Institute for Community Research and Development Multiple and Complex Needs in the West Midlands Research Briefing Paper
Dr Rachel Massie & Professor Laura Caulfield January 2021
About the Institute for Community Research and Development Focused on social justice, the core values of the Institute for Community Research and Development (ICRD) mean it works with and in our local communities to deliver effective communitybased transformational projects, drive policy developments, and promote social mobility. The ICRD was launched in 2017 to ensure that the University of Wolverhampton’s research has a direct impact on the lives and life chances of individuals in the region. The research themes of the Institute are: criminal justice and violence reduction; immigration and migration; and inequality and social analysis.
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INTRODUCTION Across England estimates suggest that a minimum
While these national estimations of the scale of
of 58,000 people experience homelessness,
the issues are important, there is a need to use data
substance misuse and contact with the Criminal
more strategically to understand the issue of MCN
Justice System in any one year, and a further
more clearly from multiple perspectives in the West
164,000 individuals are estimated to experience
Midlands and to overcome some of the limitations
a combination of two of these problems (Hard
on which these estimates are based.
Edges report, Bramley et al., 2015). Within the West Midlands, approximately 16,800 individuals are
Within the West Midlands, work around MCN is
estimated to be facing multiple and complex needs
growing. One of the West Midlands Combined
(a combination of two or three of these problems)
Authority’s (WMCA) priorities is Public Service
(Bramley et al., 2015).
Reform, in which radical prevention is one arm of the work to discover new ways to prevent
There is no single agreed definition of multiple
social problems that are entrenched in the region,
and complex needs (MCN), and terminology such
including MCN. Secondly, through their Fulfilling
as severe and multiple disadvantage, multiple and
Lives Programme - funded through the National
complex needs, and chronic social exclusion are
Lottery Community Fund - Coventry aims to pilot
often used interchangeably in this space, with small
new interventions for people facing MCN and help
variations in definitions. However, it is largely agreed
bring about systems change.
that this concerns individuals facing multiple needs at the same time, and not considering one need in
This briefing paper provides a summary analysis of
isolation. Information on the variety of definitions
the existing research and evidence about MCN in
and terminology is provided at the end of this report
the West Midlands. This briefing paper summarises
(Table A1).
the current situation in the West Midlands and aims to help better understand MCN in the region and
Since the publication of the Hard Edges report in
identify potential gaps to inform regional policy
2015 organisations have recognised that women
related to supporting individuals living with MCN
may experience multiple disadvantage differently
and the services that support them.
to men. Hence, recent work has begun to investigate the scope and scale of multiple disadvantage with a new definition of poor mental health, experience of interpersonal violence and abuse, homelessness and substance misuse which is thought to better reflect women’s experiences (McNeish et al., 2016). With these definitions, new estimations indicated 336,000 adults experience multiple disadvantage each year with an equal split between men and women (Sosenko et al., 2020; Sharpen, 2018).
Across England estimates suggest that a minimum of 58,000 people experience homelessness, substance misuse and contact with the Criminal Justice System in any one year, and a further 164,000 individuals are estimated to experience a combination of two of these problems
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METHODOLOGY This work builds on collaborative work focussed
documents being identified and sent to the research
on MCN between the WMCA and the Institute for
team.
Community Research and Development (ICRD), ongoing since October 2018. The stakeholders that
Our search identified 25 documents that met the
have been involved to date include Lankelly Chase;
inclusion criteria, of which two duplicated another
WMCA; West Midlands Fire Service; Coventry City
document in the list (i.e., separate executive
Council; West Midlands Office for Data Analytics;
summaries of full reports). In this instance, only the
West Midlands Police and Crime Commissioner;
main reports were included in the data extraction
Birmingham Changing Futures Together, including
and analysis process. The lead author read the
lived experience from Every Step of the Way; and
documents thoroughly and extracted the main
academics from the University of Wolverhampton
patterns identified in the documents. The second
and Coventry University.
author reviewed the articles and patterns generated for this report to avoid bias when analysing the
The lead author led the search and review of
data. Our report presents key findings, but not an
documents pertaining to MCN in the West Midlands.
assessment of the quality of the methods or findings
The key search terms used were Multiple and
within each document.
