Appendices Table of Contents - WY-FI Project · Member of steering group. Emergency Temporary...

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Appendices

Table of Contents Appendices ............................................................................................................................................................ i

Quarterly Partner Update Reports, Activity and Learning ............................................................................ 27

Bradford ..................................................................................................................................................... 27

Calderdale .................................................................................................................................................. 30

Kirklees ...................................................................................................................................................... 35

Leeds .......................................................................................................................................................... 39

Wakefield ................................................................................................................................................... 45

Touchstone ETE ......................................................................................................................................... 49

Starts, Demographics, Equality and Diversity, Beneficiary Progress ............................................................. 54

Starts by Locality ........................................................................................................................................ 54

Demographic Summary ............................................................................................................................. 54

Needs ......................................................................................................................................................... 54

WY-FI Beneficiaries .................................................................................................................................... 54

Peer Mentors ............................................................................................................................................. 54

Education, Training and Employment ....................................................................................................... 54

Summary (All Based on Current Caseload unless otherwise stated) ........................................................ 55

Consent form Collection ............................................................................................................................ 55

Planned and Unplanned Exits (All Discharges) .......................................................................................... 56

Support Plan (Indicated by date on MIS) – Current Caseload ................................................................... 56

Insight Questionnaire Completion ............................................................................................................ 57

Equality and Diversity ................................................................................................................................ 58

Ethnicity ..................................................................................................................................................... 58

Age ............................................................................................................................................................. 59

Progress Against Outcomes (HOS and NDTA 24 Month Score Point) ....................................................... 60

Homelessness Outcomes Star (HOS) ......................................................................................................... 60

Progress Against Outcomes (HOS and NDTA Second Score) ..................................................................... 63

Beneficiary Insight Questionnaire Refresh Analysis (Up to Nov 2018) ......................................................... 66

Tabular Demographic Summary ................................................................................................................ 66

The Questionnaire ..................................................................................................................................... 66

Response Analysis...................................................................................................................................... 66

Before and After Service Experience ......................................................................................................... 68

Summary .................................................................................................................................................... 70

Planning and Goals .................................................................................................................................... 71

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Demographics of Planning and Goals Section ........................................................................................... 71

Content of the Planning and Goals Section ............................................................................................... 72

Free Text Responses .................................................................................................................................. 72

Fixed Response Categories ........................................................................................................................ 73

Gender Response to Items 1 to 12 ............................................................................................................ 73

BME Responses to Items 1 to 12 ............................................................................................................... 74

Age Range Responses to Items 1 to 12 ..................................................................................................... 74

Full Tables for Planning and Goals ............................................................................................................. 76

Items Table ................................................................................................................................................ 76

Appendix 1: Statements 4 to 19 (S4-S19) and their corresponding groupings (G1-G7) ........................... 77

Fair Access Report October 2018 .................................................................................................................. 79

From Rough Sleeping to Housed – the WY-FI Beneficiary Accommodation Journey ................................. 100

Overview of Data Used ............................................................................................................................ 100

Analysis .................................................................................................................................................... 100

Briefing to MHCLG on the Navigator Model ............................................................................................... 101

National SCAN Mental Health ..................................................................................................................... 106

WY-FI Mental Health – Current Key Statistics: ........................................................................................ 106

WY-FI and Mental Health Services .......................................................................................................... 106

Insight Healthcare: Calderdale WY-FI Project Report September 2018 .................................................. 107

Big Lottery Report – September to November. The Network and Service User Involvement .................... 110

Co-production champions and beneficiary engagement ........................................................................ 110

Annual Learning Event ............................................................................................................................. 110

The Story of Me – Final Report to CPMB ................................................................................................. 110

The NHS Bid Evaluation work – Liaison and Diversion ............................................................................ 110

Bradford community well-being grant .................................................................................................... 111

Evaluation of the 3 life questions conducted around West Yorkshire .................................................... 111

Media and Communications.................................................................................................................... 112

Moving Towards Independence .............................................................................................................. 112

Business as Usual ..................................................................................................................................... 112

Governance ............................................................................................................................................. 112

Appendix to the Co-production Report – the Story of Me .......................................................................... 114

Workforce Development ............................................................................................................................. 117

The Training Programme ......................................................................................................................... 117

Progress during Quarter 2 ....................................................................................................................... 117

Understanding MCN… ............................................................................................................................. 117

The Complex Needs Suite ........................................................................................................................ 117

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Multi-Agency Practice Development Groups .......................................................................................... 117

Quarter 2 Meetings Summary ................................................................................................................. 118

Navigator Competency Framework ......................................................................................................... 119

Appendix 1 to the WFD Report - The Complex Needs Training Suite – What is it? .................................... 120

Appendix 2 to the WFD Report - Competency Framework for Navigators working with People Experiencing

Multiple and Complex Needs ...................................................................................................................... 124

Media and Communications Report: September 2018 – November 2018 ................................................. 125

Fulfilling Lives Programme: national communications............................................................................ 125

WY-FI Annual Learning Event .................................................................................................................. 125

Project legacy .......................................................................................................................................... 125

Materials and online content .................................................................................................................. 125

Our digital reach ...................................................................................................................................... 125

WY-FI Annual Learning Event Report ...................................................................................................... 126

Project Outcomes ........................................................................................................................................ 127

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Quarterly Partner Update Reports, Activity and Learning WY-FI Quarterly Partner Update Report

As part of reporting the progress of the project, the Big Lottery Fund require us to summarise the learning

from all aspects of project delivery, person-centred approach, navigator model, peer support to

beneficiaries, impact of multi-agency working, local system change plan/system flex. Alongside finding out

from partners “what” has happened in the last quarter, they would also like to understand “why” and “how”

things do or don’t happen as you might have expected. From year 5 there is also a need to evidence the

impact of the WY-FI model of working and how this will be sustained post reduction in funding in year 6 and

post 2020.(i.e. the “so what” from what we do).

Please note, information provided in this form will be shared with the Big Lottery Fund, in reports posted

to the WY-FI website and shared within WY-FI governance structures.

If you wish to use this report as feedback to your Locality Group you may wish to add at this point WY-FI

total starts and your local statistics re individual Navigator caseload.

Reflecting on the actions your team has taken and the situation in your locality as a whole in the last

quarter (01/09/2018 to 30/11/2018), please complete all boxes below.

Bradford Question Partner Response

Service Delivery

1. Safe Demobilisation of Navigation Support Report against agreed KPI Document and provide associated narrative

One Navigator’s post has been disestablished and the worker transferred to the Housing First post. Working effectively with the MARB to ensure referrals and caseloads are proportionate and manageable. Integrated team approach with Housing First working well. Junior post increasing team capacity.

2. Safe demobilisation – Locality sourced continuation funding

Please provide progress report including any strategic meetings attended

CEO meeting with Adult Service Commissioners in January. Various ad-hoc meetings have taken place with Council and CCG Officers to discuss opportunities/challenges.

Where there are barriers or challenges identified in the boxes above please detail the plans you have in place to overcome them? ( ignore if detailed in boxes above)

3. Equipping organisations to work with those with MCNs - Organisational Engagement

Please provide

- dates of Locality meetings and any key points of focus, local action identified/completed (where applicable)

- MARB- Provide an update about the effectiveness and make-up of your Locality MARBs and evidence of how it is being sustained and embedded.

- Progress/impact of Innovation Pilots (where not already sustained)

- Employment and support of people with lived experience in Locality stakeholder organisations (Number recruited this quarter)

Future of Locality Meeting currently being reviewed. Ongoing discussions with Bradford Council and Stakeholders about future workshop hosting re: WY-FI and MARB Legacy. The MARB remains a “success story” because of the effective chair and the buy in from partners from a whole range of organisations whom all support the ethos of individuals with multiple needs. 7 beneficiaries have commenced their WY-FI journeys this quarter. The Multi-Agency PDG have met again in October and November and are beginning to develop a sense of cohesiveness due to regular participation. Training has included: Six Two hourly sessions of group Well-being All staff trained in Emergency First- Aid

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- WY-FI training and Multi-agency PDGs promoted to local services/agencies

- Engagement with CRESR

Please include in Q1 report your locality definition of what is considered a ‘fulfilled life’.

Spice Awareness- An excellent 1 day course. Our mission is to empower people experiencing barriers to achieve positive change. Bridge is a value driven organisation, these strong values are at the heart of all we attempt to do as we believe in people’s ability to change and their right to a high quality research based service. With these values in mind the Locality considers a “fulfilled life” as individuals reach their own goals and aspirations at their own pace with meaning and purpose.


Please provide details

- of attendance at CPMB, WY SCAN, OMG and evidence communication of knowledge and feedback

- Navigators and Lead Navigators attending PDGs (include feedback on impact on working practice and shared learning, embedding in local team)

CEO has attended all relevant CPMB and WY Scan Meetings.

Bradford has always had good attendance at the WY-FI Practice Development Groups meeting in September and October this quarter, Topics included: Working with Couples, Ending Relationships, Experiences at Magistrates Hearings, and dealing with Crisis.

The learning continues to be disseminated and processed in regular team meetings.


Please reference re;

- Your own safe demobilisation plans - Employment of people with lived experience

within your organisation - Number of people with Lived Experiences

recruited this quarter - VLEW pledge update

Give examples of beneficiary and Experts by Experience involvement activity including impact/challenges:

- Meaningful activities – other Co-production Champion-led activity

- Number of beneficiaries accessing Peer Mentor training

- Number of Peer Mentors supported

CEO, Director Of Operations and WY-FI Team Leader meet to discuss systems change and operational activity. Currently advertising two posts at The Space in Leeds for people with a lived experience. All people employed with a lived experience have access to a mentor in the workplace. Meaningful activities this quarter include: horse riding, walking , sport and the attendance at the local professional football club game ( 7 beneficiaries) We have two Peer Mentors who are about to embark on volunteering within the team. Two Beneficiaries are progressing well on the recent Bradford Peer Mentoring Course with the ETE Team/

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- Number of employment placement opportunities provided to beneficiaries

6. Embedding Resources for Regional Co-Production and Involvement – Co-production Network development

Please report on how your organisation is

supporting the Hub to develop the

‘Network/constituted group’ in your Locality and

Regionally (including reference to your

organisation’s pledge)

CEO has met with the CO-Production Legacy Officer, Simon Dixon and made pledges to support the Network. Advice has been given to the Network to access local ABCD Funding.

7. Embedding Resources for Regional Co-Production and Involvement – Co-production

Please provide evidence of embedding coproduction in your organisation and in your Locality

The Mini- Network has really progressed in Bradford and is hosted in the Vault Recovery Centre, The Network meets once a month and is facilitated by the Co-Production Champion. At the meeting in November over a dozen people were present. Co- Production has also been embedded within the Housing First Model.

8. Supporting Pooled and Consultative Commissioning

Please identify any additional “key messages for” local commissioners and add any detail not covered in 2

Please Refer to Item 2 above.

9. System Change Development Please report

- any significant examples of innovation or system change. This may include emerging good practice/interesting learning

- Progress linked to your Locality System Change Plan including any impact /learning taken from West Yorkshire SCAN meetings

- the impact on support from local services/agencies following attendance at WY-FI Multi agency PDGs and training opportunities

Specialist service for Women with Multiple needs at risk of or are engaged in sex working issued by Bradford Council. The focus on multiple needs is a result of systems change activity.

10. What are Experts by Experience in the Locality:

- Concerned about? - Focusing on? - Working towards?

The big development for the Experts by Experience is the continued belief in the Mini- network. A recovery walk was well attended in Shrewsbury In the New Year it is planned to set up a peer –led “well-being” support group particularly focussing on individuals whom have multiple needs, this is supported by the Team Leaders contacts and resources.

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11. Promotional activity Please detail any promotional activity/presentations carried out including:

- Local presentations - Local strategic/other meetings attended - Good News stories - Beneficiaries and WY-FI

project - Anything shared with WY-FI Media and

Comms lead - Any local media activity (remember it must be

reported to Media and Comms lead at time of publication)

Attendance at Westfield House (Bradford) and Worth House 9(Keighley) talking to work coaches within DWP (Mental Health Network/ Work Coaches Events. Participation in International Men’s Day (19/11) at Men Standing Up. Supported Tenancy Offender Project (STOP) – Member of steering group. Emergency Temporary Accommodation Market Engagement (3/10 ) Liaison and Diversion Stakeholders Meeting ( 20/11) Attendance at MAPPA (Bradford) 6 times in quarter. Good news stories to be shared with Media and Comms Lead include the day at Bradford City Football and a beneficiary not only gaining and sustaining employment but achieving the “employee of the month” Award.

Calderdale Question Partner Response

Service Delivery


KPI Year 5 target 10 new beneficiaries. Referrals to end at end of 2018. Referrals for Upper Calder Valley area will be looked at on an individual basis and discussed with referring agency - due to Todmorden Navigator post ending May 2019. In order to demobilise the service whilst maintaining a high standard of support for service users we will stop taking referrals on 31/12/2018. Navigators will work with all cases in Case Finding and Pre-Navigation, presenting final cases at the MARB scheduled for 24/01/2019. Based on the number of current cases we would expect the service to have 50-60 live cases and 40-50 cases in parking bay. We will then set targets for closing cases with the aim of closing all live cases by June 2020 (see decant plan for projected figures). The scheme will concentrate on closing Todmorden cases first as the Navigator based there leaves in June 2019. If there is still a substantial number of live cases in Todmorden when he leaves we will look at basing a Navigator there 1 day per week. The service will consider accepting a small number of new referrals in exceptional circumstances. Before doing this they will check with partner agencies in MARB meetings and explain that support will be time limited. From June 2019 Navigators and Peer Mentors will begin calling Beneficiaries in parking bay and explaining to them that the service will be closing.

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If clients in parking bay (or those that have been closed) present asking for assistance from WY-FI they will be signposted to appropriate support agencies. Again, Navigators can consider reopening cases in exceptional circumstances but as above, they will raise it in the MARB first and explain that it would be for a time limited period. By March 2020 (3 months before the service is due to end), it is likely that the beneficiaries that remain will have significant support needs. Navigators will arrange multi-agency meetings concerning each beneficiary. They will work with the other agencies involved to develop a support plan for each beneficiary detailing which agencies will provide support and exactly what they do. The workforce consists of 5 staff members. 2 are on temporary contracts (with one finishing in June 2019 and the other in June 2020). 3 months prior to the end of the project Foundations HR department will meet with them to discuss their options. They will be informed of other opportunities within Foundation and their rights regarding redundancy. If one of the Navigators leaves before the project ends Foundation will consider hiring a staff member on a short-term contract to cover the vacancy.



We will promote the Lead Navigator to Project Manager. They will no longer carry a caseload (beneficiaries they support will be re-assigned amongst the other Navigators). The time will then be focused on promoting the Navigator model within Calderdale and driving the systems change plan forward. She will work closely with Foundations Development Team. She will attend training on commissioning and bidding and receive support from the Foundations Development Manager. This will allow her to develop the skills to explore opportunities to access alternative funding and have an increased influence on commissioning within Calderdale. Specific monthly meetings will be held with the Project Manager, the Development Director and the Development Team. The aim of these meetings will be to identify future funding for the programme. This combined focus will allow the Project Manager to develop the skills to explore opportunities to access alternative funding and have an increased influence on commissioning within Calderdale whilst also having the on-going support of a team which focuses entirely on the growth and development of Foundation services. Calderdale WY-FI will continue to promote the service and the model to all agencies they come into contact with. We will provide accurate information regarding the beneficiaries we support and encourage beneficiaries to engage with The Network. We will continue to provide case studies highlighting the positive effect WY-FI has had on the lives of beneficiaries. The Project Manager will receive significant training and support from Foundations

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Development Team which will allow her to assist DISC with any assistance they need in looking into accessing regional funding. Foundation are currently merging with Community Links which will enable greater opportunities for growth, especially in the field of mental health.


When the Navigator Post for Todmorden ends there will be a gap in service provision for people with multiple and complex needs in the Upper Calder Valley, a focus group of WY-FI beneficiaries are currently working together to promote the need for services in rural market towns like Todmorden. At locality System Change meetings the members are looking at how best to maintain the MARB meetings, with a view to a statutory agency taking on the role of chairperson.


Please provide - dates of Locality meetings and any key

points of focus, local action identified/completed (where applicable)







After we stop referrals it was felt that the MARB meetings should continue but change the meeting style and have a statutory chairperson. The meetings would then consist of discussions of problems throughout the locality and how to deal with issues of complex people. This could then be left as a legacy group at the end of the WYFI scheme. Once the service stops taking referrals and works through beneficiaries in Case Finding and Pre-Navigation we will promote the MARB as an opportunity for partner agencies to discuss clients they are having difficulties working with. Agencies will be able to share information, consult with Navigators and develop action plans for specific clients. The Locality Meetings will be used to drive forward the Systems Change plan. The Project Managers will continue to develop professional networks in Calderdale in order to ensure the meeting is attended by professionals who are able to influence provision for people with complex needs. She will ensure the meeting is an opportunity for partners to raise issues, help the attendees to develop action plans and hold the group as a whole accountable for their commitments under the Systems Change Plan. The aim would be to provide evidence that the model is based on the views of beneficiaries, that it is effective in generating positive outcomes for beneficiaries and is an effective use of resources. The Project manager will use information gathered from customer feedback and reports generated by WY-FI to demonstrate this.





The Lead Navigator will be promoted to Project Manager. This will give them the necessary authority to represent the service at the Operations Managers Group and the WY-SCAN meeting. Paul Hardman, Foundations Development and Communications Director will attend the Core Partnership Management Board. Paul will also work with the Project Manager to support the endeavours and actions of WY-SCAN Viki Whelan, Director of Operations will represent Foundation at Chief Executive Meetings.

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This approach will mean WY-FI will be represented within all levels of Foundation. Managers involved with WY-FI will attend Board meetings, Senior Management Team meeting and Operational Managers meetings. The Leadership Forum will provide an opportunity for the various Foundation Managers involved to meet and discuss progress.









- Number of Peer Mentors supported - Number of employment placement

opportunities provided to beneficiaries

WY-FI Navigators from Calderdale sit on Foundations Housing Service Delivery and People Group. The group is responsible for shaping Foundations organisational strategy. This will allow them to promote the Navigator model and encourage the organisation to further their commitment to incorporating more people with lived experience into the workforce. The Project Manager and Regional Manager both attend Foundation’s Leadership Forum with managers of all levels from across the organisation. This provides an opportunity to promote the Navigator model to Senior Managers in Foundation. The service provides case studies on good practice and positive outcomes which are put up on Foundations Intranet page (seen by all staff and volunteers). The Project Manager will work on updating the section of Foundations external website related to WY-FI. Foundations pledges on Valuing Lived Experience in the Workplace were: 1. Ensure our Volunteer Programme is open to all including PWLE. There are a number of roles available where lived experience is particularly valuable (for example, peer mentoring and group activity roles) 2. Invite PWLE to our Volunteer Forum which take place quarterly 3. Continue to recruit PWLE to our Board of Trustees 4. Continue to include PLWE on our interview panels when recruiting new colleagues. Foundation has ex-service users sitting on the board of trustees. Jobs in WY-FI have included requirements for lived experience and Foundation are looking into whether this can be incorporated for other contracts. Foundation services users regularly sit on interview panels. Volunteers with lived experience are encouraged within Foundation. They are active within all services and this has proved a valuable path into paid positions.







In the Upper Calder Valley, a focus group of WY-FI beneficiaries are currently working together to promote the need for services in rural market towns like Todmorden. Once Calderdale WY-FI Co-production Champion is back to work she will be meeting with the Upper Calder Valley Focus Group and also identifying other beneficiaries to join the network. WY-FI Network members attend Calderdale Locality meetings and system change meetings.

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WY-FI beneficiaries are included in the organisations recruitment and selection process and sit on interview panels. Foundation have a customer representative on the board of trustees. People with lived experience are encouraged to apply for paid roles within the organisation.



WY-FI Coproduction champion and WY-FI staff members have secured funding through the personalisation fund for activities including museum/art gallery/orchestra concerts/bowling/Christmas meal. These events and activities have been led by the WY-FI Coproduction champion and WY-FI staff members.



Calderdale Council commissioner has produced a report for councillors on the progress of WY-FI Project and includes details of the Innovation Fund with Insight Healthcare CBT. Calderdale Council are creating a post based on the Navigator role to work with homeless people.





Foundation are merging with Community Links, interest shown in providing CBT services for people with MCN. WY-FI beneficiary was given a detox in the community through the home base treatment team the Dales Unit, due to WY-FI involvement. WY-FI beneficiaries have been fast tracked for properties with a supported housing service, due to WY-FI involvement. Calderdale commissioner being directly involved with WY-FI to work with a homeless lady living in a tent, causing conflict from local residents and local MP’s. Calderdale commissioner involving senior Calderdale housing manager when Together Housing have refused a homeless beneficiary a property that had successfully gone through all of their requests.



When the Navigator Post for Todmorden ends there will be a gap in service provision for people with multiple and complex needs in the Upper Calder Valley, a focus group of WY-FI beneficiaries are currently working together to promote the need for services in rural market towns like Todmorden. A meeting took place on 31/8/18 with Humankind’s Area Director who has taken on board their concerns and agreed to keep the communication alive and agreed to meet again in 3 months’ time. Working towards keeping services in place for people with multiple and complex needs throughout Calderdale.

