CHANGING NEEDS CHANGING RESPONSES Depaul Ireland Ballymun Case Management Team November 2012
Written by Brian Higgins Depaul Ireland Photography by Tim Millen & Sam Gordon With thanks to Ballymun Regeneration Limited and the Health Service Executive
Foreword
Ballymun Case Management Team / Depaul Ireland
At Depaul Ireland our vision is that everyone should have a place to call home and stake in their community. We have been delighted to put this into action over the last 7 years through the service delivery of our Case Management Team in Ballymun.
Ballymun has long been an area that has experienced high levels of deprivation and we have been pleased to work in partnership with others, particularly Ballymun Regneration Ltd, to provide a pragmatic response to supporting those in this community living with alcohol misuse. Alcohol use is a common feature in Irish Society and is often considered socially acceptable and as such its misuse can often be over looked as a problem. We have been delighted, that whilst there has been investment in infrastructure in the Ballymun area, the statutory bodies have also had the foresight to invest in services to provide solutions to community social need. Whilst access to affordable and high quality accommodation is most sincerely welcomed, support to individuals to reach their potential and sustain their tenancies is also key to developing any community.
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Depaul Ireland's Ballymuin Case Management Team was a pilot project that sought to identify the level of needs of people in Ballymun with alcohol issues and to develop apprporiate responses to meet this need. It is clear that there has been, and continues to be, great need in this regard. The team have worked with individuals in a pragmatic way based on the principles of low threshold working and harm reduction. They have been flexible and adaptable to the needs of individuals, and in response to decreasing resources, by finding innovative and creative ways of responding. I would like to thank all those who have played a role in the team over the years, both staff and volunteers. I would like to thank the statutory funders, Ballymun Regeneration Ltd, Dublin City Council and the Health Services Executive, for their support. I would also like to thank the other voluntary and community sector providers in the areas for working collaboratively with us in order to respond to the needs of those who approach us. It is also important to thank those who have opened up their homes and their lives to the staff and volunteers of Depaul Ireland and have welcomed support to assist them in realising their potential.
Kerry Anthony MBE CEO Depaul Ireland
Introduction
Ballymun Case Management Team / Depaul Ireland
Ballymun has long been noted in media, television and the silver screen as an area of huge social deprivation, throughout its 40 year history its problems have been continuously publicised and its area vilified. In more recent times the huge integrated response of the local community, national and local government alongside voluntary and community agencies have changed Ballymun and its reputation. Ballymun has become the largest social re-development project in Europe and more importantly, its redevelopment has significantly improved the lives of the people of Ballymun. In the 1960’s Ballymun was developed as a new and modern response to Dublin’s inner city tenements and in 1966 when the first residents moved in to the flats, they made homes in well finished modern flats with internal amenities uncommon in the general housing stock across the country. In contrast, the promised external and community amenities which were intended to be provided were never provided and the area began a steady decline even before a real sense of community could be built. Fortunately, the recent and ongoing redevelopment of the area, which has been spearheaded by Ballymun Regeneration Limited (BRL) in conjunction with the local community have placed the community at the heart of their work and have coordinated a number of voluntary and community agencies to address the social issues in the area and to actively seek to provide real and positive supports to the area. Depaul Ireland’s Ballymun Case Management Team has been proud to have been a part of this and work in partnership with BRL over the past 7 years and hope to continue to serve the community of Ballymun into the future. This document outlines the work of the programme over the years and outlines how we as a service have evolved to meet the new emerging health, emotional and support needs of Ballymun as the physical needs changed with the redevelopment.
