 1 6 - Excellent Statement 3 5 - Very Good Quality of Staffing - 6 - Excellent Statement 1 6 - Excellent Statement 3 6 - Excellent Quality of Management and Leadership - 6 - Excellent Statement 1 6 - Excellent Statement 4 6 - Excellent

Good News:

Summary of Service Provided

Positive Steps have been working with a service user who suffers from anxiety and depression. Following an ATOS assessment he had his ESA stopped.

During 2013 to 2014 the Housing Support Service worked with 201 service users of whom 64 moved on to independently manage their tenancies.

As this was a decision M wished to challenge he was supported in asking for a mandatory reconsideration. M had then to face several challenges including making a claim for JSA and then fulfilling the job search tasks related to this. M had also to cope with a substantial drop in his income and found he could no longer meet all his financial commitments. Not only that but he also found he could not afford to heat his home or feed himself. This all happened two weeks before Christmas and lasted for two months. M went into a period of depression and voiced thoughts of self harm as a result of which his medication was increased. M was supported to access the local food bank which proved a lifesaver for him on several occasions. M was also introduced to the ADAPT project at CAB who gave practical support and advice and also helped him in making a PIP application. M needed a lot of reassurance and guidance through much of this process complicated at times by being unable to engage fully due to his mental health. Following what was a very slow and painful process for M a formal reconsideration took place during which his worker was able to speak in support of his claim. M had his benefit restored and arrears paid to him. M declared he was over the moon with the support from Positive Steps saying he would have given up had it not been for the help he had received from ourselves and ADAPT.

Fig 1.1 Service Users successfully moving on from the service.

The frontline staff worked very hard to maintain the service provided. Over the course of the year over 24,000 hours of support were delivered. In addition almost 2,800 hours were lost due to service users not engaging/attending for visits.

Fig 1.2

Number of support hours lost due to service users non-engagement.

However given the chaotic lifestyles experienced by many of the service users this should be an expected aspect of the service.

It is important that workers do not give up easily and show true persistence on occasion to prevent some very vulnerable people going from a crisis into a failed tenancy/internment. The service met their targeted number of hours support this year. During the year the Outcomes Star system became embedded into practice which allowed for easier measurement of outcomes for service users. It informed discussions and helped to illustrate to service users how much they had achieved. This is very important when working with people with low self-esteem and expectations. The service has amended its review process to reduce previous duplication whilst Outcomes Star was being introduced. It is now a streamlined process with the service user demonstrably at its centre. Outcomes Star also allows teams to be measured against each other internally and with an external benchmark of similar services. Since measuring this both teams within the Housing Support Service have equalled or excelled against the external benchmarking.

“If I didn’t have the support I would be lost. When I first got support I didn’t think it would change or help me but by doing the star and having support it has helped me”. “At first I didn’t know what to say but I think we get on fine and I can speak to J easy”. Service User B Comment

Service Process  Referral and background information  Assessment  Introduction, Support Agreement, Support Plan and Support Schedule  Enhanced Housing Related Support  Preparation for independence  Transitional independence  Sign off Good News: Service user W has struggled in the past to hold down a tenancy and would just walk away from it when things got hard. With support, W has successfully managed to stay in his new flat for 7 months and has decorated it and bought items to make it more homely. Currently looking into drug rehabilitation as he is determined to move forward with his life and make this tenancy a success.

Service Users Last year Positive Steps Housing Support Service worked with 201 service users. The service engages with adults. However, within that the age demographic changes as people come and go. Begining 40

End

30 20 10 0 1 2 3 4 5 6 7

1/ 2/ 3/ 4/ 5/ 6/ 7/

lifestyles being a significant contributor to this situation. Most service users have underlying issues which can impact upon their ability to maintain their tenancy/housing. Alcohol and drug abuse feature prominently along with mental health problems, learning difficulties and offending behaviour.

16-17 18-19 20-29 30-39 40-49 50-59 60+

PD MH LD AA DA BBV

Fig 2.1

Age demographic of service users at the beginning and end of 2013 – 14 as a percentage.

Young Offending

The younger group did not change much with the youngest 16-17 not registering any service users. This is expected given the specialist agencies available for this age group. The majority of service users are over 30 with a significant growth through the year in the 50-59 grouping and a slight increase in the 60+. This can bring with it different challenges with many people in these last two categories starting to require care rather than housing support; their previous chaotic

Sens Imp Dom V

Fig 2.2

Breakdown of service users by identified primary need.

