Institute for Community Research and Development Multiple and Complex Needs in the West Midlands

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