The right people at the table, a culture of coproduction, a shared understanding of the problem and a vision for change.

A successful MEAM Approach area will:

• Bring together a cross-sector partnership of providers, commissioners, people with experience of multiple disadvantage and key decision makers who together are committed to leading this work. The aim is to create an intervention for the “area as a whole.” Try to ensure a balanced partnership, but keep it manageable. (The MEAM Approach element on flexible responses provides practical information on setting up operational and strategic groups.)
• Ensure that people with experience of multiple disadvantage have a central role in the partnership, sharing power so that all decisions are coproduced and people have the support they need to engage in the work. This will require specific time and resources.
• Develop a shared definition of multiple disadvantage. For MEAM this means people experiencing a combination of problems at the same time including homelessness, substance misuse, mental ill health and contact with the criminal justice system. There should be a particular focus on individuals who have ineffective contact with services. The partnership should also explore gender, diversity and equality dimensions, how these are experienced by people facing multiple disadvantage, and how they might impact on equality of access to support.
• Develop a shared understanding of the problems with the current system and a clear vision for change. Partnerships should explore what ‘systems change’ means to them and how it can help them achieve this vision. (See also the section on systems change below).
• Undertake research to understand the scale and nature of multiple disadvantage locally. This should include an assessment of how many people face multiple disadvantage in the local area and where they are situated. When undertaking this research, all stakeholders and relevant services should be involved. Partnerships should also explore the possibility that certain groups or individuals facing multiple disadvantage may not be visible to local services.

Agreeing a clear referral and selection process for the new intervention.

A successful MEAM Approach area will:

• Consider and agree the focus, drawing on the research described in the previous element. A small number of the right people is better than a bigger group. A small caseload will allow partnerships to test opportunities for flexible responses and changes in the system. Local areas can then explore ways to broaden the impact to a wider group.
• Develop and agree a methodology to identify individuals facing multiple disadvantage in the local area. Identification tools like the NDT Assessment can be a useful starting point, but further consideration should be made to reflect equality and diversity issues. Consistency does not mean rigidity. Partnerships should be able to make an informed judgement regarding the most vulnerable people based on the evidence available.
• Develop a process for seeking referrals and agreeing a caseload. Referrals should come from all types of services, as well as individuals themselves. This could include hospitals, police, night shelters, outreach, soup kitchens, family members and CRC/probation workers, for example. A multi-agency group should agree the caseload. This creates buy-in and ensures a coordinated intervention for the “area as a whole” rather than an intervention that is seen as a “new service”. Referral processes should focus on individuals’ strengths, hopes and aspirations as well as their problems.
• Be clear that all referrals must come with an offer from the referring agency to play their part in the solution – don’t allow ‘dumping’ of individuals. An individual on the MEAM caseload should remain on the caseload of all other services involved, however a coordinated approach will now be adopted.
• Recognise that tackling multiple disadvantage is about intensive, sustained support to a small group of people and the caseload should reflect that. It is recommended not to go above one worker per ten clients (many report that 1:8 is better) and individuals should be kept on the caseload for as long as is needed (for some individuals this may be a number of years). Individuals should remain on the caseload not only when they are at crisis point, but also when their situation stabilises and they move away from the need for such regular support. At this point the partnership should explore how to help people develop and maintain a fulfilled life. Individuals’ journeys are often not linear and they may need different levels of support at different points in time.

The practical resource to link individuals to existing services and to broker engagement from local agencies.

A successful MEAM Approach area will:

• Recognise that coordination is about providing hands-on support that can help people facing multiple disadvantage engage with and navigate systems and services. Successful coordination also requires flexibility from local services (see next element) and these aspects should be developed in tandem.
• Explore the different ways in which coordination can be provided. Research often points to the importance of a single, consistent and trusted point of contact for the individual being supported. This may sit independently, within existing services, or as part of a multi-disciplinary team. Another approach is for the coordination to be shared amongst “lead workers” identified within the partnership, or a combination of both models.
• Recognise that regardless of the model chosen, successful coordination requires those leading on it to:
  • Have the right skills and values. Coordinators need to understand the whole system, be highly respected by clients and services, and be able to operate at the individual and strategic level. They must be passionate about improving support for people experiencing multiple disadvantage and remain positive about creating change.
  • Have a clear cross-sector mandate from the partnership to be ‘service neutral’ and to work outside single organisational boundaries (“a remit to have no remit”). Without this, a coordinator’s work will quickly sink back into organisational silos. Coordinators should report directly to the partnership and neither individuals nor agencies should associate coordinators with any existing service.
  • Have the time and flexibility to build trust and positive relationships with individuals and to provide person-centred support based around individuals’ needs and aspirations rather than the needs of services. Small caseloads are vital for this, allowing plenty of contact time. Personal experience of using services can also be very helpful in building trust. Many areas recruit on this basis or use peer support workers alongside coordinators.
  • Take a creative, open-minded approach to engaging with individuals, recognising and building on people’s strengths and not their problems. Coordinators should work in a trauma-informed way, with a good understanding of how trauma and abuse may have impacted on people’s lives and how it affects their current behaviours.
  • Have the ability to follow individuals across their journey, regardless of changes in tenancy or periods of hospitalisation or imprisonment. Individuals should not be removed from the caseload based on small-scale improvements.
  • Have the seniority and confidence to request flexible responses from local agencies, with clear lines to managers and commissioners.
  • Understand that the work is about changing systems and not just providing support. A coordinator role is much more than just a support role and partnerships should reflect this in the level at which they recruit coordinator posts.
  • Have the ultimate aim to better coordinate existing services, not provide a new one.