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Service Manager Presentation to CPMB – 11/4/18. Lead Navigator Presentation at OMG away day – 5/9/18. Upper Calder Valley Focus Group presentation at System Change meeting – 24/9/18. Upper Calder Valley Focus Group question/answer session at WY-FI Annual Learning Event – 26/9/18. Various compliments forwarded to Media and Comms Lead from beneficiaries and Social Work Student Placement. Foundations Impact Report 2018 includes coverage of WY-FI Calderdale and case study on a beneficiary N. Glossy case studies on N and B. Lead Navigator presentation to Foundation Operation Managers Forum 13 December 2018.

Kirklees Question Partner Response

Service Delivery


Ongoing navigator reviews of caseload and waiting list – deadline for applications Feb 2019

Ongoing use of Practice Development Groups to promote and embed Trauma informed working, Psychologically informed environments and Peer Mentor Models. Attendance continues to be strong in Kirklees.

Focus on navigators arranging and attending MDT groups to share specialist knowledge around multiple and complex needs and to focus on clear remits and pathways, as well as suggestions for ongoing / sustainable support

Continued use of the Personalisation Fund to think about ‘Righting Social Injustices’ (as discussed in the presentation at the WY-FI Annual Learning Event)

Ongoing discussions within MARB around continuation / hosting and safe-exit strategy

Strategic opportunities identified within external Forums to embed complex needs support and peer mentor model

Ongoing discussions around multiple and complex needs support to Housing Workers through The Customer Service Centre (Huddersfield – Donna Harkins) – DK to attend

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on 7th December 2018 to begin consultation with housing workers.



Community Links continue to be part of the Alliance group in Kirklees that have successfully got the ‘Life Chances’ funding opportunity released by the Government. This is the largest bid in the country. Fran Coard, Operational Manager is involved in discussions regarding how WY-FI fits with this funding moving forward.


Client Endings have proved challenging on occasion due to WY-FI ‘holding’ clients in cases where external staff feel uneasy / unsupported about ongoing challenge / clients going back into crisis; currently looking more at clearer signposting to Crisis support and being clearer on realistic remit of WY-FI

Information sharing, particularly around offending continues to be an issue in line with losing the arrest reports and GDPR. We have sought to hold regular meetings with IOM to share appropriate client information and continue to attend the Reducing Re-Offending Group.

Maintaining the suggested 6-10 people on caseload, whilst managing an ongoing referral waiting list – we have managed this by reviewing caseloads and by the recruitment of staff.

Recruitment – we have now recruited Admin Support, Lead Navigator and Navigator. Navigator Position out to expression internally. Trainee post to go out to peer network

MIS / Admin Support – Geoff Doyle has agreed to host support sessions at the Batley Hub.


Please provide



Housing – Complex Needs Support; discussing the idea of complex needs specialist and peer support model

Opportunities identified within Domestic Abuse Strategic Forum to offer Multiple and Complex Needs Support

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Last MARB was held on 7th Nov and was attended by Whitehouse Surgery (GP), Housing (KnH), Drug Support (CGL), The Mission (Homelessness) and PDVG (Domestic Violence). Updates were sent by probation (CRC) and IOM (Police)

Ongoing negotiations with housing around multiple and complex needs specialism / peer mentor within customer service centres

PDG groups continue to be well attended in the Kirklees area and most recently attracted a new private housing provider in the area (Bridge It Housing). The October PDG focused on Person-Centered Working and The Person-Centered Model, which was well received. Additional staff have been invited to the next PDG.





Faye Oldroyd (Operations Director) attends the Core Partnership Board.

Claire Woodhead (Service Manager & / or Lead Navigator) attending the Operational Managers Group.

Information is shared via Team Meetings and circulation of documents.

PDG’s regularly attended by staff. Feedback and learning shared via team meetings











Both posts that have been offered to potential

staff within WY-FI were to people with lived

experience and indeed across Community

Links posts have been filled by individuals with

lived experience.

Unfortunately, our co-production champion

has been away from work for a while, but is

now back in Kirklees following a phased

return. Previously he was working with 3

beneficiaries to access social and community

activities – all 3 beneficiaries have in the

interim been linked either into ETE or housing

support services, CAB & Shelter. Our Co-pro

champion is now keen to pick up appropriate

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contacts from previous work and to work with

navigators to make new contacts.

Currently still have 1 peer mentor, but have

been working closely with ETE to increase this

to 2 through current training cohort – will be

chasing up next week to check on progress

and to meet up with potential peer mentors.

Current Peer Mentor demonstrating excellent

progress and is working effectively with clients

on meaningful occupation and engagement

with The Basement through previous links.

She is mid-way through the Complex Needs

Suite of training and has been involved in

recruitment and selection.

We currently have 1 beneficiary enrolled in

college and another who is accessing the gym

on a regular basis







In the absence of our current Co-production Champion, we have requested additional support from Shaun Allison (WY-FI Leeds HUB) who has been invited to shadow and work alongside Kirklees Navigators to identify opportunities for Co-Production.

Shaun & Simon Dixon to be invited to attend a team meeting in December



Community Links ‘Bright Ideas Fund’ offers opportunity for beneficiaries and those with lived experience to pitch for a pot of money, focusing on projects that aid and support recovery

Peer mentor involved in recruitment & selection procedures, including shortlisting and panels for various roles within Community Links.



Please refer to item 2 above

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Initiative with Kirkless Housing to embed Multiple and Complex Needs Support in Customer Service Centres; future plans to showcase the peer mentor model of working

Discussions with Fusion Housing to help develop in-house Multiple and Complex Needs Specialisms

Potential for greater involvement at a strategic level within Kirklees Domestic Abuse Forum which could involve chairing MARAC and offering representation at policy level.



Continued concerns with Universal Credit whilst transitioning into paid work. Further concerns around the length of time it takes to get through on the phone to a Universal Credit Advisor






Case study ‘Louise’ shared in more detail with the Hub to be used in wider publicity.

Representation at Homelesslink Community of Practice

Leeds Question Partner Response

Service Delivery


Within the document provided by Geoff we currently have 10 outstanding assessment types but this is due to navigator sickness, many of these have been resolved this week as they needed closing, following this we have only 5 but these will be amended by the week commencing 3rd December. As for the SUSSAR forms we tend to have them done as soon as they come out, these are done on navigator office days and are returned to Geoff as soon as possible. We currently have a 100% completion rate on new starter consent forms. This is due to a process being put in place following a discussion between Marc and Geoff to not class the client as a start unless a consent form is obtained. We are still working through

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getting new consent forms for those already on caseload prior to the GDPR change and have a 55% completion rate of the caseload, this will continue to be pushed in the new year to ensure 100% completion by the end of Jan. Marc has spoken to Geoff and has got a list of those without a consent form which he will be chasing up the navigators to complete by the given date. The insight questionnaires have a 67% completion rate, this is often due to non-engagement at the time of the questionnaires going out but to tackle this Marc has asked for an updated list of clients eligible for insight returns for December, Jan and Feb. this will hopefully give us a larger pool of clients to work with if a selected client isn’t engaging at that time. Support plan completion is 83%, this will improve in the new year as this is primarily clients that have been with us for a while, previously we were unaware that the support plan date needed recording on the service user record page but now this has been communicated people going to navigation will not be sent to Geoff without the date being on their MIS record. We have cleaned up the older clients and should have a 100% completion by mid Jan. Regarding the planned exits we currently have 15/25 (60%) planned, this is to improve by 75% by the end of Q4 which we are on course to do. When looking at those on caseload for 2 years plus we have a 100% improvement rate for the CHAOS score and an 88% improvement rate with the HOS. This shows the value and effectiveness of the work the navigators do and we will look to keep this level of improvement during the winding down process. To ensure the work is reflected in the scores we will look to make the assessments more frequent to capture at the time the small improvements being made. This will be especially important for those who are new referrals from this point on as we wont have as much time to work with these clients from now until the end of the project so the more recordings we have the better that is for the research purposes.



Recently Paula Gardner has begun sitting on the Safer Leeds board and continues to build the relationship between BARCA and Safer Leeds, she provides feedback to BARCA in terms of communicating the contents of the meetings. In addition to this Paula and Foz presented to Safer Leeds to inform them of the service and what impact and outcomes WYFI has achieved over the last few years in terms of the support given to MCN clients. They also presented similar information to the mental health board and avenues continue to open to allow the WYFI message to be spread. Another great success was the locality meeting which we held at Northside on 09/11/2018. This brought together the major services across the city to discuss the issues and direction regarding MCN work going forward, we gathered a huge amount of feedback and allowed us to look at MCN work from a number of different

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perspectives allowing us for a more well-rounded view of what we should plan over the coming years. We will be hosting a follow up meeting to look at those suggestions made in the first meeting and how we can put them in place, also to follow up with services on their progress regarding what they plan to do to facilitate MCN work in the future.


Moving forward we are looking to further present the work done at WYFI and will continue to steer the MCN work within the locality in a positive direction, focusing on inclusion to services as opposed to exclusion.


Please provide








Locality Meeting – 09/11/2018. Had attendees from services across the city to discuss the future of MCN work within Leeds moving forward. There

were 4 topics of discussion which were How do you see your service working with complex needs after WY-FI? Who and how should we be approaching to influence the future of complex needs work? How do you work with complex needs currently? How do you see the MARB moving forward? Honestly. These were done as table exercises and each facilitator carried a question, each question lasted 20 minutes and the input from other services allowed us to look into the needs of the city over the next few years. Attached are the minutes from the meeting. MARB We continue to have a good attendance at our MARB meetings but after this was discussed at the locality meeting we will be looking to steer it in a slightly different direction as currently there are a high number of attendees but actions for these services are easily lost and its difficult to properly facilitate. Over the coming months we will be looking to identify the major services within the MARB and asking for their input as to how the MARB should be done. At the Locality it was suggested that the MARB be on an online system to allow tasking of actions and have everything in one place. This will be one of many suggestions we will be looking into over the coming months. Pilots Employment support As BARCA has a diverse range of services under its umbrella we encourage our peer mentors and volunteers to do placements at different teams, this can be anything from half a day a week to a full week depending on the staff member and the team they are looking to work with and learn

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about. Occasionally this leads to paid employment within BARCA and support is offered to the member of staff from helping with application through Yan at Touchstone to interview techniques with management, all is done to offer a full support during the transition from peer mentoring or volunteering to paid employments. WYFI Training Within the team we often promote the attendance of training, we aim to have at least one attendee at each training session where the diaries allow. We also aim to have at least one representative at each PDG meeting and these are communicated to our locality, MARB, BARCA mailing lists. We also talk about these at the BARCA Comms meeting to ensure people are aware.





As part of the Locality we asked other organisations how they will be preparing to work with MCN after WYFI. This has helped us to identify areas where we will need to educate mainly through training. It seems the WYFI way of working is having an impact on other services already as many of the attendees expressed that they should look at removing the constraints that exclude clients from their service and look at service flex. The education will continue through the Multi Agency PDGs, as previously mentioned we look to have someone at each PDG.


Please reference re; - Your own safe demobilisation plans - Employment of people with lived experience








We are currently having informal discussions around what the options are following WYFI for the staff. We are encouraging the team to start to think about where they may want to work post WY-FI, have reassured the team that we will look to put them forward for suitable roles when they become available. We will be freezing the referrals on the 20th December and will only be accepting them on an individual basis following a discussion with the Lead Navigator. We will look to signpost the referrals to other services who will be able to offer support. Within the team we have 9 workers with lived experience. This has to be managed differently as there are things you need to keep in mind such as meetings they may have to attend, appointments, processes etc. This is promoted across BARCA and people with lived experience have proved that they are able to not only work but thrive with BARCA.


Over the last few months the Leeds Co-production Champion, Darren Pedley has been planning a new group which he plans to become a regular

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session for the ale demographic on our caseload. After some discussion and thought it was decided that he would set up a cook and eat group. He managed to source the BLC centre in Burley to host the sessions and Darren and Marc worked together on the poster for the group. This had to be changed a few times due to the logos and wording etc but after passing this to Sarah from the media and comms team this got sorted. Marc spoke to Mark Crowe about how to fund the group and this has gone through the personalisation fund with a block booking of 4 groups to begin with. In addition to the funding for the room he needed some supplies. This was sorted with Finance and the group went ahead. The group was a great success with Darren and our peer mentor Paul Clegg facilitating the group. We have already lined up more clients for the next group so can expect 6-8 clients next group.



We continue to promote peer mentors and volunteers within BARCA. This is both in peer mentor form and in the form of encouraging them to apply for upcoming jobs. They are supported through the processes and keep in touch with the lead navigator for support. We have had volunteers from BARCA come here also as we are keen to have new employees whether that is paid or unpaid experience the different work done within BACA as it is so diverse. As of 2019 Foz is the service user involvement lead for BARCA so will be exploring ways to further include service users, he will be working with the other projects within BARCA.








System change within our locality is widely promoted, especially during the MARB meetings as this is the ideal arena to directly approach any difficulties we may have accessing services. Often when we are having difficulty engaging a client with a service due to its constraints these can be addressed within or following a MARB, one service is extremely effective in this way is Housing as they now have a much better understanding of the clients we work with and how they don’t always have the capacity to abide by their processes. This has allowed us to directly approach them and discuss cases with them and put a plan n place to ensure the service user is given the best possible chance to be housed.

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Another service we have built a great working relationship with is Forward Leeds, they are again much more understanding of the situations our clients face, often leading chaotic lives which means they are unable to attend or prioritise appointments. With the help of the navigator the Forward Leeds staff now offer solutions to these issues and try to put the client at the centre of the support and stretch the barriers where possible. This has led to increased engagement and better stability on script which in turn makes it much more workable and less erratic behaviour in most cases. Within the Navigator team the client remains the focus and they are key in the care we provide to each individual. They continue to guide them to avenues which can help but resist telling them what they need to do, this builds trust and allows the client to feel in control of the service they receive from their navigator. Again this has led to increased engagement and in many cases the clients barrier between themselves and services been lowered. BARCA continue to push this style of working as the success of this has been made clear with the successes we have had with WYFI.



Over that couple of months the experts by experience have been discussing a number of topics during the network meetings and below is a breakdown of the points. Concerns The network has been discussing what will happen once the WYFI contract comes to an end and their main concern is what will happen to the work being done at WYFI both as part of the network and the navigator work that is done. Focusing on The network has been focusing on developing the legacy of the network, this has involved a number of consultations and discussions with the legacy office Simon Dixon to discuss options and avenues to explore regarding the work the network can offer in the future post WYFI. They have also been looking into the way they can raise funds for the network and have recently done some work with the NHS, more specifically the Liaison and Diversion team to help shape their service moving forward. Working Towards They are working towards a continuation of the network post WYFI and how that may look. They are hopeful of continuing the consultation work as they feel their experience of services can offer valuable input. Recently within the Leeds locality a men’s group was started, this was well attended and well received with all attendees offering Darren and Paul positive feedback, it is hoped that

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this will become a regular meaningful activity for some of the men on caseload.






The Leeds WYFI team continue to work with other services to promote working with MCN clients, this is done in many different ways such as partnership working and often attending team meetings at other services to provide an insight as to how they work. Marc has spoken with the media and comms team about a case study that may be possible as they would like to focus on someone who has relapsed. Marc identified someone who has previously had a positive outcome with the Leeds team and has also had a case study previously done on them. This is on hold at the minute due to the current progress of the client. Foz and Paula continue to present the WYFI service to prospective funders.

Wakefield Question Partner Response

Service Delivery


Following on from last quarter we have parked a number of cases that were either not engaging with us or did not need Navigator support anymore. We have also been through the waiting list of notifications checking if they still needed navigation as we have some that have been on the list for some time, and if so to gain an update on their situation. We found that some did still need help, some were attending appointments on their own without support so no longer fit the criteria, some are in prison and some have disengaged completely. We are currently case finding as many as we have capacity for as we are preparing to close to new referrals. We are still working towards getting more beneficiaries doing meaning full activities and attending support groups to build into their support network. We have 1 beneficiary attending Andy’s Man Club with a Peer Mentor and another is attending a pre-detox group with a Peer Mentor to prepare for alcohol detox. Another is maintaining an allotment on their own that a Peer Mentor applied for on their behalf. This beneficiary has stated that because of the allotment she has managed to reduce her drinking by half.



We have not yet heard back from the bid Spectrum submitted relating to the service for young people with families who have experienced domestic abuse. The new service that the Lead Navigator and Co-production Champion are involved in developing, aimed at people with multiple and complex needs and personality disorder (diagnosed or undiagnosed) has not yet gone to tender but it has

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gone to the Mental Health Provider Alliance development group for approval and will go to tender after that. This service will be continuity for beneficiaries with mental ill health as it will follow the Navigator model.


We are trying to encourage Beneficiaries to attend activities and support groups on their own without support from WY-FI. So far the majority will not go alone. The more they attend the group with support and get used to those in the group we hope that the beneficiary will learn what to expect and by familiarity feel able to go alone and perhaps friendships may even form. Notifications – the challenge is to prioritise the most chaotic as we are going to stop taking referrals in the near future. We will do this by regularly checking through the waiting list and keeping in touch with those who referred them to keep up to date on the individual’s position.


Please provide








- Our last Locality meeting due on 02/11/18 had to be postponed as we had no appropriate Chair on that date. There were also a lot of apologies received so it would have been a very poor attended anyway. - We had a MARB on 17/09/18, and another on 12/11/18. The last one was attended by a representative from the Drug and Alcohol service which is a big step forward in Wakefield. However, because they still have not signed the sharing agreement we explained that though we wanted them to continue to attend, they would not be able to unless the agreement is signed. We had attendance from Spectrum, Police, Foundation (housing), Well Woman’s Centre, Riverside (housing) and Mental Health at the earlier MARB, and Spectrum, Mental Health and substance misuse for the later one. -No further update. - One of our Peer Mentors was approached by the manager of a supported accommodation block to apply for a job with Riverside – she did apply but was unsuccessful. - Information regarding training for those who work with women experiencing multiple and complex needs was distributed. - 2 Insight Questionnaires have been completed


Please provide details - of attendance at CPMB, WY SCAN, OMG and

evidence communication of knowledge and feedback


There was no WY SCAN this quarter. 1 OMG was attended and each Locality gave a presentation. The Lead Navigator said it was good to see Peer Mentors and Co-Production Champions there and interestingly the achievements that each locality has made were all very different. - 2 Navigator PDG’s have been attended, feedback from one Navigator was that they preferred the more relaxed style they have now to how it was previously when you had to bring a case to discuss, however it would be more useful if more Navigators attended.

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- 1 Lead Navigator PDG. Feedback was that they discussed the value of the role of Co-production Champion and its future.











-We do not know how many employees recruited in the quarter have lived experience or not as they do not have to give this information when applying for a job. - Since a Peer Mentor arranged for a beneficiary to get an allotment (last quarter) she has been using it daily and has reported that she loves this activity and has reduced drinking alcohol by half. Another Peer Mentor has supported a beneficiary to attend Andy’s Man Club and SMART groups. The pop up photography activity run by the Co-Production Champion and ETE Peer Engagement Worker has been in the planning process for some time but for various reasons previous sessions had to be postponed. We have now had the first session. Only 1 beneficiary was able to attend in the end, we are hopeful future groups will be better attended and expect that it will grow with time. The Co-production Champion has taken beneficiaries to attend the network on 3 occasions. -None of our beneficiaries have accessed Peer Mentoring Training. 2 have verbally expressed interest but have not registered for the training yet. - 2 Peer Mentors are currently supported in the Wakefield Locality. -One of our Peer Mentors was approached by Riverside Housing and encouraged to apply for a job with them. Unfortunately they were unsuccessful on this occasion but they have not been put off applying for other roles in future and it was valuable experience.







-The pop up photography group is intended to turn into a mini-network for the Wakefield Locality. This has been ongoing for some time, there have been issues with finding a suitable venue and beneficiaries who say they will come but on the day do not. -The Co-production Champion and a Peer Mentor have been doing a lot of work presenting co-production to other areas of Human Kind and outside agencies, there were approximately 100 people in attendance. This is working towards those who are involved these kinds of presentations at conferences and events can be booked by different organisations. This will help to ensure the legacy of the network with the members being employed as consultants and paid for their work. The Co-production Champion is also involved in developing a training package to be sold to agencies.


– The Co-production Champion and Lead Navigator are involved in the Chaotic Lifestyles working group to co-produce a new service aimed at those with Multiple and Complex Needs and

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diagnosed or undiagnosed personality disorder. Due to the influence of WY-FI, this service is intended to be based on the navigator model and will heavily include peer mentoring. It is ready to go before the mental health provider alliance development group for approval and will then go to tender. The Co-production Champion said he felt very included in this group as an equal, his opinion was valued and he did not feel patronised or that he was there as a token “person with lived experience”.








-When the Co-production Champion attended the Core Partnership meeting ACE (Adverse Childhood Experience) was discussed. He was unhappy with the use of the acronym as he felt that it became like discussing something very ordinary rather than something very serious because it took all of the emotion out of the subject. He felt this happened a lot so created a report on the subject which he gave to Joe Alderdice. Joe took it very seriously and shared it with Sue Northcott who has championed this passionately and taken it to every meeting she has attended since. The Co-production Champion feels this is making change happen as she is spreading awareness to other agencies about the effect of using acronyms in this way. - Unknown who, if anyone from the Wakefield locality attended training and there has not been a Multi-agency PDG this quarter. Some people from the Wakefield Locality represented their organisations at the WY-FI Annual Learning Event in September which was opened by a Wakefield Peer Mentor. Our Co-production Champion was also involved in presenting the event. There was a commissioner in housing for Wakefield Council and the manager of one of the supported housing schemes in Wakefield. The Operations Manager and Lead Navigator from Wakefield also attended.