The service also supported a number of single parents. On occasion this has brought us into contact with the Dundee City Council Child Protection Team. “Support is superb. P is fantastic and if P hadn’t been there I would have cracked” Service User C Comment

Social Return on Investment There have been a number of agencies who have tried to put a cost on homelessness in particular Crisis in 2003 and Homeless Action Scotland in 2011. Crisis put the cost at between £25,500 and £28,500 for people with underlying issues rising to £84,000 for more complex cases. Homeless Action Scotland used a different approach. They gave two Local Authorities two case studies and asked them to attribute costs. Scenario 1 had costs of £23,000 and nearly £25,000 while scenario two had costs of £15,500 and £19,000 the last two excluded £4,000 rent arrears accrued prior to eviction. The 64 people who joined the service when they were in housing need and subsequently moved on to manage their tenancy independently might well have become homeless. Taking this forward as a crude calculation of SROI for this service if we assume a low average cost of £20,000 for a period of homelessness and take the 64 people who successfully left the service this year to continue in their own tenancy it could be

argued that the service saved £1,280,000 in wider costs. Good News: Service User G was with the service from September 2010 in a Positive Steps tenancy. He has been reducing his methadone for the past 8 months and at sign off date was down to 20mg/day. He has been making really good solid progress and was ready to be signed off a couple of months ago however his flat was earmarked for demolition so support continued to assist G to find another tenancy and move in. This was successful and at the end of November G moved in to his new tenancy with a Housing Association.

Referrals The Housing Support Service operates an open referral system which means that people can self refer or refer other members of their family for example. This year the application form was amended in consultation with service users. Further the service is not restricted to people in social housing. The service can also support people with tenancies in the Private Rented Sector as well as owner occupiers. Referral Forms are available online as well as at locations around the city. However, the majority of

referrals come from Dundee based statutory or other voluntary organisations or occasionally national bodies (e.g. the Scottish Prison Service). As the service is designed to meet the needs of the people of Dundee, individuals referred must have a history of homelessness or a need for housing related support within the Dundee area. Positive Steps builds and maintains links with appropriate referring agencies and provides accurate and up to date information about the service and service availability. Our staff encourage contact through telephone and other informal approaches which makes the service more approachable for both members of the public and frontline workers. 20% of our referrals last year were self referred. Whilst some were received as a result of ‘word of mouth’ comments from current and ex-service users, this figure also reflects the direct marketing undertaken by the service and regular participation at various groups throughout the city attended by people struggling to cope.

Agency No. Self Referrals 42 Other SW Agencies 23 Lily Walker Centre 22 TAOS + Repeat Prevention 21 SW CJS 17 Dundee Survival Group 15 CMHT 11 Action For Children 7 Housing Associations 7 HHOT 6 Anti-Social Behaviour Team 5 Social Prescribing 5 Women’s Aid 5 Terence Higgins Trust 3 CAB 2 DIAS 2 New Beginnings 2 Rosendale 2 Other Vol. Sector Hostels 2 DTTO 1 Dundee Healthy Initiatives 1 Dundee North Law 1 Eagles Wing Trust 1 Faith in the Community 1 Health Visitor 1 Homefinder Dundee 1 Mitchell Street 1 SOS 1 School Community Support 1 Source of Support 1 WISH 1 The total number of referrals for the period was 211. Once a referral is received an application form is completed and an initial meeting and basic

assessment is carried out, where possible informal reports and information is obtained from social work, health professionals and other agencies as appropriate. All referrals are discussed and decided upon at a weekly Referral Meeting. Referring agencies and people referred are then advised of the outcome. If someone is to be supported then arrangements are made to visit them and complete the sign up process. As can be seen from the table referrals are received from a variety of sources. “I think it’s going alright, I think I can be difficult and I think you are good” Service User D Comment

Service User Involvement Service user involvement plays an important part in the delivery of the Housing Support Service. As a result the service has given the role to lead on this matter on one of the senior workers. Primarily Service User Involvement takes place at the individual level where each service user is actively involved in the development and delivery of the support provided.

