MEAM supports 11 local areas in co-ordinating services for people with multiple and complex needs. At Clinks, Isabel and I have been helping these areas to agree which clients to work with. This is a critical stage of the MEAM Approach.
The MEAM Approach involves working with a small number of clients who have the most complex needs and ineffective contact with existing services. There is usually a co-ordinator employed to work directly with the clients and broker more flexible support from local services. One of the first steps for local partners is to agree how they are going to consistently identify which clients to work with, which is not always straightforward. Here are some of the issues and questions we have been grappling with:
How many clients should you work with?
In Sunderland we initially envisaged a coordinator working with 15 clients over a one year period. However, this is starting to look a little unrealistic. Within the first month of the coordinator taking up post, three clients were identified as needing long-term support. The coordinator has also spent a considerable amount of time providing crisis intervention for one of the clients. Whilst a larger client base makes it easier to evaluate and demonstrate the cost effectiveness and impact of your work, it seems that in order to provide the one-to-one intensive support some clients need, a coordinator would need to work with either a smaller number of clients or a range of clients with varying degrees of need.
It is too early to provide a definitive answer to this, which is why the pilot exists. In Sunderland, we have discussed how services themselves should be providing more support to the clients, and not leaving it all in the hands of the coordinator. However, at a time of increasing demand on services and limited resources, will this be possible? This is something commissioners will need to take into consideration and puts more emphasis on the need to evidence the social and economic impact of the MEAM approach.
What assessment and referral process do you use?
Having an effective assessment process seems to be key to the success of the MEAM pilots. The process needs to be flexible enough to ensure those with the greatest needs are supported, but rigid enough that all agencies are clear about which clients should be referred in. The process should avoid agencies using MEAM as a quick solution to pass over a client that is difficult to engage / work with.
There are various assessment processes that can be used, including the New Directions Team assessment or ‘chaos index’ (recommended by MEAM), and the Homelessness Risk Impact Assessment developed in Devon. What is important is that all local agencies understand and agree to one set of criteria. It is important that it is not seen as a ‘homelessness’ assessment as opposed to a ‘criminal justice’ one, for example, but has buy-in from all partners.
There are some dangers of using risk-based assessments. As Julian Corner argued in his speech at our AGM, it is counter-productive to focus on and organise services around a standardised assessment of the risks a person poses at a given moment rather than that person as an individual with a history and background.
Another issue is that people’s needs and risk fluctuate, so a MEAM intervention needs to find a way to respond to this. In Sunderland there was discussion about the MEAM group meeting on a weekly basis to discuss client referrals. This caused concern about capacity and the ability to maintain engagement from all agencies. At a national learning event the coordinator from Cambridgeshire made a very good point; if clients who were referred into MEAM no longer need support by the time the group meets to discuss referrals, then that client was never a MEAM candidate in the first place. This point really resonated with me as MEAM is about trying to work with clients to overcome deeply entrenched issues and is therefore looking for long-term solutions and support; not quick fixes.
How do you link with other local cohorts and partnerships?
The purpose of MEAM is to improve existing systems for clients with multiple and complex needs; not create new ones. Therefore it is imperative to link the MEAM pilots into existing partnerships and local structures. One example is the NHS England Liaison and Diversion pilot schemes in which ten areas will appoint mental health workers to work in police custody suites to assess mental health needs. This is not a treatment service, but it is an identification, assessment and referral service. In order to ensure clients receive the best possible treatment the Liaison and Diversion pilot areas are developing partnerships to influence the work and identify gaps in services; very similar to MEAM partnerships. There is an opportunity for the two to work together to provide system change for clients with multiple and complex needs.
In Exeter, the MEAM partnership has discussed the relationship of MEAM to Troubled Families, which is also co-ordinating services, but for families with complex needs. After considering an overlapping cohort (where some clients fit both MEAM and Troubled Families criteria), the partners have decided that it is best for MEAM to refer appropriate clients (usually any living with their children) across to Troubled Families, allowing MEAM to concentrate on those clients not getting adequate support elsewhere. Exeter MEAM is also learning from Bristol’s Integrated Offender Management team, which has a close partnership and referral process with Troubled Families.
We would love to hear your thoughts about how to agree cohorts of clients to work with in local partnership arrangements, or any questions or comments about the MEAM approach.
Written by Natalie Maidment (Local Development Officer North East) and Isabel Livingstone (Local Development Officer South West)