-One concern is not having a community recovery hub in Wakefield. Somewhere for beneficiaries or anyone in recovery to go for support, perhaps with activities or just for a cup of tea and a chat. -Developing the mini network so that by 2020 it is sustainable, and have something sustainable in each of the 5 Localities. -As above, turning the Pop up Photography group into a mini network

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-1- A Peer Mentor and our Co-production Champion were involved in the WY-FI annual learning event. -4 meetings in relation to the new mental health service have been attended by the Lead Navigator, Co-production Champion or both. 3 IOM Police meetings have been attended by Navigators. -3 beneficiary good news snippets shared with the media team. -Details of what Spectrum were doing for Alcohol Awareness week and HIV Testing week have been shared with the Media and Comms team.

Touchstone ETE Question Partner Response

Service Delivery

1. Safe Demobilisation of Navigation Support Report against agreed KPI Document and provide associated narrative ETE TEAM

Peer mentor programme now focused on beneficiary only to support capacity issues.(see stats re this)

Finding suitable funding to support extension of delivery of Peer mentor accreditation and ETE support provision.

Discussions with staff re staffing reduction of Jun 2019 will begin in Jan 2019.



Outcome of pending bids may determine opportunities for Year 5 at risk staff. (TBC Dec 18/Jan 2019)

Ongoing paper developed with option appraisal of peer mentoring course, now sourcing other funding strand to enable a stand alone package/ exploring options for pooled funding.

DWP training for mental health/complex needs looks like opportunity to source some additional funding for staff.


Since wy-fi began services have massively increased their ETE provisions as part of commissioning. This does pose a risk for the WY-FI ETE provision in a “swamped” provision – The PMTSW model offers a unique opportunity as an ETE service, engaging with people early in their recovery as well as those sustaining recovery and tailors ETE support around this. (case studies of current beneficiaries pending consent)

The ETE team need to look at pooled commissioning as little/no funding options focus solely on ETE in this sector. To work closely with partners to support and strengthen bids through the offer/expertise drawn from Touchstone ETE. To also consider other strands of funding that could support

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the service delivery – e.g adult education grants.


Please provide








Ongoing forum developed to support Touchstone staff with peer roles to share best practice and develop improved strategies to support and develop workforce – next session planned for Jan 19.

A number of links with other ETE providers to support alternative placements and ETE support. Ashley Lucas from Works Better ( Kirklees council attended meeting and following up 27/11/2018 with team meeting). WomensLives Leeds event supported to promote peer support and mentoring best practice. Attended annual fulfilling lives event @ Nottingham to present peer mentoring model/best practice. Met with Tempus Novo – follow up meeting with team to be agreed for Late Nov/Early Dec.

Meeting with Mark Crowe to discuss the now updated Peer Mentor data and define reporting capabilities.

Increased use of the personalization fund within the ETE team including revision of access to this from the ETE team.

Please see attached stats for specific ETE data.





Due to change in roles of manager there has been a continued delay in the guidance document/resource relating to the Trainee programme. I hope this will be completed by end of March 19.

We continue to link in and develop with a range of ETE providers, for example supporting beneficiaries with volunteering and work placements across West Yorkshire – see also stats as part of this discussion we are exploring individual beneficiary/peer mentor circumstances and working with organisations to explain individual needs. We continue to face a barrier from ETE providers that demonstrates a barrier for beneficiaries in terms of them engaging with ETE ( relating to whether an organisation feels they can take someone in active recovery)







Please see accompanying stats for ETE and peer mentoring. Pledge Update: INPUT The ETE team have been working with HumanKind on developing the Board Game ( MN-Opoly) following its success at the annual learning event. We will explore ways to market this. A number of staff with lived experience continue to utilise advice and support from the ETE team in relation to in work conflict/team dynamics, benefits advice, contracts coming to an end ( For the

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purpose of anonymity these individuals are not identified). One useable example would be supporting an individual to access SDS hours at Touchstone in addition to his role reduction at Humankind.







WY-FI Board game as above. Met with Simon to discuss ways that the network could work with the ETE team.. This included looking at the network and coproduction workers accessing the moving on group and possibly exploring an ETE drop in for the network members to get Advice and Guidance. The POP Up venture is back up and running after some identified barriers relating to beneficiary engagement. The emphasis on this is coproduction so beneficiaries will be deciding where the event/exhibition takes placed ( based around a photography/art theme)



Jess Parker has now met with Simon Dixon to review Touchstones involvement with supporting the network. The ETE team have also offered support to the network to develop individual skills set and confidence. Touchstone continues to launch the coproduction quality mark and hope to utilise this and share with partners in the upcoming months.



Please refer to item 2 above Following a developed option appraisal paper on peer mentor course, we are now looking at broader funding options including adult education for grants/funding for the Peer Mentor level 2 accredited course that would sustain x 1 worker with a view to deliver to a wider cohort and/or be purchased in/subcontracted as a provision by other third sector providers who may wish to train up volunteers. Key Message – ETE is an essential part of recovery and rehabilitation. Most effective when coordinated alongside a recovery provider e.g navigator model where a wrap around support package can be given, the two can be provided together and don’t have to be recovery followed by ETE. However, this does mean a service must have flexibility to work to the speed and needs of the individual who may relapse during this paired support. People who have been able to return quickly to an ETE options have found this beneficial to their ongoing recovery ensuring the

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right support and guidance is there when they needed to take a break and reassess next steps. .





ETE Team do not have involvement with the SCAN currently. Some observations - The main focus of this quarter has been changing our own system and adapting the way in which we deliver the training to beneficiaries. This has meant increased flexibility and smaller numbers. In this approach we have to take additional risks ( see case study) that challenge our own policies and procedures in order to deliver a client centred approach and support someone achieving a fulfilled life. The increase of ETE within the project has had a few teething issues on practical systems with Navigators closing cases that the ETE team have involvement with. Many of these individuals feel that they still want to have navigator support. As we get to this stage of the project the next quarter will focus on reviewing these systems within the navigators teams to devise a clear process and review an improved process for “handing over” beneficiary support to the ETE team.



Peer Mentors – Beneficiaries. Navigators are now promoting the ETE team more effectively to beneficiaries. Key issues tend to be distance to travel and expenses to get to an ETE opportunity. We also have a number of beneficiaries who may be less inclined to take up/progress with their identified ETE opportunity due to personal animal care (e.g.dog). we are finding that many beneficiaries we work with on ETE may be keen to identify ETE options however they feel or demonstrate emotional aspects that impact on this becoming a success. This means the intervention can take longer as we have to provide coaching and signposting to support such as confidence and anger management. Employed Staff WLE – Continuation of their roles and time past WY-FI we have had a number of concerns raised from both paid and voluntary staff. Anecdotally staff who have come through the project and approach us demonstrate less understanding of funding/decommissioning and feel concerned about “ taking a step back” in their recovery if they no longer have WY-FI. The ETE team are supporting people individually to review their training and development needs and are offering 1-2-1 sessions and the moving on group where people can get support to explore future options. The project perhaps would benefit from exploring this nuance in the workforce in terms of

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how we communicate this message to individuals and support them to access ETE team and any learning that can be gleaned. For example delivering some Change-Management & resilience training focused around this element of change in the project. (For many staff they are unfamiliar with this “System”)






We continue to provide a strong presence on Twitter through the WY-FI ETE team handle. This has included joining in posts for national mentoring day (27/10/18). World Mental health Day(10/10/18).. Positive tweet from an attendee at the Moving On Group, celebrating the start Cohort 12 with captured tweets. JW at the Bradford network meeting (24/9/18). RR blog was shared with comms leads at Humankind. Attended the fulfilling lives event presenting peer mentoring talk. Womenlives Leeds Peer Forum, event. Case studies x 3 pending consent.

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Starts, Demographics, Equality and Diversity, Beneficiary Progress

Starts by Locality

Locality Years 1 to 4 Year 5

Quarter 1 Year 5

Quarter 2 Running

Total

Bradford 178 5 7 190

Calderdale 122 10 10 142

Kirklees 103 0 0 103

Leeds 213 6 8 227

Wakefield 118 8 6 132

Total 734 29 31 794

Demographic Summary

64% Male 36% Female

80% British 20% BME

Needs

78% Homelessness

97% Addiction

96% mental Health

94% Addiction and Mental Health (Dual Diagnosis)

84% Offending

WY-FI Beneficiaries Overview of starts and caseloads

Cumulative to end Y5 Q2 794

Current caseload 256

Peer Mentors

105 people have completed the accredited CERTA level 2 Qualification in Peer Mentoring

19 Beneficiaries have started the Peer Mentoring Course

72 Peer mentors have gained placements with the WY-FI Navigator/Specialists Teams

Education, Training and Employment

363 Beneficiaries took up volunteering, employability or training activities

21 People with lived experience recruited as trainees or Co-Production Champions

Locality Caseload

Bradford 36

Calderdale 67

Kirklees 47

Leeds 44

Wakefield 62

Total 256

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Summary (All Based on Current Caseload unless otherwise stated)

30% of the Current Caseload have the New Post GDPR Consent form completed

100% of SUSSAR document returned in a timely fashion

92% of Current Caseload Have Support Plan date indicated in the service user record

47% of discharges are Planned Exits (That is on the full discharge list since the start of the project)

85% OF Insight Questionnaire Completed

88% of Beneficiaries show an improvement in HOS score at two years

90% of beneficiaries show an improvement in NDTA score at two years

Consent form Collection As of 30/11/2018 256 beneficiaries are on active caseload. Table and chart below for Partner Completion.

70%

30%

Consent Not Obtained Consent Obtained

Case Load New Consent

Form Percentage

Barca 44 24 55%

Bridge 36 21 58%

Community Links 47 3 6%

Foundation 67 18 27%

Spectrum 62 11 18%

Total 256 77 30%

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Planned and Unplanned Exits (All Discharges)

Support Plan (Indicated by date on MIS) – Current Caseload

47% 53%

Planned Exit Unplanned Exit

Partner Planned

Exit Unplanned

Exit Percentage

Planned

Barca 82 88 48%

Bridge 80 64 56%



Spectrum 18 46 28%

Grand Total 231 263 47%

Partner Navigation Support Plan Percentage

Barca 40 33 83%

Bridge 27 27 100%



Spectrum 47 43 91%

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Insight Questionnaire Completion Further requests sent out for Sep, Oct and Nov. Percentages shown for 2 per partner per month (Jun to Nov)

Partner 6 Month

Completion 2 Per Month Percentage

Barca 8 67%

Bridge 20 167%

Community Links 5 42%

Foundation 11 92%

Spectrum 7 58%

Grand Total 51 85%

8%

92%

Not in Place In Place

Grand Total 203 187 92%

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Equality and Diversity

Ethnicity

36% 64%

Female Male

70.4%

17.1%

12.5%

White British BME Not Known

Locality - All Starts

Female Male Grand Total

Bradford 63 127 190

Calderdale 56 87 143

Kirklees 47 56 103

Leeds 67 160 227

Wakefield 51 80 131

Grand Total 284 510 794


White British

BME Not Known

Bradford 124 36 30

Calderdale 115 22 6

Kirklees 59 40 4

Leeds 165 34 28

Wakefield 96 4 31


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Please note that the percentage figures given for White British and BME at the top of this document are percentages for all those beneficiaries with known ethnicity.

This table and chart above is for all beneficiary starts, which include those for which no Ethnicity has been collected.

Age


18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65+

Bradford 13 46 57 47 24 3

Calderdale 6 30 57 37 8 5

Kirklees 9 22 42 23 7

Leeds 15 67 78 48 15 4

Wakefield 7 33 62 22 3 4

Grand Total 50 198 296 177 57 16

0 50 100 150 200 250 300

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65+

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Progress Against Outcomes (HOS and NDTA 24 Month Score Point) Note on the Tables: In all the tables proceeding on down from this point the figures presented are an arithmetic mean of the individual scores in the data set.

Homelessness Outcomes Star (HOS) The tables and charts below refer to the beneficiaries that have a qualifying 24-month score for HOS and NDTA. Score recorded between (23 and 24 months of first

score taken)

There are 65 beneficiaries that have an initial and a qualifying 24 month HOS score and similarly there are 60 beneficiaries that have a qualifying 24 month NDTA

score.

HOS

Mo

tivation

and

takin

g re

spo

nsib

ility

Self-C

aring an

d

Living Skills

Man

aging M

on

ey

and

Pe

rson

al A

dm

inistratio

n

Social N

etw

orks

and

Re

lation

ship

s

Dru

g and

Alco

ho

l M

isuse

Ph

ysical He

alth

Emo

tion

al and

M

en

tal He

alth

Me

anin

gful U

ses O

f Time

Man

aging

Ten

ancy an

d

Acco

mm

od

ation

Offe

nd

ing

First Score 2.4 3.1 2.1 2.3 1.9 2.8 2.1 1.9 2.2 3.5

2 Year Score 4.5 5.0 4.5 4.0 3.8 4.7 4.2 3.8 4.6 6.0

NDTA

Engagem

en

t W

ith Fro

ntlin

e

Services

Inte

ntio

nal Self

Harm

Un

inte

ntio

nal

Self Harm

Risk T

o O

the

rs

Risk Fro

m

Oth

ers

Stress and

An

xiety

Social

Effectiven

ess

Alco

ho

l/Dru

g

Ab

use

Imp

ulse

Co

ntro

l

Ho

usin

g

First Score 3.2 2.4 3.6 4.8 6.1 3.4 2.5 3.7 3.0 3.1

2 year Score 1.4 2.4 2.6 3.6 2.5 1.8 2.8 1.9 1.8 3.2

The next and proceeding page contains the corresponding Radar Charts for HOS and NDTA

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0

2

4

6

8

Motivation and taking reponsibility

Self Caring and Living Skills

Managing Money and Personal Administration

Social Networks and Relationships

Drug and Alcohol Misuse

Physical Health

Emotional and Mental Health

Meaningful Uses Of Time

Managing Tenancy and Accommodation

Offending

24 Month HOS Progress

First Score 2 Year Score

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0.0

2.0

4.0

6.0

8.0

Engagement With Frontline Services

Intentional Self Harm

Unintentional Self Harm

Risk To Others

Risk From Others

Stress and Anxiety

Social Effectiveness

Alcohol/Drug Abuse

Impulse Control

Housing

24 Month NDTA Progress

First Score 2 year Score

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Progress Against Outcomes (HOS and NDTA Second Score) The tables and charts below refer to the beneficiaries that have a second HOS and NDTA reading at least 3 months apart.

There are 535 Beneficiary who have at least 2 Homelessness Outcomes Star with at least 3 months between the first and second score.

Of those 535, 344 show and improvement in total score, 89 remain the same and 102 show a reduction in score.

HOS

Mo

tivation

and

takin

g

resp

on

sibility

Self-C

aring an

d

Living Skills

Man

aging

Mo

ne

y and

P

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nal

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istration

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etw

orks

and

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isuse

Ph

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Me

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ses O

f Time

Man

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ancy an

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First Score 2.8 3.1 2.5 2.6 2.5 3.2 2.4 2.3 2.5 4.1

Second Score 3.5 3.8 3.0 3.2 3.2 3.7 3.0 3.0 3.3 4.6

For Chaos Indexes(NDTA) there are 676 who have at least 3 months between the first and second score.

Of those 676, 414 show an improvement (decrease in score), 145 remain the same and 117 show a decline (increase in score)

NDTA

Engagem

en

t With

Fro

ntlin

e Service

s

Inte

ntio

nal Se

lf H

arm

Un

inte

ntio

nal Se

lf H

arm

Risk T

o O

thers

Risk Fro

m O

thers

Stress and

An

xiety

Social Effectiven

ess

Alco

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l/Dru

g A

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se

Imp

ulse C

on

trol

Ho

usin

g

First Score 3.1 2.4 3.3 5.0 5.7 3.4 2.6 3.5 3.0 3.0

Second Score 2.7 2.0 2.9 4.2 5.0 3.1 2.4 3.1 2.6 2.5

The corresponding Radar charts for these tables are shown in the two proceeding pages.

Page - 64

0.0

2.0

4.0

6.0

8.0

10.0

Motivation and taking reponsibility

Self Caring and Living Skills

Managing Money and Personal Administration

Social Networks and Relationships

Drug and Alcohol Misuse

Physical Health

Emotional and Mental Health

Meaningful Uses Of Time

Managing Tenancy and Accommodation

Offending

HOS Progress(1st and 2nd Score)

First Score Second Score

Page - 65

0.0

2.0

4.0

6.0

8.0

Engagement With Frontline Services



Risk To Others

Risk From Others

Stress and Anxiety


Alcohol/Drug Abuse

Impulse Control

Housing

NDTA Progress(1st and 2nd Score)

First Score Second Score

Page - 66

Beneficiary Insight Questionnaire Refresh Analysis (Up to Nov 2018) There are now 224 questionnaires that have been collected and this analysis shall be based on those

224.

There are some beneficiaries that have had more than one questionnaire done, these will be

included as the answers do differ from questionnaire to questionnaire. The details of these repeated

questionnaires will be analyses in a further document.

Tabular Demographic Summary

W/B BME Percentage

White British 82%

BME 12%

Not Known 5%

The percentages shown in each table are that of the grand

total, not of rows or columns.

Overall the Age/Gender split is a good representation of the WY-FI Cohort as a whole. As for as

ethnicity goes, it is a little more difficult to make this statement. See the comparison table below.

The insight Cohort is more well defined

for ethnicity than the wider WY-FI cohort

and while it could be surmised that the

bulk of the not knowns in the WY-FI

cohort are White British, if one assumes

the continuation of proportion to the known ethnicities, it is by no means certain that this is the

case. If one were to ignore the don’t knows in each cohort, then the White British (W/B)/BME

percentage for each becomes;

Insight Cohort -W/B 87%, BME 13%

WY-FI Cohort -W/B 80% BME 20%

This is by no means conclusive either, so in terms of ethnicity the Insight Cohort does wholly

accurately represent the WY-FI Cohort.

The Questionnaire Boxes 1 to 3 contain the initials of the interviewee, the beneficiary ID and the date of collection

respectively.

Response Analysis Responses 4 to 19 are the beneficiaries view of the WY-FI Navigator Service, statements to be

ranked in the order, Strongly Agree, Agree, Disagree and Strongly Disagree along with N/A where

applicable. In the datasheet these are associated by a numeric sale of 1 to 5, 1 being Strongly Agree

to 4 being Strongly Disagree and 5 being N/A.

Statement 20 is still marked on the same numeric scale but has the responses to the following

statement;

My overall experience of working with a Navigator was; 1=Consistently Better than Expected,

2=Better than Expected, 3=As Expected, 4=Less than Desirable, 5=N/A.

Age/Gender Female Male

18 to 24 2% 1%

25 to 34 11% 12%

35 to 44 21% 18%

45 to 54 8% 12%

55 to 64 2% 11%

65+ 1% 1%

Ethnicity WYFI Cohort Insight Cohort

White British 70% 82%

BME 17% 12%

Not Known 13% 5%

Page - 67

See Appendix 1 for the full statements and the grouping applied that produces the charts below.

I have labelled only the. “strongly agree”, percentages as these are by far the greatest in all the

responses

The analysis of the statement groups is show below. Again, the percentages for, “Strongly Agree” are

only shown for the same reason as the previous chart.

Statement 20 response chart is below;

Statement 20 is : “My overall experience working with a navigator was..”

68% 72%

59%65%

71% 68% 68%

80% 78%

62%

76%68% 69%

58%52%

70%

0%

20%

40%

60%

80%

100%

S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 S18 S19

Strongly Agree Agree Disagree Strongly Disagree N/A

66% 68% 68% 68% 72%64% 61%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

G1 G2 G3 G4 G5 G6 G7

Strongly Agree Agree Disagree Strongly Disagree N/A

Page - 68

Before and After Service Experience I’ve called this Before and After, but it should really be called Before WY-FI and During WY-FI

Navigation, but Before and After gets over the idea we are showing.

The before and after service ratings are based on the following responses and are coded on a

numerical scale as follows; 1=Very Good, 2=Good, 3=Bad, 4=Vary Bad, 5=N/A.

The services analysed are health Services, mental health Services, Housing Services, Job Centre +,

Benefits and Help with Money, Alcohol Addiction Services, Drug Addiction Services, Probation

Services, Services for Children and Mutual Aid.

1: Service Rating Pre WY-FI

52% 39%

0% 20% 40% 60% 80% 100%

S20

Consistently Better than Expected Better than Expected As Expected Less than Desireable N/A

0% 20% 40% 60% 80% 100%

Health Services

Mental Health Services

Housing Services

Job Centre +

Benefits or help with Money

Alcohol Addiction Services

Drug Addiction Services

Probation Services

Childrens Services

Mutual Aid

Very Good Good Bad Very Bad

Page - 69

2: Service Rating with a WY-FI Navigator

These two charts above just tell us the service ratings for the services Pre WY-FI and with a

Navigator. What would be more interesting is to look at how the ratings improve when someone has

a rating Pre WY-FI and a rating with a Navigator. This does not involve looking at the service ratings

on their own, but the difference in the assigned numerical values assigned, as explained earlier.

For instance, if someone rated a service as Very Bad (4) Pre WY-FI and Very Good (1) with a

Navigator then the change would be 4-1=3. Like wise if the ratings were reversed, i.e. Very Good (1)

Pre WY-FI and Very Bad with a Navigator then the change would be 1-4=-3. This gives a range of

possible changes of -3 to +3. There is no-one with a change of -3 so the following analysis leaves that

out.