Support plans reflect this partnership by identifying goals, agreeing actions and the roles to be carried out by staff and service user. This is followed up at regular reviews attended by a team leader as well as the service user and their key worker where the service user is encouraged to participate and their comments are recorded. The Outcomes Star has been incorporated within the Review and Support Planning processes. The tool enables the service user to be aware of the success they have achieved in given areas. This can be a very helpful motivational tool. In addition to involving service users at the individual level the service consulted with service users collectively on a number of issues and developments e.g. redrafting the service user exit questionnaire and the referral form. There are regular forums where service users are encouraged to meet to discuss matters of a collective interest, learn something (there is usually a speaker/activity), and have some fun. It is very social. Recognising how difficult it can be to find bus fares when on benefits

the forums are moved around the city.

2013 at the Douglas Community Centre. It was important that service users enjoyed the event, learned from the experience and had the opportunity to participate in a social occasion.

Fig 3.1

Service User Forum in action

Usually they are held in Community Centres. A secondary aspect of the forum is to help break down the perceived barriers preventing people from utilising some of the resources in their community. However, to date only 10% of service users attend the forums and whilst this is useful for some matters a wider consultation exercise takes place for others. Firstly to ensure that everyone knows what happened at the forums minutes are sent out to all service users. In addition the service has sent out questionnaires, conducted telephone questionnaires and structured interviews. In addition the service held its first Service User Conference in October

In addition the service felt that it was important that there was a health improvement aspect to the conference and wanted to consult with service users on a number of topics: communication; use of social media; key skills and attributes of a support worker. The day was broken down into a series of workshops/activities and people were placed in groups which rotated round them.

Fig 3.2

The ideal support worker as agreed at the Service User Conference Oct. 2013

The various workshops and activities were: cooking; DIY; Indian

Health Massage; GP Health Check; The ideal Support Worker; Facebook and Social Media; and Communication. There was a video booth available for people to pass comment on the day and the service in general. 15% of service users attended on the day. Feedback was very positive. Everyone seemed to enjoy the event. Additional comments will be incorporated into next year’s conference. Staffing The requirement for this service is 17 FTE staff. The majority of staff are qualified to meet the requirements of SSSC registration although that is not in force for most workers as yet. There is a plan in place to ensure that the remainder of the team achieve the necessary qualifications. Positive Steps is committed to continuous and lifelong learning and recognises that the training and development of staff is a key factor in achieving and maintaining an effective quality service. Positive Steps is committed in providing a wide a range of opportunities to staff and volunteers to acquire the

skills, knowledge and qualifications to effectively deliver the services required to meet the needs of Positive Steps, its contractors and the recipients of its services. Complaints, review and monitoring Positive Steps has Complaints Procedure in place to ensure complaints are dealt with in line with Care Inspectorate recommendations. The procedure for dealing with complaints and disputes is issued to each service user and explained to them as part of the induction process and at other appropriate times. It provides information on how to complain to SCSWIC and/or local authority if required. Quality Assurance procedures are in place to ensure the service is reviewed and monitored. This has been enhanced with the investment in the ‘Outcomes Star’ online tool. Case Studies Positive Steps Housing Support Service engages with people in housing need who in addition can face a range of issues impacting on their lives. The following two case studies have been chosen to help illustrate the diversity of the support undertaken by this service.

Case Study 1 Service User F is a 59 year old male who has learning difficulties. For most of his life he lived with his family until his mother passed away in 1994. From 1994 to 2009 he had a very difficult time. He was financially abused and had little or no money as he trusted people and their intentions. He had one outfit of clothes and had no white good that worked and was only eating because his neighbour felt sorry for him and would hand in meals. His key worker meeting him for the first time quickly realised that he was embarrassed about his home and the condition he was living in. F could not express himself verbally and no-one had really talked to him for years. His speech was poor and he had stopped verbally communicating with others as they found it difficult to understand him. His worker agreed with F that they would never agree with him if they did not understand what he was saying, as this made him feel frustrated that he was being dismissed and not respected. The support started with writing a list of things he needed to do and buy to get his house into a home. His worker advocated on his behalf

with the housing association to get the house cleared and cleaned and he agreed to pay them back. F said he wanted a really big TV, a sofa, a bed, new shoes and some food. His benefits were checked and the right benefits were put in place and backdated. Staff then got the house emptied of the rubbish; got repairs completed and helped him decorate his home. F was helped to establish a routine for his domestic tasks; access his money safely and appropriately and attend appointments. Because of his difficulty with reading and writing staff used graphics a great deal to help F understand his routines. F also had a serious health scare. At one point it was likely that he was going to die. However, he has made an excellent recovery and has been supported to adjust to his new lifestyle. F’s life 5 years later is a much better place. He has a good supportive group of friends that he socialises with, he has a home he is proud of and clothes he feels smart in. He can treat himself when he wishes and he is never hungry.

