Working with individuals who have experienced homelessness. Stresses and Successes

Purpose Staff who work with vulnerable people with multiple needs are known to experience high levels of stress and burnout, as well as high levels of job satisfaction. This paper explores the experiences of staff working in a project with individuals experiencing long term homelessness in Lincolnshire. Design/methodology/approach An evaluation of a project working with individuals experiencing long term homelessness included a focus group set up to explore the experiences and well being of front line staff and managers. One to one interviews with staff were also held to provide more in depth data about the experiences of individual staff members. Findings Six key themes were identified from the discussions with participants. Decision latitude and the ability to follow service users on person centred journeys over long periods of time were positive aspects of the work which were highly valued and seemed to contribute to high levels of job satisfaction. Things which also made a positive contribution were elements of support provided by the employer and a number of personal coping strategies. Themes identified which had a negative impact on well-being related to high workloads and to the multiple and competing demands from service users and other agencies. Originality/value Few studies of any kind have explored the experiences and wellbeing of staff working in the frontline of homelessness services. This small scale qualitative study provides a number of suggestions for further research with this population. Findings cannot be generalised but match those of other recent studies which suggest high levels of stress but little evidence of burnout, and that carefully developed workplace support mechanisms play a key role in maintaining commitment to the role and preventing burnout

Welfare conditionality and social marginality: the folly of the tutelary state?

In a contemporarnb 1`vby evolution of the tutelary state, welfare reform in the United Kingdom has been characterised by moves towards greater conditionality and sanctioning. This is influenced by the attributing responsibility for poverty and unemployment to the behaviour of marginalised individuals. Mead (1992) has argued that the poor are dependants who ought to receive support on condition of certain restrictions imposed by a protective state that will incentivise engagement with support mechanisms. This article examines how the contemporary tutelary and therapeutic state has responded to new forms of social marginality. Drawing on a series of in-depth interviews conducted with welfare claimants with an offending background in England and Scotland, the article examines their encounters with the welfare system and argues that alienation, rather than engagement with support, increasingly characterises their experiences

Re-building bridges: homeless people's views on the role of vocational and educational activities in their everyday lives

Homeless people face everyday challenges of marginalisation and stigmatisation. Consequently, they can suffer from low self-confidence, self-efficacy and agency. Empirical research in Britain on educational, skill-building and meaningful activities for homeless people principally emphasises the instrumental value of training and learning as a route to employment rather than the impact of activities on homeless people's everyday lives. Theoretical literature suggests that psychosocial benefits related to the development of self-efficacy, agency and empowerment can be gained from such activities. Participants' experiences and perceptions of educational and recreational activities were examined through 29 interviews at three homeless day centres in London. Thematic analysis suggests the restorative power of engagement in activities and shows that participants value activities, not only as the foundation for future goals of finding employment and housing, but as an immediate way of restoring a sense of self and finding positive experiences with a focus on the present. The findings underline the importance of viewing these interventions from a ‘bottom-up’ perspective. The study tentatively concludes that accepting and emphasising the immediate personal benefits as a positive achievement of activities may be a valuable approach to better engage homeless clients

Implementing psychological formulation into complex needs homeless hostels to develop a psychologically informed environment

This study explored the implementation of psychological team formulation in two single-gender hostels for homeless individuals experiencing multiple complex needs. Nine hostel staff took part in two semi-structured interviews, before and after attending up to eight formulation meetings. Thematic analysis identified that staff perceived team formulation to increase their understanding of service users, led to some developments within the team, and encouraged staff to take a different approach to their work, perceiving themselves and service users more positively; however, the usefulness of formulation was restricted by the systemic limitations. Results suggest team formulation has notable benefits for staff in hostels supporting individuals with multiple complex needs

Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review.