3: Service Use Rating Change

The chart plainly shows that for those with both a “before” and a “Navigator” rating, the service use

rating change is invariably positive.

The last outcome to consider is the service use rating for those that were introduced to a service by

a Navigator they had never previously used. That analysis is shown overleaf;

0% 20% 40% 60% 80% 100%

Health Services


Housing Services

Job Centre +




Probation Services

Childrens Services

Mutual Aid


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Health Services


Housing Services

Job Centre +




Probation Services

Childrens Services

Mutual Aid

-2 -1 0 1 2 3

Page - 70

4: Service Use ratings for Navigator Introduced Services

Summary To summarise, the conclusion of the analysis is that overall experience of service use is greatly better

with initial support by the Navigator and furthermore having a navigator enables better relationships

between Beneficiaries and Staff, helps with mutual understanding between Beneficiaries and Staff

and gives the Beneficiary confidence to move forward with their life.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Health Services


Housing Services

Job Centre +




Probation Services

Mutual Aid


Page - 71

Planning and Goals This is a new section which was added to the Insight Questionnaire late last year. It was not included

in the April analysis this year as there were not enough papers containing this information at that

time. We now have 107 responses to this section since it was first introduced.

Demographics of Planning and Goals Section

5: Age/Gender of Insight Cohort vs Whole WY-FI Cohort

Comparing men in the Insight Cohort vs men in the overall WY-FI Cohort. Men in the 55 to 64-year

age range are somewhat over represented in the Insight Cohort. The sample was taken totally at

random, within the bounds of the criteria for participation, 6 months or more on the case load.

Ignoring this the percentages for the remaining ager groups are slightly smaller but are in more of a

representative proportion.

Looking at the women in both samples, age ranges are more reasonably comparable which signifies

the female Insight sample is a very good representation of the whole WY-FI Cohort in terms of age.

6: Ethnicity of Insight Cohort vs Whole WY-FI Cohort

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Female - All WY-FI

Female - Insight

Male - All WYFI

Male - Insight

18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65+

70% 79%

17% 15% 13%7%

0%

25%

50%

75%

100%

White British - AllWY-FI

White British -Insight

BME - All WY-FI BME - Insight Not Known - AllWY-FI

Not Known -Insight

Page - 72

The percentage of unknowns in each cohort presents a small problem when attempting to compare

the two cohorts for ethnicity and it not possible to say for definite that the Insight cohort is

representative of the whole WY-FI cohort in terms of Ethnicity.

For the balance of the protected characteristics the data collected is not complete enough to

produce any meaningful conclusions either way.

Content of the Planning and Goals Section The section added was in the form of a question with multiple fixed answers and a free text answer,

the question being;

“What do you think you feel you need in order to help you achieve your existing goals and plan for

new goals in the future?”

The available selections to this question are;

1) Help with somewhere to live long term

2) Support with Addiction (in the community) – Mutual Aid

3) Opportunities for Education, Training and Employment

4) Meaningful Activities

5) Transport/Getting Out

6) Managing Myself – Healthy Eating, Exercise, Time Management

7) Reconnection to family/managing relationships

8) Access to children

9) Physical Health

10) Counselling, Mental Health or other emotional help/support

11) Managing Money

12) Confidence and Motivation

13) (Free text) Anything else you can think of

Free Text Responses There were very few free text answers 11 out of 108(Around 10%).

Four of these replies certainly indicate that the beneficiaries in question are very much looking to

the future, those replies being;

“Help with college stuff”, “Confidence building”, “Anger Management” and “Possible relocation to

Middlesbrough”

These replies imply a certain amount of self-knowledge and acceptance, especially the second and

third responses, and shows that each person in question has indeed come a long way in their

journey, one even considering a move out of area.

Health was mentioned in two of the responses;

“general health, happiness and wellbeing” and “I’d like to get my health back and see kids”

Financial considerations were mentioned by a further two;

“Help with benefits” and “Bank Account”

The other answers were;

Page - 73

“To keep motivated and not to use”, “DETOX” (Written in capitals) and “Someone to talk to and

trust”

This final response highlights an ongoing problem for those in recovery and can also be equated with

“To keep motivated and not to use”. For all the hard work done by the beneficiary with the support

of the navigator to get to a point where it is possible to look to the future, it is only possible to keep

on the straight and narrow, so to speak, if there are meaningful activities in place and SMART goals

to aim for.

Fixed Response Categories There are 12 fixed responses and there was a variable response in how many categories were

selected by each individual, some indicated no responses and some selecting all 12.

Looking at the number of selections made by the beneficiaries made compared to their gender there

is nothing that stands out.

Gender Response to Items 1 to 12 Table 1: Percentage of Each Gender Indicating Need for each Item 1 to 12

Taking a difference of greater that

5% as a significant indicator. 11%

more men want help with Long

Term Housing that Women

8% more men want support with

addiction and mutual aid.

11% more women want support

with meaningful activities.

8% more women want support

with reconnecting and

relationships.

21% more women than men want

help accessing their children. WY-FI does not collect data on number of children dependant or non-

dependant so more analysis on this cannot be done.

7% more men want help with managing money and 11% more women want help with confidence

and motivation

The top 3 for men are;

Long Term Housing (37 responses)

Managing Money (36)

Support with Addiction Mutual Aid

(34)

Transport/Getting out (34)

Counselling (34)

The top 3 for women are;

Confidence and Motivation (32

responses)

Meaningful Activities (31)

Managing Myself (29)

These responses seem to be very gender

specific and going forward we will need to

monitor the further responses of the Insight

Questionnaires.

Question Content Male Female

Long term housing 63% 52%

Support with Addiction Mutual Aid 58% 50%

Opportunities for ETE 39% 42%

Meaningful Activities 54% 65%

Transport/getting out 58% 54%

Managing Myself 56% 60%

Reconnection & relationships 36% 44%

Access to children 14% 35%

Physical health 56% 52%

Counselling 58% 56%

Managing Money 61% 54%

Confidence/Motivation 56% 67%

Page - 74

BME Responses to Items 1 to 12 Table 2: White British/BME Responses to Items 1 to 12

Two things to note before going

on with this section.

There are more than 5

times more White British

beneficiaries questioned than

those from a BME background (86

to 14)

Out of the 107

questionnaire analyses BME

information was not available for

7 of the beneficiaries.

This table is included as information only and not for any comparison purposes. This is because of

the relatively low numbers of BME beneficiaries in the sample compare to White British. The top 3

for White British(W/B) and BME can however be shown and is done so below.

The top 3 for W/B;

Managing Money (52 responses)


Confidence and Motivation (51)

Counselling (50)

The top 3 BME;

Managing Myself (11 responses)

Confidence/Motivation (11)

Long term housing (10)

Transport/getting out (10)

Physical health (10)

Opportunities for ETE (9)

Age Range Responses to Items 1 to 12 I have not presented this in terms of the age ranges but in terms of the below the mean age and

above or equal to the mean age (41). Shown below are the instances where the difference in

percentage is greater than 5%.

Table 3 Table 4: Age Responses to Items 1 to 12

Of the 7 items shown here there are

more of the younger age than the

older age that want help with

everything except for physical health.

This is reflected over the whole of the

categories including those that have a

difference of less than 5%.

Those younger than 41 say they want

help with more of the items 1 to 12 than those over 41.

Question No W/B BME


Support with Addiction Mutual Aid 56% 44%

Opportunities for ETE 38% 56%


Transport/getting out 56% 63%





Counselling 60% 50%


Confidence/Motivation 61% 69%

<Mean >Mean








Page - 75

The top 3 for Age Smaller than 41

Managing Myself (36 responses)

Long Term Housing (35)


Managing Money (34)

Confidence/ Motivation (34)

The top 3 Age greater or equal to 41;

Confidence/Motivation (31

responses)

Physical Health (30)


Counselling (29)

Transport/Getting Out (29)

For those aged less than 41 help with long term housing is very important along with Managing

Myself and managing Money. Confidence and Motivation play a part in both age ranges being

number 1 in the over 41 age range and number 3 in the other

Page - 76

Full Tables for Planning and Goals

Gender and Age

Gender/Age 18 to 24 25 to

34 35 to

44 45 to

54 55 to

64 65+

Female - All WY-FI 6% 27% 45% 17% 3% 2%

Female - Insight 6% 23% 52% 13% 4% 2%

Male - All WYFI 6% 24% 33% 25% 9% 2%

Male - Insight 3% 22% 27% 22% 25% 0%

Ethnicity

Ethnicity Percentage

White British - All WY-FI 70%

White British - Insight 79%

BME - All WY-FI 17%

BME - Insight 15%

Not Known - All WY-FI 13%

Not Known - Insight 7%

Items Table The final table, shown over, is the table that the item 1 to 12 analysis is based on. There are four

different sections to this table, explained below;

Columns Indicated and Null. Indicated is the number of persons that indicated they needed

help in this area. Null is the number who didn’t indicate.

Male and Female are the number of men and women who indicated they need help in this

area.

<41 and >=41 are the numbers in those age ranges who indicated they needed help in this

particular area.

W/B, BME and Not Known are the numbers in those White British, BME and Not Known

Ethnicity that indicated they needed help in that particular area.

The corresponding numbers in the Indicated and Null columns add up to 107, the number of

respondents analysed.

The corresponding numbers in the Gender, Age and Ethnicity columns all add up to the number of

respondents that indicated they needed help in each of the itemised areas.

Page - 77

Table 5: Full Item response Table

Indicated Null Male Female <41 >=41 W/B BME Not

Known

Long term housing 62 45 37 25 35 27 48 10 4

Support with Addiction Mutual Aid 58 49 34 24 31 27 47 7 4

Opportunities for ETE 43 64 23 20 20 23 32 9 2

Meaningful Activities 63 44 32 31 34 29 51 7 5

Transport/getting out 60 47 34 26 31 29 47 10 3

Managing myself self 62 45 33 29 36 26 48 11 3

Reconnection & relationships 42 65 21 21 24 18 32 6 4

Access to children 25 82 8 17 16 9 19 5 1

Physical health 58 49 33 25 28 30 45 10 3

Counselling 61 46 34 27 32 29 50 8 3

Managing Money 62 45 36 26 34 28 52 8 2

Confidence/Motivation 65 42 33 32 34 31 51 11 3

Appendix 1: Statements 4 to 19 (S4-S19) and their corresponding groupings (G1-G7)

S4 Working with a navigator helps me to overcome obstacles to

achieving what I want for myself

S5 My navigator helps me work on goals that are important to

me

S6 Working with a navigator gives me the confidence that I can

achieve what I want for myself

S7 Working with a navigator has given me support when

moving from one service to another

S8 My Navigator lets me know where to get help and support

S9 My Navigator responds quickly to my needs

S10 My Navigator gives me accurate contact information which I

can easily access

S11 My Navigator is someone that I am confident with

S12 My Navigator has taken the time to get to know me

Page - 78

S13 Working with a navigator has made it possible to have an

open and trusting relationship with staff

S14 My Navigator explains things to me in a way that I can

understand

S15 Working with a Navigator makes me feel understood

S16 I meet my navigator in places that are easy for me to get to

S17 I am allowed to take as much time as I need during visits

S18 While working with a Navigator I have been able to meet my

personal goals

S19 I believe my navigator is working with me to take my future

in the direction that I want it to go

G1 Goals, Confidence, The Future, Overcoming Obstacles G2 Support From Navigator, Where I Can get Support G3 Response to Needs G4 Contact Information G5 Relationships - Staff and Navigators

G6 Communication - Understand Me and Me understanding

others G7 Navigator Visits, Meeting Navigators

The colours indicate which group each statement belongs to.

Page - 79

Fair Access Report October 2018 WY-FI Fair Access Report Summer/ Autumn 2018

Summary: Mark Crowe WY-FI Research and Evaluation Lead October 2018.

The Fair Access Report was completed for Humankind in June 2018 using data for the programme up to the end

of March 2018. This has been supplemented by the relevant findings from an ongoing refresh of the WY-FI Needs

Analysis (October 2018) that we originally undertook in 2013.

WY-FI collects a great deal of information about its beneficiaries because of the unique nature of the project as is

part of a “test and learn” programme of 12 projects taking place across England with common data framework.

We have reported on the following “Fair Access themes”:

Age

Gender

Age and Gender Combined

Ethnicity

Religion

Disability

In terms of ethnicity, we are able to run analysis of the data at district level and West Yorkshire level. However

the spatial nature of BME communities is that although statistics exist at both levels they mask considerable

concentrations of BME communities at much smaller geographic levels. Even in a client base as large as WY-FI we

had difficulty robustly comparing the experiences of any subsectors within the BME population. Similarly

comparing across combinations of the Fair Access themes was not fruitful except in the area of Age and Gender

where there was an adequate population to investigate.

The findings are that frequently individuals from the diverse populations make up a representative proportion of

beneficiaries when tested against the district level population and what is known about the multiple needs

population nationally. Beneficiaries from diverse populations tend to have better outcomes as well. One useful

fact that emerged from this work is the relative lack of progress made by the 35-44 age group with white males

having the fewest good outcomes/ exits.

There is still a perception that WY-FI should have a greater number of beneficiaries from ethnic minorities and

also from LGBT communities. This is based on the relatively high proportions of people from BME backgrounds in

the criminal justice system and secure hospitals and the recently released figures for the proportion of LGBT

people who are homeless (24%). We acknowledge this is an area to explore further (having had a BME Specialist

in the project) and are seeking the help of partners to do so.

Page - 80

WY-FI

Fair Access and Exit Data Analysis – June 2018/ October 2018

___________________________________________________

Introduction

The following document aims to gather evidence to decide whether there

are any particular barriers, issues, patterns of inequality (i.e. ‘negative impact') for different equality groups in

accessing the service, or exiting positively from it.

The following characteristics have been split into sections and reported on –

Age

Gender

Age and Gender Combined

Ethnicity

Religion

Disability

Each of the above is then split into the following areas of data –

Access / Referral – Looking at numbers entering onto a Navigator Caseload based on the above characteristics.

Comments / findings on the data are made.

Exit / Discharge Status – Looking at numbers exiting the WY-FI project – positively, negatively and neutrally based

on above characteristics. Comments / findings on the data are made.

From the Needs Analysis September 2018 Where available the data in this report has been supplemented by data

from the emerging needs analysis version dated September 2018. This may show variations in actual numbers but

the benefit is that it also shows district level data. The two sets of analysis despite the mathematical variations draw

very similar conclusions about the WY-FI population overall

Headline Analysis / For Consideration – Any headline information / findings condensed and reported on based

on the above.

The above is intended to influence / guide discussion and any potential process changes required.

The Data

All data is taken from the WY-FI MIS system up to 31/03/18 and is as accurate as the information inputted

onto beneficiary records. Any significant gaps in recording that influence the findings has been mentioned

in the below report.

All graphs are based on % split of the reported diversity area i.e. Gender - 247 Female beneficiaries = 100%

as represented.

It is important to note that beneficiary data inputted onto WY-FI MIS is done so by non-Humankind staff

and beneficiaries are not case managed by Humankind staff.

The referral process and recording criteria are purposefully set to minimise barriers to the programme i.e.

Diversity related questions are not a ‘required field’.

In the following report Discharge Status is based on Exit Destinations – Positive, Negative, Neutral – It does

not take into account chaos index scores between start and end on the WY-FI programme – ongoing

analysis of this is being completed.

Page - 81

Age

___________________________________________________

Access / Referral -

Age Range 35-44 is most common beneficiary age bracket – 38% of All

Seen and 44% of Active caseload.

Retention rates (remain on caseload) for 35-44 age range is significantly higher than its closest age ranges

in cohort share – 25-34 and 45-54 – both %’s and numerically. Both age ranges 25-34 (77 active vs 99

discharged) and 45-54 (59 Active vs 83 discharged) have discharged more beneficiaries than current active

caseload – 35-44 Age range is the complete reversal with 149 Active vs 116 discharged.

Exit / Discharge Status -

Active Positive Neutral Negative Grand Total % All Seen

18 to 24 21 8 2 11 42 6%

25 to 34 77 37 18 44 176 25%

35 to 44 149 42 9 65 265 38%

45 to 54 59 34 8 41 142 21%

55 to 64 29 15 3 5 52 8%

65+ 4 7 0 5 16 2%

Grand Total 339 143 40 171 693 100%

Table 6 - Exit/ Discharge Status

Figure1 - Exit/ Discharge Status

Page - 82

Higher the age 55-64 & 65+ Age range positive exit % significantly higher than other age ranges – albeit

with smaller cohort size. That said the % negative discharge rate for 65+ is the highest of any with 31%

again with a small cohort size however.

Negative discharge rates in the highest age ranges (25-34, 35-44, 45-54) are all similar in % between 25%-

29% - all higher than the positive rates.

Largest cohort of 35-44 has the largest difference (of highest age ranges) in % discharges positive 16% v

negative 25% - both the 25-34 and 45-54 cohorts are within 5% of each other.

From the Needs Analysis September 2018

Age Range

Most of the Beneficiaries in the WY-FI project are aged 35 to 44. Over 60% of the beneficiaries are in the age group

25 to 44 which coincides with the findings of the Hard Edges report. The Hard Edges report states that the severe

and multiple disadvantages predominantly affects people in the aged 25 to 44.

Figure 2 - Age Range by gender

Figure 3 shows how the proportion of each age range varies by the different start localities, Table 2 gives more in

depth details. All the areas have different proportions of each age range, Wakefield has the largest proportion of

their beneficiaries being aged 35 to 44. Leeds has the highest proportion of those in the age range 25 to 34 almost

30% of the Leeds beneficiaries fall into this category. Calderdale have the highest proportion of people in the 45 to

54 age range.

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65+

Male

Female

Page - 83

Figure 3 – Age range by locality

Age Range Bradford Calderdale Kirklees Leeds Wakefield

18 to 24 7.10% 3.76% 8.74% 6.39% 5.60%

25 to 34 24.04% 20.30% 21.36% 29.68% 25.60%

35 to 44 30.60% 40.60% 40.78% 34.70% 47.20%

45 to 54 24.04% 25.56% 22.33% 20.55% 16.00%

55 to 64 12.57% 5.26% 6.80% 6.85% 2.40%

65+ 1.64% 4.51% 0.00% 1.83% 3.20%

Grand Total 100.00% 100.00% 100.00% 100.00% 100.00%

Table 7 – Age Range by locality

Figure 4 shows the prevalence of the HARM needs amongst the different age ranges, Table 3 gives more in-depth

details. Those aged 45 to 54 are more likely to be suffering from mental ill health, as Calderdale has the highest

proportion in this age range, it gives a reason to explain why Calderdale also has the highest proportion of those

suffering mental ill health. Offending is less prevalent as the age range increases and shown by the decreasing bars

in Figure 4. The highest offending need group is aged 18 to 24, however this does not coincide with the locality that

has the highest proportion of offenders. The reason for this is that the proportion of 18 to 24 year olds is small in

all the localities. Although this may give evidence to suggest that there is some link between offending and age

which could be described as an age/offending inverse relationship, more data would be required to give a better

insight. Another point to note is that Substance misuse is considerably lower for the 18 to 24 age group at less than

90% compared to 95%+ for the other age ranges. People over the age of 65 who are beneficiaries are more likely

to have a homelessness issue 86.67% compared to 73.17% in the age range 45 to 54.

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

50.00%

18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65+

Bradford

Calderdale

Kirklees

Leeds

Wakefield

Page - 84

Sum of Homelessness

Sum of Substance

Misuse Sum of Offending

Sum of Mental ill

health

18 to 24 78.72% 89.36% 87.23% 89.36%

25 to 34 80.11% 96.77% 85.48% 96.24% 35 to 44 79.50% 97.48% 80.94% 97.48% 45 to 54 73.17% 99.39% 79.88% 98.17% 55 to 64 75.93% 96.30% 74.07% 94.44% 65+ 86.67% 100.00% 73.33% 93.33%

Table 8 Age Range by HARM needs

Figure 4 – Age range bye HARM need

Headline Analysis / For Consideration –

35-44 Age Range – additional analysis on complexity within age range required – what is keeping this age

range on programme longer – significant differences in numbers / %’s discharged from other age ranges.

Higher chance of discharging the service positively the older the age range – 32% chance if aged over 55 of

exiting programme positively based on the combined all seen and positive discharge figures.

Significant jump in All Seen numbers between 18-24 (42 beneficiaries) and 25-34 (176 beneficiaries) – the

younger cohort is always expected to be lower however this difference is significant enough to highlight.

50.00%

55.00%

60.00%

65.00%

70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

Homelssness Substance Misuse Offending Mental ill health

18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65+

Page - 85

Gender

___________________________________________________

Access / Referral -

Overall beneficiaries seen / All Seen sees a gender split of 446 Male -

64.3% vs 247 Female – 35.6%. This gender split is in contrast to for example Substance Misuse services who

record gender splits with relative consistency of Male 70% and Female 30%.

Active caseload sees an even higher gender ratio % for Females – 42% vs 58% Male as this is significantly

higher than the All Seen figure it signifies Women staying on caseloads for longer.

Exit / Discharge Status –

A higher proportion of Women remain active on the caseload than Men (57% to 44%), this, of course,

means that the overall proportion of discharges for women is smaller than that of men.