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Background to the Ballymun Case Management Team Alcohol, drug use, homelessness and other related problems have had a significant and lasting presence in Ballymun since its development. Without the proper social support structures (in the most part absent since the area’s development in 1966) Ballymun fell into an everdecreasing circle of decline, leading to physical dereliction and disjointed community. This is a factor recognised in the Ballymun Regeneration Master plan which acknowledges the interdependence of social, economic, and environmental well-being as integral to the local quality of life. In 2003 the Ballymun Homeless Action Plan showed that people in Ballymun with addiction issues were at particular risk of losing their tenancies due to a lack of appropriate support facilities in the area. In 2006, the Ballymun Homeless Forum commissioned TSA Consulting to quantify the extent of homelessness in Ballymun. At that time TSA Consulting concluded that there were between 70 and 100 homeless households (90-130 adults) in Ballymun.
Discussions between Depaul Ireland (formerly Depaul Trust) and local statutory and voluntary agencies led to the establishment of the Ballymun Case Management Team (BCMT) as a 15 month pilot project starting in October 2005. This was initially extended until December 2007 and has continued to run to the present day with the support of Ballymun Regeneration Limited.
Ballymun Case Management Team / Depaul Ireland
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Ballymun Case Management Team had two interlinked aims
To provide an outreach service to people in Ballymun who use alcohol and are homeless or at risk of homelessness, using a case management, harm reduction approach.
To gather information and views from service users and service providers on the future needs for alcohol support services in Ballymun through an action based research project.
In 2010, the Ballymun community alcohol strategy - “Road to Change” document noted that “Ballymun alcohol consumption levels match and in some cases exceed national consumption levels which have risen exponentially since 1989”. The report highlights that the increasing consumption levels have led to a consequent rise in health and social harms. The strategy proposes that a number of areas must be addressed locally to reduce the harm caused by alcohol in Ballymun; by reducing overall community consumption levels, modifying local drinking patterns and changing community attitudes on alcohol and alcohol related harm. Depaul Ireland’s Ballymun Case Management Team impacts on the third key area: Treatment and rehabilitation, with an agreed responsibility to disseminate appropriate information in the community on support options available to families affected by alcohol use. In addition we have a comprehensive Case Management programme of support and signposting which is integral to the wider social supports to the Ballymun community.
Depaul Ireland
Ballymun Case Management Team / Depaul Ireland
Depaul Ireland has its roots in the 400 year old tradition of Vincent Depaul and Louise de Mariallac who worked in Paris and throughout France with those who were the most marginalised and excluded in society. Vincent’s focus was on what you do, not what you say. Today in Depaul Ireland there is a commitment to remain true to this Vincentian ethos seeking to actively engage with those who are excluded elsewhere, and it is in doing this that the evidence of remaining as low threshold as possible is seen.
Our vision is that everyone should have a place to call home and a stake in their community. Our Mission is to offer homeless and disadvantaged people the opportunity to fulfil their potential and make positive, informed choices about their future.
Our Values– • We celebrates the potential of people • We put words into actions • We take a wider role in civil society • We believe in rights and responsibilities
The Depaul Trust was established in London in 1989 by the late Cardinal Basil Hume as a response to growing numbers of rough sleepers in the city, and it was set up in Ireland in 2002 at the request of the Society of St Vincent de Paul, the Daughters of Charity and the Vincentian Fathers. Depaul Ireland’s first Irish service opened in Dublin in February 2002, and it has expanded since to include six supported accommodation services, a medical services team, an outreach support team, befriending service and volunteer programme. In September 2005 Depaul Ireland opened its first homeless service in Northern Ireland and currently has 6 projects across Northern Ireland in Belfast, Derry, Lisburn, Newry, Armagh and Dungannon.
Ballymun Case Management Team The team comprises one manager and two case management workers. The work of Ballymun Case Management Team originally focused on homeless street drinkers, although subsequently it became apparent that there were fewer street drinkers than had been expected, and many of them had tenancies of their own. Depaul Ireland recognises that ‘problem’ drinkers require appropriate accessible services that address their health, housing and social needs as well as their alcohol use.
A key feature of Ballymun Case Management Team’s approach is case management. Whilst there are many definitions of case management, it is in essence concerned with ensuring that each individual receives a package of services from a range of organisations that is tailored to meet their specific needs. In adopting this model of working, Ballymun Case Management Team identified four stages: assessment; support planning; advocacy, and post programme support.