OBJECTIVES: The aim of this systematic review was to identify and conceptualize the barriers and enablers to accessing dental services for people experiencing homelessness in the United Kingdom. METHODS: A literature search for studies relevant to homelessness and dental care was conducted. The PRISMA and ENTREQ guidelines were followed. Electronic databases (EMBASE, MEDLINE, DOSS, CINAHL, SOCINDEX and PsycINFO) and grey literature sources (Electronic Theses Online Service - EThOS, Kings Fund, NICE Evidence, Open Grey, Google and the Health Foundation) were searched up to 28 August 2018. The critical appraisal was conducted using CASP and an adjusted version of a JBI Critical Appraisal tool. Thematic analysis was used to develop the themes and domains. RESULTS: Twenty-eight papers were included. Barriers to homeless people accessing dental care stemmed both from the lived experience of homelessness and the healthcare system. Within homelessness, the themes identified included complexity, emotions and knowledge. Regarding the healthcare system, identified themes included staff encounter, accessibility and organization issues. CONCLUSION: Homelessness can actively contribute to both an increased need for dental care and barriers to accessing that care. The arrangement of dental healthcare services can also act as barriers to care. This is the first systematic review to conceptualize the factors associated with access to dental care for people who are homeless. It provides a set of recommendations for overcoming the main barriers for homeless people to accessing dental care. It also offers directions for future research, policy and commissioning

Reflexive mapping exercise of services to support people experiencing or at risk of homelessness:a framework to promote health and social care integration

This article describes the process to create a framework to map services for people experiencing and/or at risk of becoming homeless. Using a participative and multi-agency approach the Reflexive Mapping Exercise (RME) was proposed to increase knowledge on what is available to address the health and social care needs of those experiencing homelessness and to encourage synergies between sectors addressing prevention and management of homelessness. Applied in the Scottish context of design and implementation of national and local policies, this framework identify gaps in service provision and can be a tool to improve integration and communication between services to support vulnerable groups. The RME results provided information of the current status of services in eight areas of care, combined with their spatial distribution. The analysis revealed an unequal distribution of services, with major focus on services addressing crisis periods of homelessness and less on prevention and sustainability out of homelessness. The REM has been informing the redesign of services of a local five years homelessness strategic plan (2016-2021) in a Scottish city, with high levels of deprivation, and can be used to create more integrated pathways to health and social care for people experiencing extreme social exclusion

Policy responses to ‘Rough Sleepers’: opportunities & barriers for homeless adults in England

In the winter of 2018, high profile debates about ‘rough sleepers’ intensified following reports about men who died in freezing conditions. Government since pledged to cut the number of rough sleepers by half by 2022 and eliminate it by 2027. This commentary reviews two pieces of legislation, which could support this target: the Care Act 2014 and Homelessness Reduction Act 2018 . It argues that policies offer opportunities to improve outcomes for rough sleepers, given historic failings to provide for this social group . However, financial and institutional barriers remain

Complex needs in homelessness practice; a review of 'new markets of vulnerability'

This article reviews institutional responses to adult homeless people, to argue that there is a contemporary flourishing of debates about complex needs across homelessness research and practice fields. These understand housing need as a mental and physical health issue and a care and support need, with foundations in biographical and societal events, issues and experiences, including trauma. Responses to complex needs are conceptualised as enterprising in scope; articulated as fresh, proactive, preventative and positive. The article suggests that there are a range of legislative, policy and funding drivers for these developments, from across homelessness, housing support and adult social care fields, which are distinctive to the English context. At the same time, debates about what complex needs are, and how best to respond to them, are evident in international debates about service delivery models with homeless service users in the Global Western North. ‘Complex needs’ is defined as a travelling concept, with affective qualities, which provides foundation for practice interventions, techniques and principles in different locations. The article conceptualises institutional machinations around the governance of complex needs as ‘new markets of vulnerability’. This term theorises new markets and new marketising strategies around complex needs in the context of a much larger reconfiguring of the mixed economies of welfare around markets and market mimicking devices and practices. It is argued that the intensification of activities around complex needs give insight into processes of neoliberalisation in contemporary modernized welfare ‘mixes’