Complex Needs; Severe and Multiple Disadvantage; Chronic Exclusion; and West Midlands. To be included, documents needed to: address more than one complex need; be West Midlands based; and describe/evaluate a service or intervention. To ensure all relevant information was captured, and given many of the documents were grey literature (rather than published peer-reviewed), any form of written publication was accepted (for example, executive summaries, evaluation reports, posters, and infographics). Following an online search of databases and google scholar, the researcher followed a snowball sampling approach by following up reference lists of relevant documents, searching organisational websites and emailing a group of key stakeholders . The list identified was circulated to key stakeholders to ask them to identify any documents they were aware of that were missing. This resulted in a further four
1
.The key stakeholders from within the West Midlands were identified from a stakeholder mapping
exercise conducted by individuals from the WMCA and the University of Wolverhampton. The stakeholders identified represented local authorities, WMCA, West Midlands Police, people with lived experience, third sector organisations, Public Health, MEAM, and Lankelly Chase.
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FINDINGS A summary of the key findings of each document can be found in Table A2 on the ICRD website. Overview of the documents identified
Nine of the documents specifically discuss the
Geography: The documents have a predominant
importance of involving individuals with lived
focus on Coventry and Birmingham, with only
experience of MCN in the design, delivery and
three documents with a focus outside of these
evaluation of services. Examples of their successful
areas. This is unsurprising given the higher
involvement in programmes in the West Midlands
estimated prevalence rates of MCN in Coventry
include Peer Mentors and Experts by Experience
and Birmingham noted in the Hard Edges Report.
through Birmingham Changing Futures Together,
In order to gain a fuller picture across the West
and input into roundtable discussions such as the
Midlands, further evidence is required from across
Participatory Mapping Workshop. Meanwhile, there
the region.
is also further appetite to involve experts with lived experience in developing frameworks, development
Type of data: Ten of the documents contained
of new collaborative projects, and evaluations to
primary qualitative data from beneficiaries and
capture their insight. Finally, and importantly, the
stakeholders. Four documents analysed quantitative
input of people with lived experience was highly
data available from services, while the remaining
valued by current service users and that combining
nine had a focus on action plans, summaries, and
their input with staff input has been reported to be
position statements rather than generating and/
integral to recovery and reintegration.
or analysing data. All but one of the documents identified were published within the last five years
The qualitative and quantitative findings reported in
(since 2015).
the documents are consistently positive for service users and staff. There was a consensus that previous
Voices represented: The documents report the
services have been working in isolation and thus
voices and experiences of a variety of stakeholders
negatively affecting service users. Interviews
including service users, individuals with lived
with service users involved with new pilots in
experience, project/organisation staff, and external
Birmingham revealed improvements in wellbeing
stakeholders.
and experiences of support services had improved. However, there was evidence that low awareness
What are the key findings so far?
of wider services available remained an issue
There is widespread use of the term ‘multiple
for some service users. Recommendations have
and complex needs’ within the West Midlands
been put forward for senior management buy in
with largely consistent definitions used relating
and examples of where multiple services could be
to experiencing two or more of the following:
more aligned and joined up in supporting the same
homelessness, drug and alcohol misuse, offending,
individual.
and mental health problems (see Table A1). In line with recent national publications focussing
Three separate projects have indicated potential
on gendered experiences (i.e. Sharpen et al., 2018;
savings when considering the social value and
Sosenko et al., 2020), additional focus on violence,
economic impact of programmes supporting
abuse and poverty were referred to in two of the
people living with MCN in the West Midlands.
regional reports and may require additional focus
While acknowledging the difficulty of interpreting
when considering women’s experiences of MCN
the varied journeys and setbacks that service
more broadly.
users face, the reports identified improvements in personal wellbeing, reductions in evictions and
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criminal justice figures, increased use of appropriate
What are the current gaps?
services (thus reducing the use of emergency and
Reports identified a need to improve the ability to
inappropriate services). This could be expected to
capture data and demonstrate project or service
result in reduced public service expenditure, and the
impact. This included the experience of service
potential for wider economic and social benefits for
users, the involvement and impact of Experts
the public.