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Ballymun Case Management Team / Depaul Ireland
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Harm Reduction
Low Threshold Working In line with the roots of the organisation there is a commitment within Depaul Ireland to continue to work with those who are most marginalised within society. Depaul Ireland recognises the need for a continuum of care for those who are homeless or at risk of homelessness. Low threshold services can offer a point of entry into this continuum of care and provide an opportunity for people to be supported in accessing other appropriate services to meet presenting needs.
Low threshold in essence means high levels of acceptance of individual circumstances and essentially working with those who require high support. The adoption of this principle allows us to address the needs of the most vulnerable in a non-judgmental manner, acknowledging people make particular lifestyle choices. By applying the principles of harm reduction to this we recognise that these individuals have rights in continuing with such choices, but support them in reducing the harm they are causing to themselves. “The aim of “low threshold” is to maintain the serviceaccess requirements at such a level that as few people as possible are excluded. Emphasis is placed on engaging and maintaining engagement with service users especially working with those who present with very difficult behaviour. If peoples’ lives can be stabilised to the extent that they can move on to a “normal” higher threshold service, this is welcomed and encouraged, but it is not an expectation or a prerequisite of accessing a low threshold project. While consistency is important, in a low threshold approach, this is balanced with the fact that people have different capacities of understanding and compliance.” (Cassidy 2007).
Harm reduction refers to strategies which are aimed at reducing alcohol-related harm, where alcohol users are either unwilling or unable to stop using alcohol. Arguably harm reduction techniques are less clear-cut with alcohol users than with drug users, however, at a minimum, basic needs should be met as far as possible in order to provide a basis to reduce further harm. In order to employ harm reduction, workers should be able to present accurate information and may express their own beliefs, but they should not make judgments for people. Harm reduction recognises that even very minor improvements in a person’s behaviour, or positive small steps should be encouraged and nurtured as this may be the most that they are capable of at this time. Some principles of “harm reduction” include the following:
• Abstinence is preferable and a person who wishes to be abstinent should be encouraged and facilitated; • It is a social reality that some people are demonstrably unable to achieve or maintain complete abstinence; • Different people may have different desires and their capacity for change may vary; • Peoples’ desire and capacity for change can vary at different points within their lifetimes and are sometimes contingent on a variety of circumstances; • Harm Reduction promotes any practice that maintains or improves a person’s health; • Harm Reduction is not an all or nothing approach and is not dependent on a person observing all or any behaviours and practices recommended to them; • Taking care of oneself is a skill that can be learned; • People who value themselves and whose self-esteem is nurtured are more likely to attempt to minimise harm for them. (Cassidy 2007).
Needs based approach
Ballymun Case Management Team / Depaul Ireland
Ballymun Case Management Team provide case management and keyworking support to each service user through a user led approach. Keyworking is the process of taking responsibility to ensure that the needs of service users are met and reviewed on a regular basis. The Key worker is responsible for the implementation of specific case actions within a specific organisation. They encourage individuals to use the service(s) available, but do not push these on people who are unwilling or not motivated to use them. This needs lead approach and the willingness of staff to meet individuals where they are at with their issues is essential and has led to high numbers availing of services.