Active Positive Neutral Negative Grand Total

Male 198 102 28 118 446

Female 141 41 12 53 247

Grand Total 339 143 40 171 693

Table 9 Exit/ Discharge Status by gender

Figure 5 – Exit/ Discharge Status by gender

From the Needs Analysis September 2018

Multiple and complex needs has previously been described as a predominantly male issue with the Hard Edges

report stating that around 80% of those diagnosed with multiple and complex needs are Male. WY-FI has

approximately 36% Female and 64% Male. The difference may be caused by the Hard Edges report not taking into

account mental health issues, and also that women’s particular experiences may cause them to be

underrepresented in some statistics.

Figure 6 shows that Men are more likely to have experience of offending, Women are slightly more likely to be

affected my mental ill health. Both have their own specific set of challenges.

Page - 86

Figure 6 – HARM need prevalence by gender

Figure 7 shows a similar pattern for both Males and Females in terms of HOS, however, Females have higher scores

across the boards. In particular offending, self-caring and living skills appear to be where the biggest difference is

coming from. Differences between the experiences of the separate genders can also be seen in Figure 8, Women

are reported to be more at risk from others and less of a risk to others. Broadly the same for the other categories,

men slightly less socially effective. This gives further evidence to suggest that the experiences of those with multiple

and complex needs does differ between the genders, even if it is not in term of overall scores. Overall initial NDTA

scores shows no statistically significant difference between the genders.

Figure 7 – Baseline average HOS by gender

77.70%

96.28%

75.84%

96.65%

78.32%

97.68%

84.84%

96.42%

Homelssness Substance Misuse Offending Mental ill health

Female Male

0

1

2

3

4

5

Motivation and takingreponsibility

Self Caring and LivingSkills

Managing Money andPersonal…

Social Networks andRelationships

Drug and AlcoholMisuse

Physical Health

Emotional and MentalHealth

Meaningful Uses OfTime

Managing Tenancy andAccommodation

Offending

Female Male

Page - 87

Figure 8 – Baseline average NDTA by gender

Table 5 shows the specific HARM needs by gender and start locality. The statistics show that the homelessness

need is at a higher prevalence for Females in Leeds and Wakefield compared to Males in their respective

localities. The opposite is true for the other areas. Substance misuse is more prevalent for males in every locality

except for Kirklees. Offending is higher for Men in all areas except for Wakefield. Kirklees reports the largest

difference between the male and female offending HARM need, 90.9% and 68.1% respectively. Mental ill Health

needs are slightly more prevalent for women, which coincides with previous information in the report. No large

difference within the localities for men and women by locality in terms of mental ill health.

Homelessness Substance

Misuse Offending Mental ill

health

Female 77.7% 96.3% 75.8% 96.7%

Bradford 86.9% 96.7% 73.8% 96.7%

Calderdale 70.6% 96.1% 68.6% 98.0%

Kirklees 72.3% 97.9% 68.1% 95.7%

Leeds 69.4% 95.2% 82.3% 95.2%

Wakefield 89.6% 95.8% 85.4% 97.9%

Male 78.3% 97.7% 84.8% 96.4%

Bradford 87.8% 99.1% 82.6% 94.8%

Calderdale 83.5% 97.5% 78.5% 98.7%

Kirklees 83.6% 96.4% 90.9% 94.5%

Leeds 63.2% 97.4% 88.8% 96.7%

Wakefield 85.1% 97.3% 82.4% 97.3%

Table 5 HARM need prevalence by gender and locality

Headline Analysis / For Consideration -

It would be interesting to analyse other services that may case manage this client group – Mental Health,

Criminal Justice etc Gender ratio’s – to see if stand-alone services have a differing ratio to a combined needs

service such as WY-FI.

0.001.002.003.004.005.006.007.00

Engagement WithFrontline Services



Risk To Others

Risk From Others

Stress and Anxiety


Alcohol/Drug Abuse

Impulse Control

Housing

Female Male

Page - 88

Females exiting caseload lower in % of overall Females seen in all areas than Male – statistically less likely

to exit service in anyway once you are on navigator caseload if you are Female.

Page - 89

Age & Gender Combined

___________________________________________________

Age and Gender are the only demographic fields in which an additional

breakdown of data is feasible, other demographic field breakdowns give us data in the singular figures making

comparison and analysis difficult.

Access / Referral –

As expected based on Age Range split the 35-44 Age range contributes the highest number and % of

beneficiaries for both Male and Female cohorts. This contribution however is considerably higher within

the Female Cohort -

Gender/Age(Active Caseload) Male Female Total

18 to 24 15 / 8% 6 / 4% 21

25 to 34 45 / 23% 32 / 23% 77

35 to 44 74 / 37% 75 / 53% 149

45 to 54 39 / 20% 20 / 14% 59

55 to 64 24 / 12% 5 / 4% 29

65+ 1 / 1% 3 / 2% 4


Table 6 Number of beneficiaries on caseload by gender/ age

More Females (75) in the 35-44 age range than Male beneficiaries (74).

Over half – 53% of all Female beneficiaries are within the 35-44 age range.

Significant shift in % of Active total the older the beneficiaries get – 20% of all Female beneficiaries are 45+

whereas 33% of all Male are 45+.

Gender/Age (All Seen Caseload)

Male Female Total

18 to 24 28 / 6% 14 / 6% 42 / 6%

25 to 34 108 / 24% 68 / 28% 176 / 25%

35 to 44 149 / 33% 116 / 47% 265 / 38%

45 to 54 106 / 24% 36 / 15% 142 / 21%

55 to 64 43 / 10% 9 / 4% 52 / 8%

65+ 12 / 3% 4 / 2% 16 / 2%


Table 7 Number of all beneficiaries by age/ gender

Looking at the above All Seen (Active and Discharged beneficiaries) figures this compounds the differences

in the cohort for ages 45+ - significant drop both numerically and % for Females opposed to Males.

Consistency in the % and numerical jump in beneficiary numbers between the 18-24 and 25-34 cohorts for

both Male and Females.

Page - 90

The 35-44 Female Age range is by far the largest single demographic subset at 47% - closest is the same age

range but for Male beneficiaries.

Exit / Discharge Status -

Figure 9 - Discharge Status: Female Beneficiaries

Figure 10 – Discharge Status Male Beneficiaries

Male beneficiaries have a slightly more even split for positive discharges than Females – i.e. more discharges in more age ranges.

55-64 age Range is the solitary age range where positive discharges outweigh others in both gender cohorts.


Male beneficiaries show a much more even split over the Age Ranges in number and % of cohort than Female beneficiaries. Does this mean Males hit the multiple complex needs criteria more frequently across every age range? OR does it suggest Females become less complex the older they get – see difference in 45+ age ranges.

Despite 35-44 being the highest numerical range for beneficiaries – they are more likely to discharge negatively than positively in both genders (significant difference noted in Male) – does more targeted work

Page - 91

need to be done within this cohort? It is the pivot age range for both genders – Female – beyond less likely to discharge positively and reverse for Males.

Page - 92

Ethnicity

___________________________________________________


Below full breakdown of Ethnicities recorded on WY-FI MIS for all beneficiaries

seen -

Ethnicity – All Count Percentage

White British 485 69.99%

Not Recorded 82 11.83%

Any Other White Background 33 4.76%

Irish 13 1.88%

White and Black Caribbean 12 1.73%

Pakistani 12 1.73%

Any Other Ethnic Group 9 1.30%

No Record 8 1.15%

Caribbean 7 1.01%

Any Other Asian 6 0.87%

African 5 0.72%

Gypsy or Irish Traveller 4 0.58%

Indian 3 0.43%

White Asian 3 0.43%

Any Other Black/African/Caribbean Background 2 0.29%

Any Other Mixed/Multiple Ethnic Background 2 0.29%

White and Black African 2 0.29%

Declined To Say 2 0.29%

Chinese 1 0.14%

Arab 1 0.14%

Bangladeshi 1 0.14%

Grand Total 693 100.00%

Table 10 - Breakdown of Ethnicities

It is worth noting the following about ethnicities in the WY-FI cohort. As is expected the modal ethnicity is

White British with 485 (70%), followed by Not Recorded with 82 (12%) and Any Other White Background

with 33 (5%) the remaining balance, approx. 13.5% is divided between 18 ethnicities, in other words, so

small individual analysis is, while possible, not meaningful. The ethnicity data will be presented under the

Sub Headings, White British (WB) and BME – Not Known / Recorded (90 beneficiaries) are discounted from

following Exit statistics.

Page - 93


Active Caseload and Discharge Categories for White British and BME beneficiaries – 90 Not Known /

Recorded discounted from below.


White British 243 123 25 94 485

BME 60 22 8 28 118

Table 11 - • Active Caseload and Discharge Categories for White British and BME beneficiaries

Figure 11 - Discharge Status: White British/ BME

50% of White British beneficiaries as oppose to 51% BME remain on navigator caseload, pretty much the

same – denoting no difference in length of time on caseload.

From Needs Analysis September 2018

West Yorkshire Bradford Calderdale Kirklees Leeds Wakefield

Ethnic Minority (Non-white UK %)

19.76 36.1 13.3 23.3 18.9 7.2

Table 12 - 2011 Census Ethnic minority statistics

Page - 94

Figure 12 – Pie chart showing Ethnicity of Beneficiaries in the WY-FI project

Figure 13 – Ethnicity by locality


White British Positive and Negative discharges are 25% and 19% whereas BME Negative and Positive

discharges are almost opposite 19% and 24% respectively – this denotes if you are exiting caseload from a

BME background you are more likely to do so positively than negatively.

80.1%

19.9%

White British BME

23%

77%

17%

83%

40%

60%

17%

83%

4%

96%

BME White British

Bradford Calderdale Kirklees Leeds Wakefield

Page - 95

Religion

___________________________________________________


Religion is not a well-populated field in the MIS, out of 693 in total,

202 are marked unknown, 134 not recorded which results in nearly half of the population.

Religion Recorded Beneficiary Total

%

Unknown 202 29%

Not Religious 147 21%

Christian 138 20%

Not Recorded 134 19%

Declined to answer 32 5%

Muslim 20 3%

No Record 8 1%

Any other 8 1%

Sikh 2 0%

Buddhist 1 0%

Hindu 1 0%

Total 693 100%

Table 13 - Religion recorded for all beneficiaries

All Analysis is based on the following - 138 identifying as Christian, 147 as Not Religious 20 identifying as

Muslim, 32 Declined to Answer (used as this denotes a beneficiary choice) and 12 ‘Other’ – including (Any

Other, Sikh, Buddhist and Hindu).



Christian 73 31 10 24 138

Muslim 7 7 1 5 20

Not Religious 93 24 4 26 147

‘Other’ 7 1 1 3 12

Declined to Answer

16 3 1 12 32

Table 14 - Religion by Exit Status

Page - 96

Figure 14 – Exits/ Discharge by Religion

63% of the Not religious population remain on the caseload whereas 53% of the Christian remain on the

caseload, this falls to 35% for Muslims, that final observation should be taken with the caveat that the

proportion of Muslim Beneficiaries is 6% of the chosen subset of the WY-FI cohort here.

For Muslim’s in our cohort the positive discharge percentage is the highest (35%), taking into account the

caveat already mentioned. Only 35% of Muslim beneficiaries remain on the caseload whereas that goes up

to 53% for Christian Beneficiaries, 58% for ‘Any Other’ and 63% for those who have defined as non-religious


Correlation is noted between having a recorded Religion and positive discharge rate – Muslim and

Christian % Positive discharge are the only two areas where positive out performs negative.

Declined to Answer cohort is a significant one (32 beneficiaries) and also shows the biggest differential

between positive and negative exits – it would be interesting to extend some research to look at these

beneficiaries – when electing to ‘Decline to answer’ does this denote a ambivalence to working with the

programme?

Page - 97

Disability

___________________________________________________

Access / Referral -

The table below shows the number and %’s of beneficiaries accessing (active

/ discharged) WY-FI that have Primary, Secondary and Tertiary disabilities recorded. It must be stressed that of the

693 beneficiary records – Not Recorded is the most prevalent – 435 / 693 = 63% have a Not Recorded Disability

status – These are assumed to have No Disability.

Primary Count

Secondary Count

Tertiary Count

% w/ Disability Based on Primary vs Total

Behavioural and Emotional 138 33 7 20%

Progressive Conditions and Physical Health

50 18 2 7%

Mobility and Gross Motor 21 15 7 3%

Learning Disability 14 19 7 2%

Other 9 14 8 1%

Manual Dexterity 4 4 1 1%

Personal, Self-Care and Continence 4 7 7 1%

Sight 3 2 1 0%

Hearing 1 4 2 0%

Not Stated (Asked but declined Answer) 1 0 5 0%

Perception of Physical Danger 0 12 1 0%

Speech 0 2 0 0%

No Disability (Inc Not Recorded) 448 563 645 65%

Total Beneficiaries 693 693 693 100%

Table 15 - % of beneficiaries with a disability by type of disability

Over 1 in 4 (25.6%) of beneficiaries have a recorded Behavioural and Emotional disability based on Primary, Secondary and Tertiary counts.

70 beneficiaries have recorded ‘Progressive Conditions and Physical Health’ = 10.1% of all seen – these progressive conditions include Cancers, HIV, Multiple Sclerosis etc.

35% of All Beneficiaries have a Primary Disability recorded > 19% have multiple Disabilities recorded – this is significant in number = 130.

Active caseload – 139 / 339 have recorded Disability = 41% - denotes recorded disability = longer on caseload.


Active Caseload Positive Neutral Negative Grand Total

Has Disabilities 139 56 7 44 246

Has No Disabilities 200 87 33 127 447

Totals 339 143 40 171 693

Table 16 - Active Caseload and Discharge Categories for those with and without stated disabilities

Page - 98

Figure 15 – Exits/ Discharges for disabled/ non-disabled beneficiaries

Of those with a stated disability, or number of disabilities, a greater percentage remain on the case load

for longer eg 41% currently active vs 35% of all beneficiaries seen.

39% of all Positive Exits from WY-FI are beneficiaries with a recorded disability – this is higher than the

overall all seen % of 35%.

From the Needs Analysis 2018

Around 32% of the beneficiaries have at least one disability as shown in Figure 16. This figure may be higher due

to the number of people that have not recorded any disability status.

Page - 99

Figure 16 – Disability by gender

If we break down the percentage of those with at least one disability by locality we can see that we have quite a

variation as shown in Figure 17. 51% of Calderdale’s beneficiaries have at least one disability, whereas Wakefield

only has a value of 21%. This may help to explain the low initial HOS for Calderdale. It may also be worth noting that

some disabilities may make it harder to travel, which will become more difficult in areas which are not as well

connected.

Figure 17 – Disability by locality

Headline Analysis / For Consideration –

If Positive Discharge / remain on programme (active) and lesser Negative discharge rates are considered

positive outcomes, those beneficiaries with a recorded Disability have a greater % of encouraging

outcomes than those without – i.e. Positive Exit rates 23% vs 19%, Negative Exit rates 18% vs 28%.

36%

30%

Female Male

51%

39%

29%

23%21%

Calderdale Leeds Kirklees Bradford Wakefield

Page - 100

From Rough Sleeping to Housed – the WY-FI Beneficiary Accommodation Journey

Overview of Data Used The data used was adapted from the CFE return data which captures percentage of time spent in various different

types of accommodation over a three-month period. Those types of accommodation being; Friends and Family,

Rough Sleeping, Temporary Accommodation, Supported Accommodation, Own Tenancy (Private and Social

Landlord), Shared Property, Prison and Other Type.

The types I have excluded from this analysis are Prison and Other, Prison for the reason that this is not stable

accommodation and Other which is very much undefined.

The data is recorded by the Navigator teams and is returned to be collated and processed by the HUB team.

I have only included beneficiaries who have had a complete journey with WY-FI so current open case load data is

ignored. This gives a total of 521 records to analyse.

To reflect the question; “How many beneficiaries referred in to the project were rough sleeping and of these how

many ended their journey in stable accommodation”, I used the following methodology;

In assessing how many beneficiaries were initially homeless I counted numbers in the first two sets of CFE data,

which is up to the first 6 months of a beneficiary journey, to see how many spent time in that period rough

sleeping. In order to find out the number of those instable accommodation I counted how many people in the last

two CFE periods, up to six months before the end of the journey, were in stable accommodation who had been

rough sleeping in the first two CFE periods of recording.

For the purpose of this analysis I have defined Stable Accommodation to be one of the following;

Social Housing or Private Tenancy

Temporary Accommodation

Supported Accommodation

Shared Accommodation

Analysis

Initial Rough Sleeping Tenancy Temporary Supported Shared

104 10 11 25 0

Percentage of Initial Rough Sleeping 10% 11% 24% 0%

17: Number initially rough sleeping and their end journey accommodation outcomes with percentages

Of those 104 above, 10% managed to achieve enough confidence to be able to gain their own tenancy, 11%

managed to be able to secure some form of temporary accommodation while more than double either of these

figures (24%) managed to stay in some form of Supported Accommodation.

Page - 101

Briefing to MHCLG on the Navigator Model

Rough sleeping navigators: Learning from MEAM Approach and Fulfilling

Lives areas.

About this briefing

The government has made important commitments around rough sleeping navigators and local accountability

structures as part of its strategy to halve rough sleeping by 2022 and end it by 2027.

“Navigation” or “coordination” is a vital part of helping individuals with the most complex needs move away from

rough sleeping, and it is an approach that is distinct from outreach or other forms of engagement.

Across the country, 33 local areas are working on navigation – either as part of the Big Lottery Fund’s Fulfilling

Lives programme, or as part of the national MEAM Approach network. This briefing explores learning from these

areas and highlights six important considerations which can help ensure that navigation, rather than outreach, is

promoted as part of the strategy’s implementation.

About the authors This briefing has been prepared by Fulfilling Lives and Making Every Adult Matter:

Fulfilling Lives is a Big Lottery Fund programme supporting local voluntary and community sector partnerships in 12 areas of England to work together to improve services and systems for people with multiple and complex needs. The briefing has been shaped by the Systems Change Action Network (SCAN) group, which comprises the project managers from these twelve areas.

Making Every Adult Matter (MEAM) is a coalition of the national charities Clinks, Homeless Link and Mind;

with Collective Voice as an associate member. Working together, the MEAM coalition is supporting 21

local areas across England to develop effective, coordinated approaches to multiple needs that can

increase wellbeing, reduce costs to public services and improve people’s lives. These local areas use a

framework called the MEAM Approach to guide their work.

Based on our learning, successful rough sleeping navigators must:

1. Report to a cross sector partnership and have the seniority and confidence to request flexible responses

Accountability for rough sleeping and the specific needs of people with multiple and complex needs, must be

shared across a local system. Navigators must have the authority to act in flexible ways for clients and be able to

call on flexible responses from other statutory and voluntary services. The best way to achieve this is to ensure

that navigators report to a local cross-sector partnership.

In Fulfilling Lives areas navigators operate as part of a wider partnership of statutory and voluntary sector

agencies. This takes a number of forms across areas but can include Multi Agency Review Boards, multi-

disciplinary operational groups and strategic forums. These partnerships provide the mandate for navigators to

flex the system and by doing so highlight gaps in the current design and delivery of services.

Page - 102

In MEAM Approach areas coordinators sit within a structure of operational and strategic groups. Operational

groups of frontline services meet regularly to discuss casework and develop flexible responses. This is fed directly

into a strategic group of senior decision makers who explore and address any systemic barriers that are

highlighted.

2. Have the time and flexibility to build trusting relationships and follow individuals throughout their journey

Navigators are more than outreach workers. Our work has shown that effective support starts with the ability and

time to form a trusting relationship, based on the needs of an individual (rather than the needs of services). The

support provided builds on people’s strengths and is shaped by an understanding of the role of trauma. Over time

navigators become a single, consistent and trusted point of contact for the individual they are supporting.

In Fulfilling Lives areas navigators have the flexibility and freedom within their role to build relationships with

people over time and work at the pace of the individual. Unrestricted by traditional time limits and targets,

navigators advocate on behalf of beneficiaries and support them through a complex system of services,

coordinating a specific package of support.

In MEAM Approach areas coordinators also work with people over an extended period of time. Caseloads are

small, with a ratio of approximately 1:10. Support is ongoing and follows the individual across rough sleeping,

changes in accommodation, contact with the criminal justice system or periods in hospital. Individuals are kept on

the caseload as their circumstances improve to ensure support is quickly available if necessary. Many

coordinators have access to a small budget to purchase services or items that are not otherwise readily available

for individuals, but which can promote engagement and support the individual on their journey to recovery.

3. Have the right skills and values

The ability to draw on personal experiences and common ground can be an important first step in supporting

people to access the services they need. When recruiting navigators, the right values such as compassion,

resilience, aspiration and a belief in change, is just as important as having the right skills and experience

In Fulfilling Lives areas many navigators have had direct experience of homelessness, the criminal justice system,

substance misuse and mental ill health. While not an essential criteria, this insight can help early on to build

trusting and positive relationships with service users, and can also help in providing challenge and an impetus to

change.

In MEAM Approach areas there is also a strong emphasis on ensuring that coordinators have the right skills and

values. Particular attention is paid to recruitment, with MEAM Approach areas learning from others in the

network about what has worked best in other areas. The best coordinators have a mix of skills and are equally

comfortable working with individuals as they are advocating for change with senior partners.

4. Be diverse enough to engage ‘hidden groups’

Our work has shown that women and BAME communities are ‘hidden’ within much of the available data on

multiple needs. A combination of shame, stigma and risks to personal safety from rough sleeping can make

women less visible to services. Equally for BAME communities a lack of trust, language difficulties and a lack of

access to mainstream referral services can prevent coordinated support for multiple needs.