To conclude F feels much more confident, so much so that he has been accepted to be part of the interview panel for new staff at Dundee City Council. He is very proud of his achievement. He has travelled such a long way from that very frustrated, quiet, unassuming man. He recently described himself as the luckiest man in the world because he was happy. Case Study 2 Service User G was referred to Positive Steps in June 2008 by Community Mental Health Team 4. He had a very long history of mental health and was diagnosed with schizophrenia in 1998, following an aggressive incident at the family home. G has had many periods in a psychiatric hospital, the longest being 14 months. G had many involvements with the police; usually when G was drinking heavily and taking illicit drugs whilst un-medicated. G does not believe he has an illness and was refusing to take any medication. G to this day still challenges and states that all psychiatrists that have had involvement with his diagnosis are

wrong and truly believes he has never been unwell. This period led to a breakdown in his relationship with his family. G`s brothers no longer have any involvement with him and both his parents are dead. G can become grandiose and believes he has been to university and studied several courses including Architecture, Poetry, Mathematics, and English literature and received degrees in these subjects. G had disengaged with all services when Positive Steps became involved. He was placed on a Compulsory Treatment Order. G`s housing support started in July 2008, G was assessed as needing 4 visits a week which included shopping, budgeting, home maintenance, developing social networks and assistance with correspondence. He had accrued a lot of debt and Social Work put him under Appointeeship. He was initially supported by a male worker however this was not a success. A female worker was appointed, initially on a temporary basis.

At first G was never in for his visits except for Tuesday and a Friday as that was when his money was delivered by Social Work. This suggested G had the capability to acknowledge he had to be available for support visits but chose not to be. He never really stayed at his flat and refused to call it home as he referred to it as “the place the social work put me”. G’s home maintenance skills were non-existent and he was refusing to learn new skills as he felt they were not needed. Dishes would pile up, laundry was never done, and G always appeared un-kempt; his bin would always be overflowing and flooring was never hoovered. G shopped twice a week but bought only the basics and normally only spent £15 over both shopping days. At this time his Care Programme Approach meetings were every 2 months as he was non-compliant. The CMHT had put a lot of intense support in to try and support G including a Mental Health Officer, Community Psychiatric Nurse, Social Care Officer, Psychiatrist, Social Worker, Care Manager, and Mental Health Support Worker. However, they experienced a significant lack of engagement from

G and found he would only engage if he thought they would put him back to hospital. With the support provided by Positive Steps, G now keeps both himself and his home clean and tidy which was something he did not care about when he first came to Positive Steps. He takes a lot of interest in his personal care and likes to go out only after showering and shaving, wearing clean, ironed clothing. G also now closely follows a home maintenance cleaning rota which we supported him to complete in line with his own wants and needs. His diet has been much improved through weekly shopping trips and advice on healthy eating and shopping on a budget whereas prior to support, G ate mainly snack foods and ate erratically. Initially, G seemed to lack the ability or motivation to socialise with others however, over time he has gradually made friends and developed the skills required to mix socially with others Correspondence was also an issue for G years ago as he did not open or deal with it and had trust issues with others opening his mail.

He now will happily give any letters he doesn’t understand to his key worker who visits in order to keep on top of bills and any issues relating to maintaining his tenancy. As a result, he has successfully made the transition to a secure tenancy with a Housing Association. On a final note, there is one aspect of G’s life we cannot change and this is his mental health; we have, however, through close liaison with other agencies, developed various strategies which we all use to help G cope when he is struggling. This multidisciplinary approach will continue, the aim being to provide the best and most appropriate support possible to help G continue to develop his independence. Conclusion 2013 to 14 was a challenging year for Positive Steps Housing Support Service. Facing up to the consequences of a 5% cut in income staff worked extremely hard to limit the impact on service users. That they succeeded and in the process did not allow the quality of the service to suffer reflects highly on their efforts. The development of meaningful service user involvement continued

over the year leading to the first service user conference taking place in October. The diverse range of service users accessing this project underlines both the need for the service and the complexity of the issues which need to be addressed. Having a person centred approach and focussing on individual outcomes has helped the service provide the flexibility needed to respond. Enabling 64 people in housing need move on this year to independently manage their own housing situation has been a significant achievement. As well as the benefit for the individuals the wider savings to the public purse gained through their success should be recognised, particularly in these stringent financial times.

Housing Support Service 1314.pdf

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