Depaul Ireland Alcohol Services Depaul Ireland have been working with long term street drinkers in Dublin, Belfast and Derry for 10 years, beginning November 2002 when Dublin’s first ‘wet shelter’ Aungier Street was opened. During the course of the last 10 years Depaul Ireland has developed a wealth of skills and knowledge in providing low threshold services based on the principles of harm reduction, in both community settings (Ballymun, Derry, Armagh, Dungannon, Newry, Belfast) and accommodation services (Dublin and Belfast). At inception, the Ballymun Case Management Team was tasked with a specific emphasis on working with people who were homeless and street drinking – the assumption being that people who street drink are most likely homeless. A definition of street drinking is provided by Lamb (1995) as:
‘... A person, who drinks very heavily in public places and, at least in the short term, is unable or unwilling to stop or control his or her drinking’. Most street drinkers have a long history of alcohol misuse. Street drinkers often drink in groups for companionship’. Depaul Ireland recognises that those who street drink experience a number of problems related to their lifestyle, including (but not limited to):
• Housing problems - there is a perception that street drinkers are sleeping rough. This is not always the case but they do have housing problems of various types • Health problems - often related to their alcohol use • Problems with the Gardaí this may be because they are contravening bye laws, begging etc. • Safety problems - street drinkers are often subject to physical violence • Low self-esteem and feelings of “hopelessness”
It is recognised that street drinkers need appropriate, accessible services which address their: • Housing needs - single homeless people face problems in finding appropriate housing. This is partly due to the fact that local authorities are unlikely to class people with drug or alcohol problems as vulnerable or in priority need. The ending of this practice would make a considerable difference, allowing more single homeless people to find accommodation. • Social needs - for most street drinkers, their whole life revolves around drinking. Therefore if they decide to give up or cut down their drinking, something is needed to fill the gap. For many, employment is not a viable option, but befriending schemes or skills training may be. • Drinking - mainstream alcohol services aim to enable people to change their drinking habits but research suggests that “many who are homeless or inadequately housed, in poor health and with a chaotic lifestyle may not be ready for this dramatic change. Health, welfare and housing issues may need to be tackled first. Some street drinkers may never be ready to or wish to address their alcohol problem” (Lamb 1995). • Health needs - many street drinkers have difficulty in gaining access to healthcare services, especially psychiatric services. They suffer from a wide range of illnesses which are exacerbated by their drinking, poor diet and sleeping rough for extended periods and they are at risk of injury from falls and attacks.
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Case Management
Ballymun Case Management Team / Depaul Ireland
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Employing the model: Ballymun Case Management Team In adopting the case management model the team looked at the model in four different stages: assessing, planning, brokerage and tracking/post programme support. The staff members of the Ballymun Case Management Team are all trained in these four areas. Service users with substance abuse problems require assistance in linking with multiple systems and support services since their needs are so complex. A model of care and case management has been adopted by the Ballymun Case Management Team. There are different definitions of care and case management but a general consensus as espoused by Depaul Ireland are: Case management involves the co-ordination of services at management and administrative level. Fragmentation and the poor integration of services, increased care costs, and trends towards locally-based service delivery have all contributed to the development of care management models. Case management involves actions at service user level and the delivery of individually, tailored support plans. The recognition that service users have multiple, complex needs has led to individualised, personcentred planning and thus case management. The core principle of person centred planning is the central involvement of service users in planning their own futures.
This distinction is recognised in the Homeless Agency Strategy (2004-2006), “Making It Home” (Homeless Agency 2004). In this strategy, care management is described as a support to the delivery of case management through sector wide planning, monitoring and evaluation, and troubleshooting in the event that there are blockages in the system. Case management is described in terms of holistic needs assessment, support planning and implementation, through a multi-agency approach with a case manager taking responsibility for an individual or family, ensuring those assessments, planning and implementation occur according to commitments made by the relevant service providers. Benefits cited in the use of care and case management include: • better co-ordination of service delivery, • improved outcomes for service users, • improved service accessibility, • more accurate identification of service user needs, • more appropriate use of services, • provision of continuity of treatment, • focus on positives/strengths of the service user • a means of marshalling restricted resources, • it engenders and supports a ‘what works’ philosophy
1. Assessing- Ballymun Case Management Team supports service users in determining what services they need and securing access to them. Aspects of the work of the team include assisting individuals to sustain their tenancies; and carrying out assessments of service users’ health, social, and housing needs. The team links people into the required services to assist and support them and advocate on their behalf when needed. The Ballymun Case Management Team works within a harm reduction framework as mentioned earlier, through a personalised programme of support planning and keyworking. Support planning consists of advice and supports on areas such as budgeting, alcohol management, health related issues, creative activity, meaningful occupation and activities that promote selfesteem. Ballymun Case Management Team works with families of dependent service users and educates them as to the services available to them. 2. Planning- Support plans are agreed in partnership with service users and outline realistic expectations. These support plans are reviewed and changed accordingly depending on the current needs of the service user.