In Fulfilling Lives areas variations in gender, ethnicity and personal experience across navigator teams has

allowed us to work in ways that are both gender informed and culturally aware. As a result greater numbers of

women and people from BAME communities are accessing the coordinated support they need.

In MEAM Approach areas 30 % of people supported are women. A number of areas are developing gender

informed approaches and developing partnership responses to issues such as diverting women with multiple

needs away from the criminal justice system.

5. Have the right training and supervision, including an understanding of the role of trauma

Page - 103

A significant number of people with the most complex needs have experienced trauma in childhood. For women

in particular, this frequently continues into adulthood, where they experience domestic abuse and violence. In

addition, learning disabilities, brain injury and digital literacy can all impact on an individual’s ability to engage

with services.

Fulfilling Lives areas have used a range of approaches to support navigators to take a trauma informed approach

and to support staff working in this challenging environment. This has included the use of clinical supervision from

trained therapists, solution-focused practice, group reflective practice and training on specific issues such as

attachment theory and managing aggressive behaviour. Psychologically Informed Environments have also been

developed across a number of areas.

In MEAM Approach areas there is a focus on strengths based practice and ensuring that coordinators have an

understanding of the role of trauma. Our recent learning hub brought together navigators and coordinators from

across MEAM Approach and Fulfilling Lives areas to share learning on these approaches.

6. Have a focus on changing systems and not just providing support

The aim of navigation is to better coordinate existing services, not to provide a new one. Navigators play an

important role in identifying blocks and barriers within existing systems and finding solutions.

In Fulfilling Lives areas there is a commitment to creating systems change as part of the programme. Each area

has a set of system change priorities that it is working towards. A number of navigators in Fulfilling Lives areas

were drawn to the role because of its potential to change the current system.

In MEAM Approach areas there is a strong focus from strategic groups on exploring the systemic barriers arising

from the work and taking collective action as a partnership to address these issues.

The impact this is having in local areas

Andy, West Yorkshire Finding Independence (Wy-Fi)

At the time of the referral by West Yorkshire Police Andy was residing on the vulnerable persons unit at HMP

Leeds serving a short sentence for breach of his Sexual Offences Protection Order. Over 5 years Andy had been

sentenced for 6 different sexual offences and had breached his Sexual Offences Protection Order on 5 occasions.

On release Andy was homeless, drank high levels of alcohol (120 units per week), had frequent visits to A&E and

failed to meet the requirements of his Sexual Offences Protection Order which meant he was taken back to court

and returned to HMP Leeds to await trial.

Andy was initially referred into WY-FI following a meeting between the WY-FI Navigator, Probation and the

Positive Futures team at HMP Leeds. Andy was 68 years old at the time but when the Navigator first met him he

was struck by Andy’s childlike joke telling and constant need to repeat his history. The Navigator liaised with Adult

Social Care to carry out a mental capacity assessment for Andy. The Navigator also met with the Court Liaison

Officer and Andy’s lawyer while the judge remanded Andy in custody to allow for a separate assessment of

cognitive functioning to take place. The Navigator arranged for a Consultant Forensic and Clinical Psychologist to

prepare a court report of the assessment to support Andy’s case.

The mental capacity assessment found that Andy lacked capacity to retain and understand information, weigh up

risks and communicate decisions. This meant Andy was not able to make informed decisions about

accommodation or care arrangements. The cognitive functioning assessment concluded that Andy was suffering

from Korsakoff’s which manifests in memory deficits, confabulation and lacking insight.

As a result of partnership working Andy was housed in an appropriate care home on release and allocated a social

worker to fully assess his needs.

Page - 104

A supportive Deprivation of Liberty Safeguards (DOLS) was put in place at the care home to prevent Andy from

leaving without an escort while extra funding was secured for 1:1 support and a male carer. An Independent

Mental Capacity Advocate was also arranged to represent Andy.

Andy is now housed appropriately, is abstinent, has not re-offended and has more stable mental health. Andy has

also managed to reconnect with his brother who now visits him at the home and in general he feels contented

and happy for the first time in a long period.

Without partnership working Andy’s Korsakoff’s and lack of mental capacity may have been overlooked and he

could have continued to be a frequent offender.

Anne and Marie, Counting Every Adult Service in Cambridgeshire

Marie remembers the day she first met Anne. It was in the healthcare wing of a local prison. “The moment I

walked in I knew she was in the wrong place. We talked about how we could help her, but mostly about what she

wanted me to do to help.”

Anne had mental health problems and had been sleeping rough. “I found my life spiralling out of control,” says

Anne. “The things that mattered to me had become finding enough food to eat and a roof over my head. I felt as

though society had thrown me away. Whenever I went anywhere, people would glaze over and go ‘oh no, not

her’.” Then she was referred to Marie from the Counting Every Adult Service in Cambridgeshire, which was

developed using the MEAM Approach. Anne says: “When I met Marie in prison, she smiled at me, she gave me a

hug; she treated me like a human being. Marie said she would walk with me every step of the way, giving me the

stability I needed to rebuild my life. Marie was a place of hope for me. I felt as if somebody was actually listening

to my voice for the first time in a long time.”

The flexibility of Marie’s role means she is able to develop relationships with the agencies that can deliver a

coordinated response for people with multiple needs in the days before release from prison. Working closely with

colleagues in the CRC, housing, metal health, substance misuse and others, she can prepare a transition to

services within the community and prevent the ‘cliff edge’ caused by short sentences in which accommodation

has been lost, access to GPs, mental health and other primary care has been severed and the need to rebuild

these connections can be overwhelming. In some cases, working with a coordinator like Marie to attend mental

health, substance misuse and other services can become part of the individual’s rehabilitation requirements.

Marie sums up the change this kind of approach makes possible: “We’ve shown that we can work with people

that otherwise would be thrown away by society. And we really are making a difference to people’s lives.”

A poem from a client in West Yorkshire (a Fulfilling Lives area) about their navigator, Roxanne. Roxanne There’s no messing about, you get the job done It’s amazing you climbed the Three Peaks for charity I know you had fun You take on the world, sun, rain or fog Only one thing can distract you and that’s somebody’s dog People like you Roxanne are really hard to find Thoughtful and caring you are very kind All your work is done with maximum effect I’ve got so much appreciation for you with the utmost respect I have made you frustrated but never intended to You care about my life and the situations I go through

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If I can’t do it then I know you can Thankful for all you’ve done for me, I mean that Roxanne

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National SCAN Mental Health Mark Crowe, WY-FI Research and Evaluation Lead, Humankind

WY-FI Mental Health – Current Key Statistics:

Of the 760 beneficiaries that we have data for, 96% experience mental ill health of some description and

94% experience both mental ill-health and addiction (dual diagnosis). Female beneficiaries are slightly more

likely to have the mental ill health need, as shown in previous work

Early work suggests that less than one fifth or 20% of WY-FI beneficiaries who have a mental health need

receive services from a mental health provider, either in hospital or in the community. Consequently it

appears that 80% do not.

The most common treatments are provided by hospitals (as in-patients) and community health teams,

followed by psychotherapists, CBT practitioners and counsellors

Three quarters of those beneficiaries that do receive a service have all four needs (Homelessness,

Addiction, Re-offending, Mental Ill-Health, HARM) although there is not much difference .

The big difference is that those who do not receive treatment have a much higher risk of having an

unplanned exit from WY-FI, they are also not as likely to remain on the programme for as long as

beneficiaries who do receive treatment

WY-FI and Mental Health Services Since the development phase of WY-FI West Yorkshire has acknowledged the challenges in working with mental

health services. This was initially at all levels, and although we have to accept some of the responsibility in this the

way mental health services are delivered and managed is so opaque that even to the informed lay person working

out where to go to collaborate on behalf of people with multiple needs is nigh on impossible. We are covered by

three major mental health trusts all of whom also work outside West Yorkshire. We produced a paper entitled

WY-FI and Mental Health 15 Months On which summarised the work done to date. One aspect of this was to

understand beneficiaries’ experience of mental ill-health through drama workshops which were really powerful

and exposed some of the unexpected power imbalances in the mental health system.

The persistence of Navigators in working with individual professionals on a case by case basis has, over the years,

created relationships were trusted joint working can take place. In some districts prior professional connections

also helped (Bradford, Wakefield) and although it is suggested that each MARB has representation from mental

health services this has not always been the case (Calderdale, Kirklees). Joint working relationships have got

representatives from MH services onto the MARBS. Through this process we learned that the people of interest to

WY-FI were likely to be the ones that had been struck off services’ patient lists because they did not attend

appointments. We did find extraordinary examples of MH services only communicating by letter (because that

was what they always did) to someone with no fixed abode. It took a while to get both clinical and administrative

staff on board with the idea that someone who was NFA could be contacted through a navigator.

Through these MH representatives on MARBs we have been able to unpick some of the barriers to engaging more

strategic managers in WY-FI but there is still a strong disconnect between the operational management/

deployment of mental health staff and the proscribed limits of their professional practices. Nowhere is this

clearer than in their attitude to patients that experience substance addiction in addition to either chronic/

enduring mental health conditions or psychotic episodes brought on by substance use. One of the critical factors

at play here is the presentation of the patient. This is often with low level MH or emotional well-being needs; or

substance related psychosis. The person is also self-medicating with substances to deal with deeper psychological

issues (over 60% of people with multiple needs have had some sort of childhood trauma, much of which has not

been effectively treated, if treated at all.

In one district (Calderdale) the Locality Group identified a particular problem of WY-FI beneficiaries being

excluded from access to mental healthcare. This was based on a reluctance to assess and if assessed a reluctance

to diagnose or treat (often citing dual diagnosis). Unsurprisingly, neither the beneficiaries’ mental health nor

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emotional wellbeing improved. The district WY-FI Locality Group (including the local authority commissioner for

mental health services) ran a pilot project with an independent mental healthcare provider which would operate

more flexibly in terms of thresholds, attendance, length of engagement, joint working with the Navigator Team

and approaches to treatment. The attached Project Report summarises the practical challenges and successes of

running such a project and includes a suggested model for future adoption.

Insight Healthcare: Calderdale WY-FI Project Report September 2018 Insight Healthcare is a not-for-profit organisation specialising in the delivery of primary care psychological therapies

services.

Project Objectives

1) Provide 30 Beneficiaries with a full assessment of MH needs delivered by qualified High Intensity Therapists 2) Support beneficiaries to access treatment, either within Insight Healthcare or supported referral to

secondary care and/or other services that would better meet their needs 3) For those offered treatment within Insight, support 40% (12) to move to recovery or achieve significant

clinical improvement as measured by appropriate psychometrics (such as the PHQ-9, GAD-7 and others) 4) Provide evidence-based recommendations to improve mental health pathways for adults with multiple

needs in Calderdale, including supporting people with a dual diagnosis

Targets

Assessments within 5 days of referral from Navigator (appointment booked) Treatment offered within 10 days of assessment (appointment booked). Insight will provide up to 25 1.5hr

treatment sessions of CBT/EMDR/Counselling as appropriate 40% recovery rate expected from those in treatment (either complete or significant improvement) shown

by PHQ-9/GAD-7/other measures If a beneficiary is not contactable or is having difficulty engaging with assessment/treatment, they will be

put on the ‘paused’ list, and reviewed every 6 weeks in conjunction with their recovery navigator.

Report on Activity from July 2017 to August 2018

The project initially had a High Intensity Cognitive Behavioural Therapy (CBT) practitioner (Katie), employed by

Insight Healthcare from July 2017. Katie worked alongside the Navigator team at Foundation, accepting referrals

and conducting assessments. Katie made a good start to the project, developing positive relationships with the

Navigator Team, the drug and alcohol service, and taking up opportunities for joint working. This continued when

Katie left in September 2017, and three new CBT therapists joined the project, Jayne, Fiza and Sara.

As previously described in my report dated February 2018, this group of clients have presented with greater

complexity and higher levels of need than Insight’s mainstream primary care patients. Consequently, a more flexible

and adaptive approach has been necessary in order to engage and to work therapeutically with the clients. The

majority of the beneficiaries who engaged with therapy have responded positively. In the main, the beneficiaries

that did not take up the opportunity also struggled to engage with other elements of WY-FI.

The assessments conducted by the Insight practitioners have ascertained that most beneficiaries have multiple

mental health issues, and in particular, many have underlying psychological issues that may require longer-term

therapy, or difficulties that have not been appropriate to address at the time (such as severe and complex

developmental trauma). Instead of attempting to focus on historical or longstanding issues, the practitioner and

beneficiaries worked collaboratively to identify focused interventions to improve the beneficiaries’ current

functioning. The treatment sessions involved developing an understanding of and modifying unhelpful behaviours

and thinking patterns. The treatment sessions also involved implementing adaptive coping strategies and

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strengthening emotional resilience, conducive to improved well-being and to the beneficiaries leading a more

fulfilling life.

Objectives and targets

The project came to a close at the end of August 2018 by which time a total of 35 beneficiaries had been referred

to the Insight practitioners for assessment. Thus, the original target of providing assessment to 30 beneficiaries was

exceeded.

The outcomes for the 35 beneficiaries who completed an assessment were as follows:

Assessment only 21 beneficiaries 13 dropped out 1 in prison 1 completed suicide 1 relocated 5 already open to Secondary Care Services

Engaged with treatment 14 beneficiaries 5 dropped out during treatment 3 started treatment and then relocated 6 completed treatment

Across the duration of the project, the DNA rate was 32% which is lower than originally expected considering the

engagement challenges that are apparent with the beneficiaries.

The attendance rate was 59% and the remaining 9% were cancellations

Of the 14 beneficiaries who engaged in treatment, the recovery rate was 43%.

The target of assessment within five days was arduous to achieve due to difficulties with engagement from the

beneficiaries. Insight’s practitioners worked closely with the recovery navigators to work flexibly and to encourage

beneficiaries to engage.

Most of the beneficiaries were taken straight into treatment from assessment where appropriate, and therefore,

the target to provide treatment within 10 days of the assessment date was achieved. The only period when this

was not achieved was the gap between practitioners at the beginning of the project which was unforeseen and

unavoidable.

Where primary care treatment was not appropriate for beneficiaries’ needs, Insight practitioners worked with the

navigators to facilitate a referral to the Single Point of Access (SPA) for Secondary Care Services. Insight practitioners

also provided training to the recovery navigators and additional staff on the structure of mental health services and

care pathways in Calderdale. This training was warmly received with immensely positive feedback from attendees.

Next steps for WYFI

Following completion, Insight’s practitioners reflected on their experiences of working on the WY-FI project,

identifying key learning, and generating useful ideas to improve mental health support for this service user group.

It is evident that mental health support is required, and that it needs to be provided in a flexible manner in order

to provide beneficiaries with the best possible opportunity to engage. It would be useful to consider the intensity

of treatment. Some beneficiaries, depending on where they are in their recovery journey, could benefit from a full

dose of Cognitive Behavioural Therapy, whereas for others a lower intensity intervention would be more

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appropriate. For the latter group of beneficiaries, support could be provided by a Psychological Wellbeing

Practitioner (PWP) or mental health practitioner, with experience of drug and alcohol work, in order to provide

support and to instil stability. Briefly, examples of low intensity interventions that could be useful are, behavioural

activation to improve mood, motivation and daily functioning. Sleep hygiene to improve sleep-wake cycle and to

implement a stable daily routine. Problem-solving skills to deal with daily issues and setbacks, and communication

skills to promote appropriate assertiveness and to facilitate communication with professionals and others.

A clinical model similar to that adopted by the Improving Access to Psychological Therapies (IAPT) program could

be implemented, and this is illustrated below. This would include referral onto secondary care services where

appropriate to ensure beneficiaries’ needs were met. Practitioners would collabarate with recovery navigators to

promote engagement with psychological therapies, and these would be provided in a flexible manner to maximise

engagement.

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Big Lottery Report – September to November. The Network and Service User Involvement By Rachael H, with input from the Co-Production Team

Co-production champions and beneficiary engagement The co-production champions’ roles continue to evolve locally along with the developments of the Network. Each

of the localities have developed a wide range of ways to engage Network members and beneficiaries such as

through meetings and social groups. In Bradford a number of Mini-Network meetings have taken place where

various guests from partner organisations have spoken with the hope to inspire beneficiaries to become more

involved. The co-production champion in Wakefield has set up a photography group with local beneficiaries with

the intention of eventually having an exhibition of their work. A ‘chaotic lifestyles workshop’ will become a service

commissioned by the NHS with the intention of working with people with personality disorders, which the

Wakefield beneficiaries and co-production champion will be involved with. This workshop will begin when a building

has been found to facilitate the service. The Leeds team have started a men’s cook and eat social group with good

attendance so far and the hope to expand. The idea was created to use a different environment setting for our

WYFI beneficiaries to get involved in the Network as a group activity instead of the normal board room meeting

setting. The aim for this group is that hopefully as time goes on this will integrate into the network more, as the

members take ownership of this group. Two co-production champions were sick in October and November, one of

whom has made a positive return work.

Some members of the WY-FI team held presentations at Humankind Sunderland’s away day about co-production,

to share learning that WY-FI have gained over the past 4 years. The presentations were well received, and there is

a positive movement towards incorporating co-production within their service.

Two members of the co-production team went to the Bradford Cares event with various other services attending.

Two presentations were done by the team. One of which explored lived experience in which questions were asked

to beneficiaries about their experiences with other services and WY-FI. The second presentation was about co-

production and the value of lived experience. This highlighted the importance of professionals and people with

lived experience working together to make full use of the expertise and understanding that a professional may not

always have.

A co-production champion and a Network members were among colleagues who presented at an Academy for

Social Justice seminar around commissioning for complex needs.

Annual Learning Event In September WY-FI held its Annual Learning Event at the Civic Hall in Leeds which was a great success with the

biggest turnout that WY-FI have seen. This year the Network became more involved in the event with one of the

Network members opening the event with a speech about her experience with WY-FI. The Network had the

fantastic opportunity to deliver a speech about the future of WY-FI and what it means for them that the project,

in its current form, will end in 2020. In addition to this the Network Legacy Officer did a presentation on the plans

for the future of the Network. In closing, a Network member performed a poem about the event after listening to

different aspects of the event. The Annual Learning Event gave the Network a huge opportunity to showcase their

work to a wide range of professionals, which gave a very positive message about possible work for the future.

The Story of Me – Final Report to CPMB This co-authored report was presented to the CPMB in October as planned. While the tool will not be introduced

universally following the pilot, there are several opportunities to embed learning, most notably with multiagency

practice development groups. The report is included as an appendix to this report

The NHS Bid Evaluation work – Liaison and Diversion In October, the Network was given the opportunity to evaluate bids for involvement with the NHS Liaison and

Diversion team. A number of Network members expressed their interest in helping to evaluate these bids which

with the only criteria being that they have lived experience of being in police custody. Each Network member was

given a number of different bids to read and then evaluate answering a series of questions that accessed the

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quality of the proposal they were putting forward. Once the evaluations had all been completed the Network

members were invited to an assessment day in which professionals from services were brought together to

evaluate each of the bids and along with the voice of the network give bids a collective final score. The hard work

did not go unrecognised.

“This was a complicated procurement process with a number of different lots across the North of England.

The feedback I have received is that the evaluators were very professional and undertook their role within

the process very conscientiously. Their input to the process was invaluable and they were able to provide

insights and comments which would otherwise have been missed and undoubtedly helped to ensure that

the process overall was more thorough.

I have no doubt that this also reflected the hard work undertaken by you and your team to organise and

coordinate the work and make sure that everyone was prepared to carry out their role so effectively.”

Chris Jewesbury, Head of Health and Justice (Yorkshire and Humber) - NHS England

Bradford community well-being grant In November, it was suggested to the Network that they plan and write an application to receive a grant of £1000

from Bradford VCS Alliance for a community peer led well-being project. Members of the team, the co-production

champion for Bradford and a Network member met and planned how to facilitate the group and what the

structure would be. The group planned for the first four weeks to do various well-being and self-help sessions,

with a focus on beneficiary engagement led by peers. On the fourth week there will be an attendance certificate

celebration and feedback from the group will be recorded. It is hoped that once the first four sessions have taken

place, peers will step back and the group will follow on with the sessions themselves. This has been accounted for

in the budget. The Network are waiting to hear back about whether they will receive this grant.

Evaluation of the 3 life questions conducted around West Yorkshire In May 2018 network members asked these questions aimed at WY-FI beneficiaries.

What does a fulfilled life look like?

Does the perfect service (WY-FI) that Experts devised lead beneficiaries towards a fulfilled life?

Has WY-FI really delivered on the perfect service and do beneficiaries feel that they have arrived at a

place that they think is a fulfilled life?

The reason for this was to ascertain if WY-FI as a project was actually working in delivering its objectives.

Evaluation

The findings were those interviewed stated their life was much better in terms of improved mental health and

overall stability however it was highlighted much more could be done regarding mental health. WY-FI was an

overall good service for beneficiaries. It was found WY-FI did not meet the expectation of being a perfect service

for beneficiaries. More exploration in terms more research needs to be done in this area.

Recommendations:

To explore/ research why the beneficiaries feel they haven’t reached a fulfilled life.

Are the services available lacking and not providing the adequate service eg waiting lists for referrals?

Are beneficiary’s expectations too high?

A full report will be available at a later date as this piece of research will continue.

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Media and Communications A Network meeting newsletter has been developed as a more accessible way for Network members to read about

actions from the regional meeting and anything that was discussed. The team hope that this will be an easier way

for everyone to feel in the loop if they were unable to attend the meeting itself. Content for the website has been

developed in order to make more of a web presence for the Network which will go live in the third quarter. This

will provide a useful link moving forward for anyone who wishes to work with the Network in the future to

showcase the work already done.