by Experience, and challenges of conducting assessments of social value due to small sample
There appears to be a need and willingness to
sizes and incomplete datasets. Furthermore, the
explore whole systems change focussed on
literature sourced was predominantly from third
supporting people living with MCN through a variety
sector organisations and would benefit from access
of organisations and individuals within the West
to wider data sets and research/evaluation from the
Midlands. Three reports demonstrate work that is
police, probation, and health services in particular.
taking place in specific localities to provide solutions to the challenges identified, particularly related to
Five of seven evaluation reports provide the
data intelligence and sharing. These include: the
gender split of participant service users, of which
use of the i-CAT tool by member organisations of
approximately two thirds of respondents were male.
the No Wrong Door Network in Birmingham (see on
Aside from this breakdown, there was no distinction
the ICRD website); the aggregation of data from local
in the service user experiences by gender. The
public services to estimate the need in Coventry.
lack of availability of support from female Experts
The launch of the West Midlands Office for Data
by Experience was also raised. Further studies to
Analytics highlights the investment being made to
explore the experiences of women living with, and
improve such systems.
receiving support for, MCN in the West Midlands would be warranted.
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LOOKING AHEAD This review provides an overview of the work pertaining to MCN in the West Midlands that has been documented and/or evaluated. Yet, we believe there is much more work tackling MCN taking place across the West Midlands and improved tracking and sharing of this work would help to build up a better picture of need and gaps across the region. It is promising that attempts have been made to use local data to scope the extent of MCN in local areas. There is an opportunity through the Office for Data Analytics Use Case on MCN to begin to address some of the questions about how this can be extended more widely across the West Midlands. The ability of the i-CAT to share and track service user information and progress between organisations is extremely valuable. It is important to explore whether and how this management tool can be replicated or extended for wider use across the West Midlands, and who the most suitable host organisation would be. It may be valuable to pull together a guide that shares the approach and learning associated with MCN between organisations and with new organisations. This could include recommendations and lessons for involving individuals with lived experience in the services and projects to ensure roles are clear, and how they can realise the wider impact of these ‘experts’ beyond their own personal development. Future commissioning should factor in the involvement of individuals with lived experience in the design, delivery, and evaluation of services.
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Improved tracking and sharing of this work would help to build up a better picture of need and gaps across the region.
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ACKNOWLEDGEMENTS The authors would like to thank the West Midlands Combined Authority and Lankelly Chase, in particular Claire Dhami and Oliver French, respectively, for supporting this work. We are grateful to UKRI for funding this work through their Strategic Priorities Fund. Thank you to all the individuals who participated in the stakeholder events and/or responded to emails requesting relevant documents be shared with the research team.
REFERENCES A summary of the key findings of each document can be found in Table A2 on the ICRD website. 1. Clifford, C. (March 2019). Multiple Complex Needs Programme in Coventry – Evaluation.. 2. Moore, J., Botchway, S., Wrench, G. (January 2018). Appendix 2: Using intelligence to inform the work of the Multiple and Complex Needs (MCN) Board in Coventry. In Creating Intelligence that enables effective action - The role of population intelligence in supporting the WMCA objectives. 3. Chun Lam, S. (April 2017). Identifying the extent and nature of multiple complex needs in Coventry. 4. Chun Lam, S. (February 2018). Development of an assessment and evaluation framework for the Coventry Multiple Complex Needs Programme. 5. Coventry Multiple and Complex Needs Board (June 2018). Coventry Multiple Complex Needs Programme – Programme Initiation Document. 6. Billiald, S., McAllister-Jones, L.T. (November 2015). Behaving like a system? The preconditions for place based change. 7. Randle, A., Anderson, H. (February 2017). Building collaborative places: infrastructure for system change.