3. Brokerage- An important aspect of the work is of the Ballymun Case Management Team is in relation to advocacy or brokerage. The team supports people to advocate for themselves but advocates on their behalf when appropriate -many are unable to access services for many reasons including literacy problems, intoxication and lack of awareness of current available services. 4. Tracking- Ballymun Case Management Team will keep an open channel of contact with each service user that wishes to stay working with the team. This is an important part of case management as many of our service users have complex needs and are transient in nature, moving from service to service. If they have a particular service which they can link in with to provide referrals and general support, then the service user is not lost in the system. All service users accessing the Ballymun Case Management Team more than once have a file set up which records personal information and support plans. The longer the service user accesses the service the more information is gained.
Basic Profile of Ballymun Case Management Team
Ballymun Case Management Team / Depaul Ireland
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Aim • To provide an Outreach and Floating Support service to people in Ballymun who use alcohol and/or are homeless or at risk of tenancy breakdown, using a Case Management and Harm Reduction approach to enable positive and lasting change.
Objectives • To provide information and advice to those engaged in, and affected by, alcohol misuse through outreach and floating support, one to one sessions and group work. • To carry out holistic assessments of the individual’s needs in order to identify the relevant supports and services required to address those needs. • To work in a holistic manner and plan actions around the needs of each service user through keyworking, risk management and support planning, encouraging a journey of change for each individual. • To advocate on behalf of each person, liaising effectively with other services in a joined-up case management and interagency approach to support provision • To work within harm reduction principles to enable positive choice-taking As the physical environment of Ballymun has developed and improved, the social and emotional needs of our service users have changed accordingly; the high quality housing has reduced homelessness and helped secure tenancies, the access to transport has reduced street drinking and increased community safety, the coordinated approach of all agencies has helped support the local people in developing and celebrating a real sense of community. With these developments, the Ballymun Case Management Team has had to be malleable to the needs of the service users within the ever improving structures in Ballymun to ensure the delivery of a comprehensive service to the people and families who need it in Ballymun. The aims and objectives of the programme remain:
• To deliver a non-judgemental and confidential service, respecting each individual’s choice and dignity.
Ballymun Case Management Team offers a range of support services to people in Ballymun; to Individuals and groups of people dependent on Alcohol and support to families of people dependent on alcohol. Our work primarily focuses on individuals with alcohol related problems. We apply a comprehensive assessment of current levels of drinking and individual needs and develop a specific support plan that enables individuals to reduce or stop their drinking. This is achieved through a harm reduction approach through 1 – 1 work or group work with their dedicated key worker. We also deliver regular group work sessions throughout the year. The focus of the group work is to equip individuals with skills and coping strategies to manage or stop drinking. In addition, we work with family members who are concerned about their family member’s level of alcohol use. This is done through 1 – 1 work and/or group work and focus on awareness, support, skills and strategies to help move forward.