Moving Towards Independence

Advisory Board Meeting – Community Interest Company vs Charity

An Advisory Board was set up to get information for the Network to make an informed decision regarding the

future. The intention for the meeting was to explore the types of social enterprise and which legal entity best

suited the Network model. At the forefront was whether this should be a Community Interest Company (CIC) or a

charity. Those who were invited had experience in setting up or working in this field. The Network subsequently

discussed the outcomes of this advisory group at their regional meeting, considering possible routes to take and

what these paths would look like. The consensus was that the Network should propose to move forward initially

as a CIC with the possibility of becoming a charity in the future.

The Network Legacy

The Network Legacy Development Officer started in post on September 3rd and work has now begun to practically

implement the Network proposals and develop the three strands of the business model presented to the Core

Partnership Management Board (CPMB) in July. The Co-Production team are working together to build the mini-

networks and are engaging with Network members in the localities, and a new database of network members

skills and assets is being created. A core group of Network members have now been identified and the regional

network meetings have started monthly in Leeds and are planned ahead for the coming year.

The Network has continued to assist the WY-FI project research team. Links have also been made with partners to

incorporate the Network into future bids, to build upon experience, skills and knowledge of the network

members in preparation for being able to bid for work themselves. Ad-hoc training opportunities have been

offered to Network members in building training sessions with the ETE team at Touchstone, and bid writing with

the Humankind Business Development Unit. The training has been planned to take place in January with a

number of Network members taking part.

Business as Usual In September the new co-production admin assistant started a new role to give support to everyone in the team.

The role includes preparing for meetings, co-ordinating administration tasks and leading on new developments

with media and communication for the team and the Network.

The mini Network meetings are starting to take place in each of the localities and have developed in different

ways specific to each area. This can range from simply social meetings and events or more formal meetings with

guest speakers. The co-production team are working well to engage people in different ways as many of the

beneficiaries are at different points in their journey.

Network members from the mini network meetings have gained in confidence and now represent at our formal

hub network meeting, this allows the network to make decisions more often on the legacy.

Governance

CPMB

During the last reporting period a job description was negotiated for the role of co-chair of the Core Partnership

Management Board (CPMB) which would help with writing the agenda and represent the Network in these

meetings. This is a huge opportunity for the Network to be involved in decision making, system change and

negotiation at a board level. After expressed interest from a number of Network members, an application was

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submitted by one of the Network members and accepted by the Network. The now appointed co-chair will be

having meetings with the chair to take this forward.

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Appendix to the Co-production Report – the Story of Me

Story of Me

CPMB update – October 2018

Rachael Hurst and Joseph Alderdice

Background

Barriers to further field research

Reflections from WY-FI Network researcher

Where next?

Conclusion

References

Background

The July meeting of the WY-FI Core Partnership Management Board discussed a report by the WY-FI Network and

Co-Production Team, containing the following summary and recommendations:

This paper offers some of those researcher reflections, details both the barriers that prohibited further field work

in the last three months and the opportunities to embed learning from the pilot elsewhere.

There is evidence that the benefits of the Story of Me may be different to those originally

envisioned. Those benefits may be less about reducing the need for repeat assessment, but

more about

Taking control of one’s own journey through those services

Creating space and time, through completing the Story of Me document, to process, reflect on and accept difficult life events

Focusing on assets, even if in self-image alone

This pilot exists in the context of the WY-FI Network preparing to take steps towards being an

independently constituted body, which aims to be financially self-sustaining from 2020. The

opportunity to research and test a prototype product at this stage is essential experience.

Researchers have talked about their growing confidence as a result of this work.

It is recommended then that the pilot continues, while incorporating some initial learning

into the research design, specifically:

Including specific questions about the unintended benefits of Story of Me, as listed above

Journaling any reflections and learning about peer-led research practice as an added outcome, to inform future product-testing by the WY-FI Network.

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Barriers to further field research

In the time since the last update, the whole small sample of participating beneficiaries and navigators disengaged

from the pilot.

The Wakefield beneficiary disengaged from WY-FI for much of the summer. His experience of taking his Story of Me to an appointment had been disappointing.

The Kirklees beneficiary was similarly elusive. Her navigator left the project.

The Bradford beneficiary passed away

We were unable to convince colleagues in the two remaining localities to participate in the pilot The capacity of the Network’s fledgling research team was also prohibitive, particularly at this time in the WY-FI

calendar. In preparation for September’s Annual Learning Event, the Network contributed to two concurrent

research activities, specifically the external evaluation of WY-FI and the peer-led evaluation of the dual diagnosis

talking therapies Innovation Fund pilot in Calderdale.

Reflections from WY-FI Network researcher

The July update described in detail the benefits to the Network as a group, in terms of the research skills gained.

It also made reference to the benefits to beneficiaries, in terms of opportunities for personal reflection and

growth. What it did not include, however, was how conducting the research activity contributed to the personal

journey of Network members conducting it, including those who are looking towards volunteering and paid

employment.

Rachael Hurst, who was among the most active researchers, has shared her personal reflection.

It is of note that Rachael was not an active Network member when the Story of Me design workshop was held in

October 2017, many participants in which have since moved on. Those who participated to the earlier passport

incarnation workshop have even longer since left. There is a significant lesson here for future projects, whose

design should incorporate discrete milestones to match the typical length of service of a Network member.

Where next?

Based on the experience of evaluating the pilot, it would be difficult to recommend that the Story of Me tool is

incorporated universally into the WY-FI navigation model. Nevertheless, the benefits to some beneficiary-

navigator pairs, as described in the July report, are worth sharing across the workforce should anybody wish to try

it for themselves. A short summary sheet of those benefits, along with the Story of Me template and usage guide

will be shared with every team.

I hadn't much hope regarding work, especially in support services because of the toils of

managing my own needs but with endorsement from my own support workers I gave it a shot

and applied for the peer mentor training. I was approached with the Story of Me pilot whilst

on the course; WY-FI team members would pop in, sharing their experience working with

their respective services/ organisations, impassioning prospective volunteers. I tentatively

accepted the opportunity to be involved in the project, pushing away self-doubt and

insecurities with reassurance that I wasn't under any obligation and I can walk away at any

time.

The collaboration with participants was crucial to the narrative of the work and having my

voice heard, requested throughout the process was so cool and important for my own

personal development as well as research development. The more I took part in, the more

people I met and the more I learned. I felt safe to challenge myself within the supportive

work environment and quickly realised that I have found my place, I have skills, I am an

asset. My outlook is increasingly positive, my whole attitude to life has changed which

further motivates me contribute to WY-FI. I plan to be a part of the Network’s future

endeavours including peer-led research so I can encourage and inspire that positivity and

drive in others and push to create change alongside my new peers.

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Looking further afield, other Fulfilling Lives areas are currently developing local multiagency care plans. The

findings from this pilot will be shared with them, as they look to design any free-text personal statement sections

in those care plans.

Finally, perhaps most significantly for future WY-FI activity, the discussion at the July CPMB meeting

recommended the following:

Conversations are underway between the Workforce Development and Co-Production Teams about developing

such a session, to be delivered once Multi-Agency PDGs have been fully re-energised following the quiet summer

period. It remains to be agreed whether to incorporate an item into a scheduled PDG or to offer a separate

regional workshop. In any case, it is proposed that a session would include the following:

Presentation of the pilot findings by Network members

Content already developed and presented by the Co-Production Team about asset-based approaches (eg Leeds Beckett seminar, Kirklees assets group)

Feedback from PDG participants on their own experience of asset-based approaches, both within and between agencies, in addition to their feedback on perceived value of the Story of Me tool, to inform our ongoing learning.

Conclusion

This pilot has had a fittingly long and winding journey. It was anticipated that a ‘completed piece or work’ would

be presented to the October CPMB. However, the opportunity to embed this work within WY-FI Multi-Agency

PDGs and in the wider Fulfilling Lives programme presents yet another chapter.

Above all, the development and evaluation of the Story of Me pilot, with all its challenges, has been invaluable for

the WY-FI Network. In carrying out this activity, the Network has firmed its ambitions on having research as

integral to its legacy after 2020.

References

Story of Me - Interim Report July 2018, WY-FI CPMB papers

There was a suggestion to look at embedding the ‘story of me’ through the Multi-Agency

PDGS as some organisations are not accepting the information provided in the document and

still completing their own paperwork too.

Roger, Sue and Joe to discuss how to embed the ‘story of me’ through a possible strengths

based practice session.

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Workforce Development

The Training Programme

Summary of Aims for Year 5

The principal training offer for Year 5 will consist of a suite of courses delivered by one provider (Community Links

Training). The intention is to provide an opportunity for a group of front facing staff from across West Yorkshire to

experience a cohesive training package on working with complex needs.

All participants will complete an introductory course consisting of the following elements: Psychologically

Informed Environments; Personality Disorders and Trauma; Risk Enablement; Working with Challenging

Behaviour.

The participants will then complete 3 of the following extension courses: understanding personality and

personality disorders; trauma informed practice; working with personality disorders (Level 2); dual diagnosis – For

mental health practitioners; dual diagnosis – For substance use practitioners; Learning disabilities, cognitive

impairments and complex needs; working with psychosis. This suite will be delivered as a pilot to a cohort of 32.

In addition, WY-FI will aim to offer the trio of awareness raising courses: understanding MCN as experienced by

women; BME communities, and; prison leavers.

Progress during Quarter 2

Understanding MCN… Understanding multiple and complex needs in BME Communities. To be delivered by WY-FI delivery partner,

Touchstone. Two dates have been agreed and the courses promoted to the wider workforce: 29th January and

29th March.

Understanding multiple and complex needs in Women. To be delivered by Clare Jones from Women Centred

Solutions. The first course has been delivered and impact evaluations have been sent to the delegates for

feedback on changes made to practice and engagement. Additional courses will run on 7th December 2018 and 8th

February 2019.

Understanding multiple and complex needs in Prison Leavers. To be delivered by the WY-FI Workforce

Development and Learning Team following consultation with the West Yorkshire Criminal Justice Network. This

consultation is set to begin in quarter 2. No further progress has been made here – to be discussed with the WY-FI

Programme Manager.

The Complex Needs Suite 29 delegates from the 32 invited have attended stage 1 of the training in late September and early October. All

have returned the impact evaluations for this stage of the training and have selected their stage 2 courses. An

interim impact report will be published in January which will assess stage 1. Of the 7 subjects offered for Stage 2,

5 will run. The 2 which will not run are: dual diagnosis – For mental health practitioners, and; Learning disabilities,

cognitive impairments and complex needs. These were dropped from the suite due to insufficient interest from

the candidates.

Full details of the training suite course contents are appended to this report.

Multi-Agency Practice Development Groups There are five PDGs currently running across West Yorkshire in each of the five localities. The PDG for Calderdale

Upper Valley was recently ended following a year of low and inconsistent attendance. A progress summary for

each locality follows the summary table.

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Quarter 2 Meetings Summary Date Staff Locality Topics/Themes Discussed

04/09/2018 3 Leeds Ending Relationships; NDT Chaos Index

06/09/2018 3 Calderdale Recognition of Good Practice; Working with Unwise Decisions

12/09/2018 6 Kirklees Working with Unwise Decisions

11/10/2018 7 Bradford Managing Challenging Behaviour; Dealing with Crisis

18/10/2018 3 Leeds Working with Resistance; Working with Couples

24/10/2018 12 Kirklees Person Centred Support

25/10/2018 2 Calderdale Building/ending relationships

20/11/2018 5 Bradford Professional Relationships; Structuring Your Day

21/11/2018 6 Wakefield 1st meeting: Introduction to Reflective Practice

27/11/2018 8 Leeds Non-engagement; Managing competing needs/agendas

Kirklees

Actions for Year 5 Contact key managers in the CHART services to encourage and enable attendance at the PDG

Complete evaluation report. Completed with the following recommendations:

o Review membership by organisation

o Vary venues for the meetings

o Agree discussion topics in advance

o Complete further evaluative work to measure the impact on practice and outcomes

Agree a research question with CRESR

Progress

Contact details have been obtained for the team manager of a newly formed street outreach team within CHART.

Although messages have been sent, no responses have yet been received. Continue to establish contact directly

and through the MARB.

The meeting has moved to the Huddersfield Mission recently

Topics for discussion are routinely agreed in advance of each meeting. This has worked well and has been

adopted at other PDGs.

The research question with CRESR remains outstanding.

Calderdale

Actions for Year 5 Deliver PIE training for the upper valley group with a view to enabling reflective practice to start.

Maintain regular contact with the existing membership organisations in the lower valley.

Increase the membership of the group through the year.

Progress

The offer to provide training on reflective practice and PIE was not taken up by staff in the Upper Valley outside of

WY-FI. As there is a PDG running in Calderdale, a decision has been made through WY-FI’s Operational

Management Group to bring the Upper Valley Group to an end.

New contacts have been made in Halifax in the local authority and CMHT. These will enable a broader perspective

at future groups.

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Wakefield

Actions for Year 5 Target six organisations in the Wakefield District to commit to enabling staff to attend.

Provide an opportunity for PIE training for those organisations.

Note: the above actions have changed and are to be replaced as follows:

Utilise the offer to Sustain Wakefield to run a reflective practice group for their staff as a means of

assessing the impact on practice and outcomes for them. Report on this after 12 months (Y6, Q2)

Progress

Initial training workshop on reflective practice delivered to staff at the service.

Bradford

Actions for Year 5 Continue to target the key organisations identified by our local operations manager. Meet with this manager to look at next steps for Bradford.

Progress

Meaningful reflective practice is the norm for this group although attendance has been a little low this quarter. Targeting previous attendees with specific invitations is intended to address this.

Leeds

Actions for Year 5 Contact previous attendees and invite them to return

Progress

All previous attendees are on the current distribution list. Attendance has picked up a little but this needs to be managed in Q3. There is a consistent membership, however, who value and contribute to meaningful reflective practice. Summary The summary from the previous report still stands:

“Establishing multi-agency practice development groups in each locality across West Yorkshire continues to

be challenging, interesting and complex. Work in this area during Year 5 needs to look at the impact of this

work and evaluations such as those begun in Kirklees will be extended out to the other areas. At some point

this year, a decision will have to be made about which groups are more likely to provide WY-FI with sufficient

evidence to assess whether this approach has an impact on work practice and outcomes for people

experiencing multiple disadvantage. Those groups that are not in a position to help with this learning will

have to be wound up so that the evaluative work can be given sufficient focus.”

The decision as to which groups will continue into the final year of WY-FI will be taken at the beginning of quarter

4.

Navigator Competency Framework Although there has been interest from other FL projects to take part in this work, the only contributors so far have been WY-FI and Newcastle & Gateshead Fulfilling Lives. The Competency Headings have been agreed and request for notes and comments has been sent out nationally. The notes from the meeting during which the headings were agreed is in the appendices to this report.

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Appendix 1 to the WFD Report - The Complex Needs Training Suite – What is it? This suite of courses will be delivered by Community Links Training at the WY-FI Hub in Leeds. This is an opportunity for a group of front facing staff from across West Yorkshire to experience a cohesive training package containing key principals and learning which both the National Fulfilling Lives programme and MEAM have established are fundamental to working with multiple disadvantage. Also, the programme of training will be evaluated robustly to measure the impact this training has on its participants, their colleagues and, most importantly, the people they work with. All participants will complete an introductory course over two days which will consist of the following elements:

Psychologically Informed Environments

Personality Disorders and Complex Trauma

Risk Enablement

Working with Challenging Behaviour

This course will run on the 19th/20th September 2018 and on the 1st/2nd October 2018. Participants can indicate

their preference on their expressions of interest.

The participants will each then choose to complete 3 of the following extension courses (all 1 day each):

Understanding Personality and Personality Disorders

Working with Personality Disorders

Trauma Informed Practice

Dual Diagnosis – For mental health practitioners

Dual Diagnosis – For substance use practitioners

Learning disabilities, cognitive impairments and complex needs

Working with Psychosis

These courses will run during January, February and March 2019

Who can do the training? The training is not open for general booking. Please do not contact WY-FI and ask for a place. Training will be provided to a cohort of 32 people (divided into 2 groups of 16). These will be selected following expressions of interest. The selection will ensure that there is representation on the training from all HARM* areas and a proportional representation from the five localities in West Yorkshire. The successful candidates will complete a learning agreement prior to starting the training which must be signed by both the participant and their line manager. A sample copy of the agreement can be seen here. Please read this before applying for a place on the training. *HARM = Homelessness, Addiction, Re-offending, Mental Health

What will the Complex Needs Training Suite consist of? Stage 1 - Introduction to Working with Complex Needs (2 days) Aims and Learning Outcomes Part 1 - Psychologically Informed Environments Aim To explore and understand the 6 key areas of PIE At the end the course participants will have:

Begun to complete a PIE evaluation for their service Looked at a psychological approach – Ladder for Life Taken part in Reflective Practice

Part 2 - Introduction to Personality Disorder & Trauma Informed Practice Aim

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To provide participants with an overview of personality disorder & trauma informed practice At the end this session, participants will:

Understand what personality disorder means

Have an overview of personality disorder diagnosis

Have been introduced to the concept of Trauma Informed Practice

Understand key principles of best practice

Part 3 - Risk Enablement Aim To revisit risk assessment and risk management as a means to getting the best out of situations for service users and their families. At the end this session, participants will have:

Revised the concept of risk and considered positive risk taking

Looked at practices that make dialogue and the recording of risk and recovery better

Part 4 - An introduction to challenging behaviour Aim To increase participants understanding of how and why challenging behaviour may present. At the end the course participants will have:

Identified different types of challenging behaviour

Considered factors which contribute towards challenging behaviour

Reflected on their own practice

Stage 2 – Working with Complex Needs (1 day each) Aims and Learning Outcomes (Participants will complete 3 of the following courses) Understanding Personality and Personality Disorders Aim To enable participants to become more psychologically informed about the development of personality and personality disorders. At the end of the course participants will have:

An understanding of the development of personality

Explored how someone’s past experiences can affect the present

An overview of personality disorder diagnosis

Related schema therapy to personality disorder

Reflected on their own practice

This one-day course is aimed at anyone interested in developing their understanding of personality difficulties

and disorders. It will focus on the development of personality using the therapeutic model of schema therapy to

explore the impact of early life experiences on the adult self. The course uses a number of learning activities (for

example presentation, group work and reflection) to help participants develop their understanding.

Trauma Informed Practice The majority of people accessing mental health, substance abuse, homeless and criminal justice services have trauma histories. Despite this high prevalence the role of trauma is often unaddressed by both services and practitioners. Emerging evidence from the field of trauma research is leading to a new understanding of the psychological and neurobiological impacts of trauma and highlighting new possibilities for recovery. Aim To enable participants to become more psychologically informed about the impact of experiencing trauma. At the end of the course participants will have:

An understanding of different types of trauma An overview of diagnosis related to experiencing trauma Been introduced to psychological models used to explain trauma An overview of the principles of best practice

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Reflected on their own practice This course is aimed at anyone interested in developing their understanding of trauma and the impact it can have on psychological and physical health. It will explore how experiences of trauma in both childhood and adulthood can affect people psychologically, physically, behaviourally and emotionally. It may be of particular interested to practitioners working with people with experiences of trauma or diagnosed / experiencing symptoms of Post-Traumatic Stress Disorder (PTSD), Complex PTSD, psychosis and personality disorders. Furthermore, it complements the ‘Understanding personality + personality disorders’ training currently delivered by Community Links. The course uses a number of learning activities (for example presentation, group work and reflection) to help participants develop their understanding. Working with Personality Disorders and Complex Trauma (level 2) Aim To build on ‘Understanding Personality & Personality Disorders’ and ‘Trauma Informed Practice’ training and enable participants to apply practical skills to work more effectively with people diagnosed with or traits of personality disorders and complex trauma. At the end this session, participants will:

Have been introduced to the principles of good practice guidance

Understand and have practiced skills for establishing and maintaining a therapeutic

relationship

Understand and be able to identify cognitive distortions + dialectical thinking

Understand and have practiced validation skills

Reflected on how learning can transfer into practice

This 1-day course is aimed at anyone interested in developing their skills to work more effectively with people diagnosed with or traits of personality disorders and complex trauma. It is recommended that participants have completed ‘Understanding Personality & Personality Disorders’ and ‘Trauma Informed Practice’ prior to attending the course as it builds on the knowledge and psychological models covered during in this training. The course uses a number of learning activities (for example presentation, group work and reflection) and will involve significant skills development exercises. Dual Diagnosis – For mental health practitioners Aim To enable participants to work more effectively with service users with dual diagnosis issues. At the end of the course participants will:

Understand the relevant evidence base and good practice guidance

Have reflected on their own values/attitudes

Understand effects of substance use and its impact on mental health

Be able to undertake screening + assessment

Looked at a range of brief interventions to support change

This course is aimed at staff who primarily support people with mental health problems or distress and who also misuse drugs/alcohol. It will provide useful information about dual diagnosis good practice guidance, and look at a number of helping strategies to enhance participants’ confidence in addressing difficulties. The course uses a number of learning activities (for example trainer presentation, group work, skill practice and individual reflection etc.) to help participants to have a deeper insight into the challenges faced by those with dual diagnosis. Dual Diagnosis – For substance use practitioners Aim - This course intends to help drug, substance and alcohol workers to practice key techniques for supporting dual diagnosis issues By the end of day participants will:

Have continued to build knowledge of mental health issues

Understand and practiced screening and assessment skills for DD issues

Understood the possibilities offered by guided self help

This course is aimed at staff who primarily support people who misuse drugs/alcohol and have mental health problems or distress. It will provide useful information about dual diagnosis good practice guidance, and look at a number of helping strategies to enhance participants’ confidence in addressing difficulties. The course uses a

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number of learning activities (for example trainer presentation, group work, skill practice and individual reflection etc.) to help participants to have a deeper insight into the challenges faced by those with dual diagnosis. Learning disabilities, cognitive impairments and complex needs Aim To raise participant’s awareness of learning disabilities, learning difficulties and cognitive impairments which may be experienced by people with multiple and complex needs. At the end of the course participants will be able to:

Understand the difference between learning disability, learning difficulty + cognitive impairment

Understand key diagnoses within these categories Identify potential signs + symptoms Understand the key components of the Mental Capacity Act 2005 and how to work within

the act Understand good practice guidance Identify support and services available

The aim of this 1-day course is to raise awareness of Learning Disabilities with a particular focus on people with MCN (multiple and complex needs - at least two of: homelessness, addiction, offending behaviour and mental ill-health). It provides an overview of Learning Disabilities, the varying impact especially when present in someone with MCN. It then focuses on identifying signs and symptoms of LD that may be present and who to refer to/get further advice and support from.