Birmingham Changing Futures Together (National Lottery Community Fund’s Fulfilling Lives) 8. Revolving Doors Agency (March 2019). Highlights from the Evaluation of Birmingham Changing Futures Together. 9. Revolving Doors Agency (March 2019). Service User Perspective: Peer Support Research. 10. Revolving Doors Agency (March 2019). Evaluation of Every Step of the Way Experts by Experience and Systems Impact. 11. Birmingham Changing Futures Together (2018). Economic Impact Analysis Infographic: 2018. 12. Birmingham Changing Futures Together (no date). Systems Change Action Plan (2019-2022). 13. R evolving Doors Agency (August 2019). Evaluation of the impact of Psychologically Informed Environments. 14. Birmingham Changing Futures Together. (July 2019). Social Cost Benefit Analysis. 15. Kiberd, E. (July 2019). Social Cost Benefit Analysis of the Lead Worker Peer Mentor Programme. 16. A BIC Ltd. (March 2016). Birmingham Changing Futures Together - Every Step of the Way Evaluation Fieldwork Summary Report. 17. Emerging Horizons (March 2016). Lead Workers and Peer Mentors Fieldwork Evaluation. 18. Birmingham Changing Futures Together (January 2020). Recovery Navigators Pilot Report.
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West Midlands Combined Authority - Public Service Reform – Radical Prevention. 19. M assie R., Caulfield, L. (April 2019). Multiple and Complex Needs: Individuals with lived experience tell their story. 20. French, O. (November 2019). Participatory Systems Mapping Workshop Summary. 21. W est Midlands Combined Authority Office for Data Analytics. (November 2019). Use Case Project Initiation Document: Use Case 4: Multiple Complex Needs.
Other 22. B irmingham Mind (2018). Birmingham Mind Annual Report – Our Impact (2017/18) (pages 10 and 11 relate to BCFT) 23. Inglis, J. (April 2011). P3’s Sandwell Complex Needs Service Social Return on Investment Analysis. 24. Birmingham Changing Futures Together (no date). All you need to know about iCAT. 25. Fulfilling Lives (June 2019): Changing systems for people facing multiple disadvantage (pages 6 and 7 relate to BCFT).
National Contex 26. Duncan, M., Corner, J. (July 2012). Severe and Multiple Disadvantage: A review of key texts. 27. Bramley, G., Fitzpatrick, S. (2015). Hard Edges: Mapping severe and multiple disadvantage: England. 28. McNeish, D., Scott, S., Sosenko, F., Johnsen, S., Bramley, G. (October 2016). Women and girls facing severe and multiple disadvantage: An interim report. 29. S osenko, F., Bramley, G., Johnsen, S. (2020). Gender Matters: Gendered patterns of severe and multiple disadvantage. 30. Flinn, J., Harris, D., Hart, D., Hughes, C. (2020). Telling a different story: Understanding news media coverage of severe and multiple disadvantage. 31. Sharpen, J. (August 2018). Jumping through hoops: How are coordinated responses to multiple disadvantage meeting the needs of women?
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APPENDIX Table A1: Terminology used and definitions provided within documents reviewed
REF:
TERMINOLGY DEFINITION
Coventry Multiple Complex Needs Programme
1
Multiple and Complex Needs
Individuals experiencing two or more factors such as, but not exclusively: • homelessness • offending behaviour • mental ill-health • substance misuse • worklessness
Coventry Health and Wellbeing Board
2, 3, 4, 5
Multiple and Complex Needs
Individuals experiencing several problems at the same time, including a combination of: • offending behaviour/violence • homelessness • substance misuse • mental ill-health • or adverse childhood experiences
Birmingham Changing Futures Together
8, 9, 10, 11, 13, 14, 15, 17, 22
Multiple and Complex Needs
People experiencing two or more of the following: • homelessness • problematic substance misuse • risk of offending • mental ill-health
West Midlands Combined Authority
19
Multiple and Complex Needs
People facing at least two of the following at the same time: • homelessness • substance misuse • offending behaviours • mental ill-health
Lankelly Chase
20
Severe and Multiple Disadvantage
Left deliberately open to interpretation for workshop, but commonly understood to be a combination of: • homelessness • drug and alcohol use • mental ill-health • involvement in the criminal justice system • extreme poverty • exposure to violence and abuse
P3 Sandwell Complex Needs Service
23
Chronic Exclusion
Entrenched in a cycle of: • criminality • severe mental health problems • substance and alcohol misuse • homelessness
Fulfilling Lives
25
Multiple Disadvantage
People who experience two or more of: • homelessness • current or historical offending • substance misuse • mental ill-health