Ballymun Case Management Team / Depaul Ireland
Needs and Background (of SU's and Service)
Questionnaire Overview and 6 year review:
Ethnic Origin: White Irish: 99.96% Other Ethnic: 0.04% [10 Travelling Community, 1 Indian, 3 Polish]
GENDER
18-25
26-40
41-65
65+
TOTAL
MALE
8%
34%
20%
2.5%
64.5%
FEMALE
4%
18%
12%
1.5%
35.5%
TOTAL
12%
52%
32%
4%
100%
Primary Needs: Alcohol Misuse – 90% Housing Need – 10%
Secondary Needs: Emotional & Mental Health – 80% Physical Health – 70% At risk of tenancy breakdown – 65% Family/Relationship Difficulties – 25%
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In 2006 the Ballymun Case Management Team carried out an extensive research project into the alcohol related needs of the community in Ballymun and the responses to these. As part of the research a number of questions were asked to organisations and individuals in the area and allowed us to gain an insight into the reality of the situation in Ballymun for people addicted to alcohol, their families & friends and the wider community. For this report we asked the same questions 6 years on to gauge what, if anything had changed for these people in Ballymun and if so, what were the emerging needs. While this survey is not to be considered extensive academic research, it is of significant indicative value and while the results were much the same as the 2006 survey, there were some exceptions which are worthy of consideration. In 2006, 90% of respondents had reported that alcohol was a “Very Serious” problem in Ballymun, by 2012; this had reduced to 55%, with a further 45% considering alcohol to be a “serious” problem. In addition to this, the number of respondents who felt that there were still barriers in Ballymun to people accessing appropriate services had gone from 59% in 2006 to 27% in 2012. In 2006, 81% of respondents noted that Alcohol was too readily available in Ballymun, in 2012, this level had risen to 100%, however it is worth noting that there was a reduction in the number of 2012 respondents (69%) who felt that alcohol was being sold to underage young people in Ballymun from the 2006 respondents (81%).
There were differences in the prioritisation of need from 2006 to 2012, the 2012 results are shown in the table below, it is noteworthy that the top 5 results from 2006 were; 1. Poverty, 2.Family, 3.Antisocial behaviour and crime, 4.Children and Young People and 5.Housing. The 2012 results shared only 2 areas (Antisocial behaviour and Poverty) with 2006 and placed a much higher importance on: other substance use, Mental Health and Employment. It is commendable that in face of the financial crash of the Celtic Tiger, the work of Ballymun Case Management Team and the other agencies in Ballymun have together seen a stabilising of the overall community in Ballymun with no significant regression of services in the area in line with the recession as may have been expected. It is imperative that we ensure that such vital services are continued, particularly in light of current circumstances in Ballymun and the country in general. The final chart details the “locations” where respondents felt services to alcohol users should be delivered; “in their homes” was top of the list, followed by “in a dedicated alcohol service” and “on the street” in joint second. This in itself indicates to the success of the Ballymun Regeneration work carried out by Depaul Ireland’s Ballymun Case Management Team and our colleagues who have managed to work so productively on securing appropriate tenancies that the alcohol issues can be taken from the streets and into people’s homes.
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01
03
In your opinion what are the most significant problems in Ballymun?
Where do you think the main alcohol support services to people in Ballymun should be provided?
45% 5
Housing
27% 3
Family
55% 6
Physical Health
82% 9
Mental Health
64% 7
Children / Young People
18%
Community
2
55% 6 In the Community Centre 55% 6 In the Health Centre / GP 64% 7 Dedicated alcohol support service 73% 8 In their own homes 64% 7 On the street
100% 11 Anti-Social behaviour / Crime 82% 9 91%
Employment
10 Other Substance Misuse
73% 8
0
Money and Poverty
2
4
6
8
People may select more than one checkbox, so percentages may add up to more than 100% 0
2
4
6
8
10
12
People may select more than one checkbox, so percentages may add up to more than 100%
02
04
Alcohol affects OTHER people both Socially and Emotionally in Ballymun. In your opinion, who are the most affected by alcohol use?
Do you think that additional services/supports are required in Ballymun for alcohol users?