Working with Psychosis

Aim To introduce participants to key ideas and skills for best practice in supporting people experiencing psychosis. At the end of the course participants will:

Understand different perspectives for understanding psychosis Understand the benefit of a psychosocial perspective on psychosis Look at applying Cognitive Behavioural Therapy (CBT) skills to working with the

experience of distressing psychosis This course is aimed at staff who are supporting people who experience psychosis that distresses them, or causes them problems in relationships with others. It will provide useful information about best practice, as recommended by NICE and the British Psychological Society. The course will involve skills development and uses a number of learning activities. Expression of Interest – How to apply for a place If you would like to apply for a place on the suite of courses, please click on the link below. You will be directed to a questionnaire that will be used to select the 32 candidates for this training programme. Further details are on the first page of the survey. Please read these fully before completing the questionnaire.

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Appendix 2 to the WFD Report - Competency Framework for Navigators working with People

Experiencing Multiple and Complex Needs Draft Notes – these follow a conversation between Roger Abbott (WY-FI) and Ray Middleton (N+G

Fulfilling Lives)

Drawing from “Workforce Development insight report: What makes an effective multiple and complex needs

worker?” by Ang Broadbridge, Newcastle and Gateshead Fulfilling Lives, March 2018, the competency headings

below were agreed. Each heading will require a description. The notes below each heading will inform the

content of those descriptions.

Competency Headings

Accepting People as they Are

o Engagement skills; validation; active listening; the core conditions of Rogers’ person centred

approach (Congruence, Unconditional Positive Regard, Empathy)

Believing People can get Better

o Motivational Interviewing; Solution Focussed Practice; Strengths Based Approach

Collaborating to Solve Problems

o Working together to overcome barriers; preventing dependency; empowerment; building self-

reliance and agency

Developing Trusting Relationships

o Reliable, Consistent, Honest, Realistic about and with services; managing expectations

Establishing and Maintaining Roles and Boundaries

o With flexibility for individual relationships

Reflecting on Practice

o Recognising and managing the impact of work on own thoughts, emotions and behaviours

Negotiating Flexibility from Services

o Advocacy; able to identify where system change is needed and able to communicate this to

others appropriately

Caring for Yourself

o Willing to engage with employing organisational support offers (counselling, formal supervision,

case conferencing, reflective practice meetings)

Experience of Support, Treatment, Criminal Justice and Welfare Systems

o Either lived, worked or both

Next Steps

Complete competence descriptors

Define levels (how many?) of competence for each area

Future Steps

Prepare a guide for employing organisations

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Media and Communications Report: September 2018 – November 2018

Fulfilling Lives Programme: national communications We are working with colleagues across the Fulfilling Lives programme to deliver an awareness campaign around multiple needs. The campaign is aimed at the general public, and designed to reduce stigma and raise the profile of our work. We plan to have an Awareness Day in Spring 2019 and feature case studies in the national media. A creative agency is currently being recruited. The campaign is being funded by the Big Lottery Fund.

WY-FI Annual Learning Event This year’s Annual Learning Event was the largest event we have presented to date, being attended by over 200 participants. We have received very positive feedback and started some extremely useful conversations about the Project’s Legacy. What next after May 2020? In the end, we were able to produce 7 short films from the event which will be used to communicate key messages.

Project legacy Early in 2019, we will be reviewing our key messages for the remaining 17 months of the Project and which audiences we need to target. Any thoughts or feedback are welcomed by the Media and Communications team.

Materials and online content This quarter we have made the following resources, stories and information available online:

CRESR Evaluation Report 2018

Statistics and infographics for International Men’s Day and Alcohol Awareness Week (19 November)

Sharing partners’ content for Alcohol Awareness Week (w/c 19 November)

Full beneficiary case study – Ellen from Leeds

Full beneficiary case study – Brent from Calderdale

Frank’s story – a good news beneficiary snippet from Wakefield

Gareth’s story – a good news beneficiary snippet from Wakefield

Howard’s story - a good news beneficiary snippet from Calderdale

BBC News story: you’re on the verge of losing everything – but you don’t understand why

Papers for 7 x Practice Development Groups

Films The Media and Communications team have worked with the WY-FI Network to produce a short 2 minute film called Recovery Journeys.

Our digital reach

The WY-FI newsletter is circulated to 473 contacts

Twitter Followers have increased 5.5% this quarter to 1,545 and our Twitter engagement rate peaked around the International Men’s Day & Alcohol Awareness Week activity

Facebook Page Likes have increased 3.9% this quarter to 453

YouTube views remain steady at a total of 792.

Website views have dropped slightly post-conference to 4,002

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WY-FI Annual Learning Event Report The WY-FI Annual Learning Event took place on Wednesday 26th September, at the Civic Hall in Leeds. More than 200 guests attended the event, which focused on the learning and knowledge gathered over the last four years, which will help to establish better services for people with multiple needs. West Yorkshire Police and Crime Commissioner Mark Burns-Williamson opened the event, addressing partners, professionals, academics and network members, as well as Humankind staff. He had a strong message that joint working was essential to address complex issues surrounding mental health and criminal justice. As well as listening to other keynote speakers which included:

Members of the WY-FI Network, people with lived experience of homelessness, addiction, re-offending and mental ill health

Del Roy Fletcher, Professor of Labour Market Studies, CRESR at Sheffield Hallam University – Head of WY-FI’s External Evaluation Team, The Evaluation of WY-FI: Key Lessons & Reflections

Craig Sibson, WY-FI Navigator, Leeds - From Barriers we faced before WY-FI to Four years on ... from a navigator’s point of view

Prof David Best, Sheffield Hallam University – Strengths Based Approaches to Building Recovery

Chris Brill, Policy Manager at Homeless Link - Multiple disadvantages: the national policy context Guests were invited to choose from a selection of Information Sessions to attend during the day, which included: • The Ripple Effect of WY-FI • Multi-Agency Working and Multi Agency Review Boards • Evaluating Talking Therapies with Complex Needs • Housing First – a case study • Embedding Co-Production and the Value of Lived Experience in the Workplace • The Value of Peer Mentoring • Developing the Workforce for Everyone • Cost Benefit Analysis The event closed with some personal messages from the Network, reflecting on how much work WY-FI has done, and is yet to do between now and May 2020. There’s a strong focus on the project’s legacy, to ensure that support for people with multiple and complex needs doesn’t end when the project ends. Network Member Adam was the last onto the speaker podium, to recite a poem he’d written just that day, reflecting on all the key messages from the event and the importance of sticking together to continue making a difference.

92.3% of participants who responded to our survey said the event gave them the opportunity to hear the voices of people with lived experience of homelessness, addiction, re-offending and mental ill health.

92.3% of participants who responded to our survey said they gained knowledge/learning that they could take back to their own organisation to help improve services for people with multiple needs.

88.4% of participants who responded to our survey said the event helped them find ways of actively working together.

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Project Outcomes

WY-FI Partner Performance Management June 2018 to May 2020 The table below sets out the Project outcomes and indicators of change over the lifetime of the project with the

progress column showing the position as at 3.12.2018

No Project Outcome Indicator Level Timescale Progress

1 Adults with 3+ complex needs will experience improved physical and mental health, relationships, life-skills, housing, employability and reduced re-offending through access to person-centred and co-ordinated services

Adults with multiple needs report they;

are better able to

manage and

maintain tenancy

and

accommodation

have reduced their offending behaviour

are better able to take responsibility and have improved motivation

have improved their self-care and living skills

are better able to manage money

have improved relationships with their families and social networks

have reduced their misuse of drugs and/or alcohol

have improved physical health

have improved emotional and mental health

are engaged in meaningful activities

Beneficiary starts (as on MIS from Pre-navigation)

71 225 225 225 225 79

Total 1050 Beneficiaries report positive outcomes on completion of Second Homelessness Outcome Star Navigator support

8 100 200 200 200 200

Navigators record improved Chaos Index Score after 12 months Navigator support

71 225 225 225 225

79

Total 1050

Beneficiaries report increased scores in at least 6 areas of need at 2 year assessment point ( or final if earlier) on Homelessness Outcome Star

15 105 225

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 2nd HOS Year 1 Year 2 Year 3 Year 4 Year 5 Year 6

Year 2 Year 3 Year 4 Year 5 Year 6 Post programme continuation Year 2 Year 3 Year 4

130 200 223 181 60 794 Cumulative 8 75+ive 111 193+ive 325T 304+ive 470T 374+ive 601T 65 250+ive 378T 406+ive 520T 492=ive 559 23 out of 47T 47 out of 100T 68 out of 130T

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225 225

Year 5 Year 6

87 out of 138T

2 Services for People with multiple needs are informed by service users themselves and become more accessible and provide a person- centred response allowing the service user choice and control

Service users will benefit from the development of a co-produced portable care plan ‘passport’ reducing the need to ‘repeat their story’

50 services and agencies sign up to the WY-FI Information Sharing Protocol and adopt the ‘passport’ by the end of year 4 8 in pilot Locality 12 with rollout in 2 Localities 30 with full roll out in West Yorkshire Number of service users with a passport

100 225 225

75 Total 625

Year 2 Year 3 Year 4 Year 3 Year 4 Year 5 Year 6

Year 4 Q4 Pilot underway. Navigator participants briefed. Network evaluation subgroup interviewing participants May-June. Supersedes ‘passport’ and its metrics. Wider roll-out pending decision at October CPMB.

Service Users report that

local services;

are more

accessible,

providing timely

and flexible

support

provide a

person- centred

response to

service user

needs, allowing

them choice and

control

WY-FI Insight audit completed annually

40 60 80 80 60

Year 2 Year 3 Year 4 Year 5 Year 6

32 71 78

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3 People with 3+ complex needs will achieve positive outcomes in peer mentoring, volunteering, training and improved employability during the project.

People with multiple and complex needs achieve their self-defined employability goals as included in the individual support plan

255 Service User are trained as Peer Mentors and support delivery of the programme collectively across all Localities

20 35 60 60 60 20

TOTAL 255

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6

10 19 46 *cumulative Y1-4 = 104 completed from 150 starts and 69 have started in placements

3 People with 3+ complex needs will achieve positive outcomes in peer mentoring, volunteering, training and improved employability during the project.

People with multiple and complex needs benefit from pathways to employability through volunteering, training and work experience

210 service users take up volunteering, employability or training

10 20 45 50 50 35

125 service users complete work placements in locality services

20 25 30 25 25

15 trainees recruited over lifetime of project with progression opportunities (using ethos of GROW model)

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 2 Year 3 Year 4 Year 5 Year 6 Years 2-6

Cumulative 84 149 336 *as with outcome 1 0 6 12 19 (includes 5 Co-Production Champions)

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4 The basic requirements of individuals with multiple and complex needs are addressed through systemic change

Bespoke locality system change plans are effective working documents that fit with the local context and agencies in the localities actively participate in these

5 Localities review system change plans annually

5 5 5 5 5


5 5 By end of June 2018

People with multiple and complex needs benefit from the Navigator practice of person-centred and co-ordinated multi-agency support which empowers sustainable engagement and outcomes.

Evaluation of Navigator Practice/model over time. CRESR submit

Baseline evaluation report

Interim evaluation report

Final evaluation report end

By end of Year 2 By end of Year 3 By end of Year 5

Completed April 2016 Completed July 2017

Multi agency working is embedded as ‘usual’ working practice when delivering services to individuals with multiple and complex needs

Evaluation of the effectiveness of MARB from an agency perspective over time. CRESR submit

Baseline evaluation report

Interim evaluation report

Final evaluation report end

By end of Year 2 By end of Year 3 By end of Year 5

Completed December 2015 Completed July 2017

Consultative commissioning involves Beneficiaries and Experts in the design and procurement of services

Beneficiaries and Experts by experience are involved in the design and procurement of services

2 2 2 2 2


2 2 1 (consultation session with HMI Probation)

Beneficiaries and Experts by Experience evaluate effectiveness of Co-Production and Innovation Fund Pilots

Year 3 report Year 4 report

Y4 Q3: Three beneficiaries significant contributors to Locality review of Calderdale pilot. Network-led evaluation in

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development for Y5 Q1.


4 The basic requirements of individuals with multiple and complex needs are addressed through systemic change

Culture Change – Perceptions and operational practices relating to individuals with multiple and complex needs are improved

Multi Agency Practice Development Groups are delivered with a minimum of 8 attendees at each session. Sessions:

2 6 6 6 6


0 5 12

Principles of Co-Production and WY-FI learning are adopted and embedded in WY-FI Partners’ practice.

Consult and shape policy

Design and deliver Procurement processes

Train professionals

‘Experts for hire’ group established to support and deliver on the above

Years 3-6

Y4 Q4 Co-Production Seminar Delivered to Leeds Beckett students. Co-Production subgroup influenced design of Leeds Quality Mark Expert Citizens support day around transition to independence held. People with lived experience and Network members involved in the following submissions to policy consultations: Crisis call for evidence on ending homelessness; Work and Pensions Committee Inquiry into the effectiveness of ESA and PIP assessments; and a paper for the DWP ‘ From benefits to employment’.

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Tables below based on WY-FI EOI Framework 2018

Strategy Area Measured activity Generic – Evidence Locality specific measured activity and evidence

Link to BLF programme outcomes

Safe Demobilisation of Navigation Support / (Explore Continuation Funding)

1 – Demobilisation Beneficiary support

When will referral stop/local numbers

Planned and unplanned exits

Essential data to be captured

Support plans

Risk assessments

Link to ETE outcomes

Last day referrals accepted Above + 3 months for acceptance at MARB 100% completion of consent forms (year5/year6 caseload includes ETE) Timely completion of assessments (HOS and CHAOS) 75% planned exits achieved 100% support plan completed 100% consent forms completed 100% completion of SUSSARs 100% of allocated Insight questionnaires completed Improvements at 24 months on HOS and Chaos index (75% of returns completed. Qualitative and quantitative Peer research linked to unplanned exits – hub/network/navigators ETE outcomes;

Barca – December 2018 -14/15 starts Bridge – ongoing- MA support-12/15 starts Community Links – February 2019- 0/5 starts ( linked to Nav recruitment and start date) – Q3 Foundation – September 2018 – 20/10 starts Spectrum - December 2018 - ( May 2019 for DA Navigator referrals) – 14/15 starts All teams will take referrals by exception and as caseloads permit. Total year 1-4 starts = 734 Target starts year 5 = 60 By exception starts = 6 Revised cumulative target for years 1-6 = 800 3/12/2018=794 October agenda item

Project Outcome 1

Starts

Positive and improved outcomes

Project Outcome 3

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Workforce

System Change Lead

Navigator-reduced posts in year 6

Peer mentor support

30 beneficiaries to complete peer mentor training Hub provide timely reports and support; Quarterly reports will include

Percentage Consent Forms signed for current caseload

Percentage SUSSAR documents returned

Insight Questionnaires Completed

Percentage Support Plans Completed

Percentage of planned exits. All delivery partners to support a minimum of 4 Peer Mentors (Yrs 5-6)

Need to add placement opportunities - Jennie Workforce: System Change Leads: Barca: Paula Gardner Bridge: Jon Royle (TH-deputy) Community Links: Fran Coard Foundation: Debbie Priestley Spectrum: Rachel Savchenko (MT-deputy) Navigator posts: Barca: remodelling of team Yr5Q2 Bridge: phased reduction and transfers to Housing First posts Yr5Q2

Project Outcomes 1 and 2 Project Outcome 4 Peer Mentors- Project Outcome 3 Navigator model Project Outcome 4

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Demobilisation/ Continuation Plan

Agenda item Dec OMG

Community Links: recruitment of 3 vacant posts complete by end of Yr5 Q2 Foundation: plan in place by end of Yr5Q3 Spectrum: 1 post P/t over yrs 5 & 6

2 – Continuation Funding Regional commitment Local commitment

By end of Q2 all partners to provide Funding Action Plan December OMG agenda item

Report against plan on Quarterly Partner Update Report

Legacy

Equipping Organisations to work with those with MCN

3 – MARB & Localities (not applicable to Touchstone ETE delivery) : a) continue effectively with

appropriate and engaged stakeholders, and,

b) drive forward the implementation of local System Change priorities, and,

Embed and sustain MARB model All delivery partners engage in CRESR research All delivery partners engage in WY-SCAN priorities:

Multi-agency working

Person-centred approach

Embed Co-production

All Localities to agree revised MARB terms of reference by end of Y5 All Localities to review role of Locality meetings and agree revised terms of reference by end of Yr5 Q3 (include how Local system change plan/priorities continue to be taken forward)

Project Outcome 4

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c) work towards future (post contract end) sustainment of these functions.

Provide Quarterly report for WY-SCAN and CPMB

Link to #9

Link all above to demobilisation plans and locality priority needs

Report on Quarterly Partner Update Report

4 – Organisational Engagement a) engage with the existing

systems of oversight and coordination, specifically: I. Core Partnership

Management Board, II. West Yorkshire

System Change Action Network (WY-SCAN),

III. Operational Manager Group.

b) ensure that knowledge

and feedback is communicated effectively at all levels

a)Named contacts attend relevant meetings (OMG, WY-SCAN, CPMB, CEO meetings) b)Organisational and WY-FI staff

Ensure Navigator and Lead Navigator attendance at PDGs

Reflect on impact on working practice (feedback)

Share learning and embed in local team

Attend WY-FI wide team meetings

Navigators and ETE meet to review needs at least quarterly

OMG – bi monthly meetings WY-SCAN- quarterly before CPMB CPMB – quarterly CEO meetings-convened by Humankind CEO (CPMB Chair is deputy) Ensure dissemination of information/learning through delivery partner WY-FI team meetings Report on Quarterly Partner Update Report

Project Outcome 4 -System Change

5 – Organisational Development how your own organisation: a) will continue to take

forward and formalise any learning from within the programme, and,

b) what your plans to achieve your

VLEW pledges –embedded end of yr6

develop/provide work placements for beneficiaries/peer mentors/network members

local learning events

All delivery partners to review VLEW pledges by end of Yr5Q2 and provide report to VLEW group and CPMB Provide evidence as requested on Quarterly Partner Update Report

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organisations ‘Valuing Lived Experience in the Workplace’ pledge(s).

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Embedding Resources for Regional Co-Production and Involvement

6 – Co-Production Network Development (eg. CiC/ Charity/ constituted group) How will your organisation support the Hub to develop the Network/ CiC in your: a) locality, and, b) regionally.

Support Network activity in developing local ‘mini’ network- lead by Co-Production Champions Support development of Regional constituted ‘Network’

Evidence work/impact of work by Co-production champion All Partners to meet with Network Legacy Officer in Yr5Q2 Barca: Paula Gardner Bridge: Jon Royle Community Links: Claire to check with Faye Foundation: Paul Hardman Spectrum: Linda Harris Touchstone: Jess Parker Report on Quarterly Partner Update Report

Project Outcome 4

7 – Co-Production How is Co-production being embedded in your: a) organisation, and, b) locality.

All delivery partners to report Organisation evidence on Quarterly Partner Update Report Local evidence to be provided in Quarterly WY-FI SCAN update report to be shared with CPMB –embedding co-production Linked also to #8


Project Outcome 4 – Local System change plans

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Supporting Pooled and Consultative Commissioning

8 – Commissioning How will you support the programme aims to develop Pooled and Consultative commissioning: a) in your locality, and, b) regionally (supporting

the WY-FI commissioner network).

By end of Q2 all partners to provide Funding Action Plan Support Regional funding/commissioner engagement activity Linked to #2


Project Outcome 4

System Change Development

9 – System Change Activity (not applicable to Touchstone ETE delivery) Your approach be to increasing System Change dedicated staff resources and how will this lead to long term sustained change.

Named system Change lead – see #1 All delivery partners engage in WY-SCAN priorities:

Multi-agency working

Person-centred approach

Embed Co-production

Provide Quarterly report for WY-SCAN and CPMB

Link to #2 Engage local services/agencies into Multi agency PDGs and training opportunities


Report;

number of system change workshops

number of multi-agency PDGs (also recorded by HUB including numbers attending)

Raise profile through;

presentations to key local stakeholder groups

case studies- minimum 1 per Quarter to Media and Comms team


Project Outcome 4

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