Addaction logo Drug Related Deaths Conference 2017 Workshop Street Outreach A positive approach
Introductions Lee Derrick; Assertive Outreach, Addaction Sarah Necke; Community Safety Officer, Cornwall Council Marion Barton; Social Inclusion Lead, Drug & Alcohol Action Team, Cornwall Council
Background Rough sleeping is increasing nationally and across Cornwall Cornwall now the 3 rd highest rough sleeping area in the country Truro car park - Cohort of approx. 16 individuals - 6 female; 10 male; Serious and organised crime - links to homelessness and modern slavery; Potential risk of CSE;
Impact on the public & public services Resource demand: Cornwall Council and commissioned services; Police (e.g. 22 calls in 48 hrs); Between Nov-March 56 police calls resulting in 15 crimes being recorded Health (38 A & E presentations 5 admissions in approx. 3 months. 1 female safeguarding referral); Only 3 presentations since start of project (from Moorfield cohort) Overdoses Waste management (discarded drug paraphernalia, litter, urination and defecation); Negative public perception; Verbal abuse towards members of the public and public service staff. Request for eviction of the cohort from Council
Demographics of the cohort Mental ill health including anxiety and depression; PTSD; personality disorder; self harming behaviours & threats of suicide; eating disorders; Trauma (with some disclosure of childhood sexual abuse); Domestic abuse; Physical abuse; Sexual abuse/assault; Physical ill health; Drug (including alcohol) problems Drug overdoses Other conditions brain injury; hearing impairment; Prolific and Priority and other Offending; ASB escalation; Lack of life skills and limited ability to maintain a tenancy.
Main strands in the approach Strands 1. Assertive Outreach & multi-disciplinary approach (Co-ordination; Brokering of accommodation/treatment) 2. Individual client plans case management approach 3. Communications (Members, press, other teams within council, public) 4. Eviction (Equalities assessment; witness statement; court appearance; notices; bailiff action). Timing agreed in partnership in response to increase risk to the cohort 5. Public reinforcement & enforcement Increased police presence; arrests; CBOs 6. Cleansing (liaising with cleansing staff and council departments
Assertive Outreach Approach Wider partnership Multi-disciplinary, multi agency Team meeting weekly (14 weeks): Community Safety/DAAT (Co-ordinated) Voluntary Sector (Addaction; St Petrocs: Konnect Cornwall) [Delivered front line outreach] Adult Social Care & Safeguarding Supported Housing commissioners Cornwall Housing Limited Police & ASB Team Mental Health IDVA service
Assertive Outreach Approach Multi disciplinary, multi agency assertive outreach team (8 weeks) meeting daily; (Addaction; St Petrocs; Konnect Cornwall) Outreach response - Co-ordinated on the ground by Community Treatment Provider, Addaction (Lee Derrick)
Meet Lee Assertive Outreach Daily meeting & work co-ordination Dynamic Risk Assessment Plans for each client Case management Small client fund food; mobile phones; clothing etc. Back up of commissioners IB for additional support Assertive, persistent & consistent response
Toxic Trio Case Study 1 Support in own home (IB) 6 hrs per week (now being reduced to 3 hrs at client s request) Sexually assaulted in car park Early Intervention Mental Health Team (Missed appointments) IDVA support Funded gas/electricity client fund Support to clean up property/remove rubbish 1 hospital presentation -5 th April
Case Study 2 Reduced hospital presentations/admissions- only 3 since the start of the pilot Client case study 4 38 year old, male - formerly lived with mum & then sister until alcohol use meant he was putting her tenancy at risk. AT lived & worked but after a prison stay, he slept rough in Exeter area and on return he had memory issues, slurred speech, and family struggled to cope with his behaviour Rough sleeping started September 2016 Pay day drinker drinks to excess once until money has run out. After binge drinking has slurred speech, balance & memory problems & very vulnerable. Questions around acquired brain injury or Korsakoff s, possibly history of epilepsy. Neuropathy in feet. Since November 2016 he has presented to A&E 20 times, with one admission. Vulnerable to being bullied & harassed for money, alcohol from others and so would often disappear, but given his ongoing health issues this was a particular concern to agencies. Placed in emergency B&B by Cornwall Housing but this quickly broke down Placed in Crisis Accommodation by Coastline Homeless Service. Was evicted Placed in hospital discharge beds provided by St Petroc s with extra support over weekend to maintain that placement from Shelter and Konnect Cornwall Moved into New Start in a planned way Accessed detox and rehabilitation Now moved back into supported housing No further hospital admissions.
Outcomes All clients were offered detox, rehab or accommodation (some accessed all 3) At the end of the pilot (14 wks) 70% clients were in a better position than at the start No DRDs or overdoses. Naloxone distributed The car park was cleared and public complaints ceased Hospital presentations greatly reduced Police logs greatly reduced An effective partnership and multi-disciplinary approach was developed that is being used to inform future practice.
What worked well Partnership work and additional partnership support/budget Information sharing Commitment from agencies to target resources An immediate, flexible and targeted outreach intervention Outreach support even after being accommodated An agreed/shared single approach/plan for each client Good communication & regular meetings Strategic brokering & support from commissioners with political influence
What worked well (cont.) Individual budgets provided additional resource with an aim to accessing/maintaining provision. Met the objectives of clearing the car park Short term client success Reduction in police logs and hospital admissions Enforcement where required Good will of agencies involved providing weekend support to maintain tenancies
Gaps & Challenges Housing (input to the process was inconsistent & unsuitable options offered to clients on occasions ie B&B above a pub) Assertive Mental Health engagement Admin support & secure email Ability to share data different databases Support not in areas where clients may move Complex needs accommodation Services for women (Cosgarne small new female service) A lack of provision that will accept high risk individuals referrals (due to previous evictions; reputation; banning) CCTV maintenance & extension
Gaps & Challenges (cont.) No out of hours service (although goodwill provided some weekend cover) Organisations were stretched in providing additional services without a budget. Continuity of staff holiday and sick cover Long term support for individuals Managing expectations Quick access back into residential treatment following lapse
One month on.. Most clients continue to be in a better position than at the start of the project Andy Filkins (Truro PO) said the last 3 weeks have been the best ever in Truro in the past 10 years. There has been positive feedback from retail, street cleaners and members of the public. It s the most invaluable multi-agency work that s ever been done with no police logs around street drinking over the last 2 ½ weeks
One month on.. Colette Jolly (Hospital Discharge) said there has been an end to the numerous hospital presentations as previously experienced by this cohort. Tom Styles (ASB Team) said It s amazing how quickly things have been put in place. This multi-agency approach has provided real solutions.
QUESTIONS??