73% 8 Children 0-12
55% 6 Day Service
91%
10 Young people 13-18
55% 6 Outreach Service
18%
2 Single Parents
64% 7 Increased homeless services to
91%
10 Families
55% 6 Increased primary health services to
18%
2 Men
55% 6 Counselling
18%
2 Women
45% 5 Prevention / Public education initiatives 64% 7 Training for people who work with
support people with alcohol issues support people with alcohol issues
alcohol users
36% 4 People using other substances 18%
64% 7 Training / Support for people affected by alcohol (eg. Family members)
2 Local businesses
36% 4 Information on harm reduction in relation to alcohol
36% 4 The Elderly
100% 11 Support for children affected
45% 5 The wider community
0%
by alcohol
0
2
4
6
People may select more than one checkbox, so percentages may add up to more than 100%
8
10
0 Other
0
2
4
6
People may select more than one checkbox, so percentages may add up to more than 100%
8
10
12
Partnership working:
Ballymun Case Management Team / Depaul Ireland
Our Ballymun Case Management Team works with a wide range of other groups, agencies and individuals and since opening have been fortunate to have worked with the following:
AA meetings (Alcoholics Anonymous) Aisling Project Ballymun Gardaí Ballymun Law centre Ballymun LDTF Ballymun Mediation Ballymun Partnership Ballymun Women’s Resource Centre Ballymun Community Organisations Network (BCON) Ballymun Regional Youth Resource (BRYR) Community and Family Training agency (CAFTA) Community Action Programme Citizens Advice Coolmine House Community Psychiatric Nurse (CPN) Cuan Mhuire - Limerick Dublin City Council (DCC) Domville House (HSE) Drop In Well Finglas Addiction Services Team – Finglas / Cabra Partnership Focus Ireland Friends of the Elderly Geraldstown House Community Recourse Centre Headway Ireland Home Help Health Service Executive – Primary Health Care Team Jobs Club Lantern Project (Peter McVery Trust) Local Community Welfare Office Local Off Licenses
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Highs and lows of the service and challenges
Local Pharmacies Money Advice Bureau Service (MABS) Mater Hospital Men’s Centre (Ballymun) Men’s Resource Centre (Ballymun) Merchants Quay Ireland Occupational Therapist Team Peter McVerry Trust Probation Services Rape Crisis Rehabilitation and Integration Santry Lodge (Dublin) Simon Alcohol Detox
Lows (Challenges)
Highs (Successes)
•Changing Needs: In the early phase of the service homelessness was not the prevalent issue for street drinkers as many had tenancies and weren’t homeless – consequently the service had to adapt to their needs.
• Changing needs and adaptability: We successfully re-focused work with people who were street drinking to work through outreach and in their own homes.
•Service-user Engagement: The nature of our work has presented difficulty with serviceuser engagement, attendance, one-one engagement and openness etc. Staff have been trained in methods of working which create an open and comfortable space for individuals to feel welcome and supported. •Sourcing Housing Options: The initial lack of appropriate accommodation (especially private rental) for move on led to significant difficulties in accessing suitable temporary and longer-term supported accommodation for service users. •Encountering Multiple Needs: Discovering additional complex needs of service-users in addition to their alcohol dependency , e.g. housing/tenancy sustainment, family/ relational issues (including DV), anti-social behaviour, bereavement, emotional and mental health, a history of social exclusion, required a strong joined up approach with other agencies in Ballymun.
• Networking and Relationship Building: Our work with partner agencies is the essence of case management, where the service has embedded in the local area, working with other agencies and groups for the good of service-users. • Relational approach to engagement: Our proactive approach has meant that through a mix of outreach, sessions in the Ballymun Case Management Team offices, work in people’s homes, group work and one to one work as well as a person-centred SUled approach the service has ensured higher levels of engagement and continuity with service users despite challenges. • Specialist housing support: The development of our tenancy sustainment and signposting, advocacy and partnership work for successful housing transition has proved vital in helping service users move on positively with their lives in their own homes. • Low-Threshold and Case Management: The service has established a strong case management approach, thus enabling robust work in harm reduction with service-users with complex needs, and a low-threshold approach that ensures the service remains accessible and flexible to those who need it.
Flow of change: Development of Ballymun Case Management Team in line with the re-development of Ballymun
Physical Change and Street Drinking: When the programme began in 2005 there was a significant amount of street drinking in the area, this reduced over 2006-8 as we were able to assist service users to access hostels, private rental options and transitional housing. As the demolition of the tower blocks progressed, some problems which had been previously out of sight became more evident, which gained considerable attention from the media and Gardaí who took a tougher stance on street drinking. Flexible outreach work from the Ballymun Case Management Team was introduced to address these trends and led to the development of the Ballymun Case Management Team’s initiative to work in people’s homes. This has in turn developed into the group work sessions with our service users and their families aimed at enhancing living skills, tackling social isolation and addressing anti-social behaviour.
Interagency Partnership in the Local Area: Ballymun Case Management Team has worked tirelessly to develop local partnerships with statutory and voluntary agencies in Ballymun and the success of our work is due in no small part to the huge support and professionalism of our partners in Ballymun. The needs of the service-users in Ballymun clearly required a multi-agency response as multiple needs on top of alcohol use became apparent. A series of open days (2006/7/8), as well as one to one relationship building with other providers helped develop the strong interagency partnerships visible today. As the area began to address the wider social issues, the Ballymun Case Management Team too moved from meeting needs with individuals as we found them, to working in more strategic partnership around the presenting (and continually changing) issues.
Ballymun Case Management Team / Depaul Ireland
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Experience Speaks – Words from our Service Users: Simon’s Story Simon first came into contact with the Ballymun Case Management Team back in early 2007 due to his levels of alcohol intake and anti-social behaviour. Simon is living in a Statutory Housing provider accommodation and his neighbours had made many complaints about his anti-social behaviour while drinking – not maintaining his accommodation well and returning very intoxicated, abusing neighbours and generally letting his personal care deteriorate to a very poor level. At the start Simon was not able to recognise or deal with these issues. Ballymun Case Management Team spent a long time building a relationship and trust with Simon and eventually he allowed them into his home, where many efforts have been made to support Simon in all of the above issues. Success and progress has been made in several areas, and importantly Simon is now linked in with a number of supports – Home Care, local Nursing Support, his local Church, GP, his Community Welfare office, his statutory housing provider and his case manager from Ballymun Case Management Team. Despite all the odds against him, and still with some supports in place, Simon has avoided homelessness and further social exclusion and has maintained his home and developed stronger links with his community.
Peter’s Story Peter is a middle-aged man who came into our service 2 days before Christmas Eve one year looking for support relating to accommodation, as he was homeless due to his excessive drinking. Peter had suffered a recent bereavement and was estranged from his children due to an increase in his drinking to cope with his loss. As a result, Peter had been asked to leave the family home. Ballymun Case Management Team staff accessed emergency accommodation for Peter; however this soon broke down due to Peter’s chaotic behaviour. The team then worked with Peter’s family who, with the support of the staff, offered Peter a place to stay if he engaged with services. These supports for Peter and his family were put in place and the team advocated with numerous other services through the case management approach. This approach enabled Peter to attend relapse prevention sessions, counselling, stress management and perhaps most importantly gave him the opportunity and support he needed to remain sober. After a lot of hard work and support, Peter remains sober and has recently got new accommodation with his family. He is resolutely moving forward with his life.
“Eight weeks ago my life felt messed up badly. With the support in Ballymun Case Management Team I had my issues addressed and now I'm moving on. The Ballymun Case Management Team is an honest group and I'm enjoying my time with them”. Male, aged 44 “Your service saved my life. Depaul Ireland (Ballymun Case Management Team) has saved my life without the support I would still be in the gutter. You have provided me with the skills and the knowledge of moving forward and I have learned how to enjoy life once more”. Male, aged 49 “Depaul Ireland in Ballymun has helped me so much over the past couple of years in dealing with my alcohol abuse. the staff are always available to offer family support and are an asset to the local community”. Male, aged 51
Conclusion: What does the future hold? The Housing Strategy report (Sept 2010) has stated the expected completion of all replacement social housing in Ballymun by 2014. This is indeed excellent news but while this may bring resolution the physical and social housing needs of the community in Ballymun, it is not the end to our social problems. If we were to hold onto one lesson from Ballymun’s past, it is that irrespective of the quality and modernity of its housing stock, a community needs support, guidance and advice to help it grow and develop, to help it address its problems and move towards a positive and stable future.
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