Ensuring flexible responses from all statutory and voluntary agencies.

A successful MEAM Approach area will:

• Recognise that coordination won’t work unless local services provide flexible responses that promote equality of access for all. There are many different ways to achieve flexibility in local areas including cultural, strategic, commissioning, economic and legal approaches. Most MEAM Approach areas will use a combination of these.
• CULTURAL
  • Recognise the importance of culture change at all levels and ways in which this can be achieved. Working closely with experts by experience can help with this, as can promoting an understanding of the impact of trauma and strengths-based approaches. Without working closely with those who have accessed services, partnerships risk repeating previous assumptions which may have left people excluded or unable to access support.
• STRATEGIC
  • Consider developing a strategic board of senior individuals to oversee a coordinated intervention. The board can troubleshoot, fundraise, share data and give permission for things to be done differently in frontline services.
  • Consider developing an operational group of service managers and practitioners that can provide a forum for case conferencing, for agreeing shared support packages for individuals and for supporting each other to work more effectively together.
  • Recognise that for both boards and operational groups, local areas may wish to utilise existing forums rather than setting up new structures, but that it is important attendees have enough time to dedicate and that they are willing to adopt new ways of working.
• COMMISSIONING
  • Consider how flexible responses can become part of commissioning and service contracts. Some MEAM Approach areas have successfully included coordinated ways of working into commissioning contracts, so that providers are required to respond flexibly to individual needs rather than sticking rigidly to fixed criteria and thresholds. Local areas should ensure the involvement of people with experience of multiple disadvantage in all stages of the commissioning process.
• ECONOMIC
  • Explore different financial approaches. For example, pooled budgets can allow different commissioners to contribute to the shared outcomes (either equally or based on savings made); individual budgets can allow services to be purchased for people based on their needs; alliance contracting can procure a system of services from a group of providers working collaboratively to achieve shared outcomes in partnership with commissioners; and social investment can incentivise providers (or a group of providers) to deliver services that meet a set of locally agreed outcomes.
• LEGAL
  • Consider relevant legislation and its impact. In some circumstances people experiencing multiple disadvantage will be protected by certain legislation and in other circumstances legislation may serve to exclude someone from much needed support. The partnership should consider its response both to meeting statutory requirements under relevant legislation, but also to acting outside of legislation where it is necessary to meet the needs of the individual.

Seeking continuous improvement in local services.

A successful MEAM Approach area will:

• Ensure that all local services operate in the most inclusive way possible for individuals facing multiple disadvantage, including those who experience additional barriers to accessing support. Exploring and acting on feedback from people using services is vital for this.
• Provide staff training and support to ensure that staff in all services working with people experiencing multiple disadvantage have an understanding of trauma and strengths-based approaches
• Explore any gaps in service provision that can’t be provided through flexibility from existing responses (examples may include certain accommodation or specific talking therapies). If so, a case should be made for commissioning these in the future. Gap filling should only be done once coordination and flexibility have been developed.
• Consider arrangements such as co-location of services and expertise in order to enhance existing responses and support joint working (e.g. a mental health worker within probation or a homeless outreach worker in the hospital discharge team).
• Use peer support from across the local partnership and the MEAM Approach network to support training, capacity and workforce development needs.

A commitment to measuring social and economic outcomes.

A successful MEAM Approach area will:

• Ensure that there is a clear methodology for measuring the success of their work and that all relevant audiences are aware of, and can act on, the findings.
• Ensure that evaluation covers both the impact on individuals and the impact on local services and systems. Qualitative and quantitative methods should be used, resulting in a mix of data about wellbeing, service use cost changes and personal stories/case studies.
• Ensure that individuals with experience of multiple disadvantage are involved in designing and implementing the evaluation and in disseminating findings.
• Work with the MEAM coalition and Cordis Bright (the national evaluators) to contribute data to the MEAM Approach evaluation. This will include seeking consent from clients to enable data sharing and ensuring that all relevant agencies are willing to provide data. Local partnerships may wish to develop data sharing agreements to support this. The MEAM Approach evaluation provides tools and resources for local partnerships on these issues.

Making sure the intervention is sustainable through systemic change

A successful MEAM Approach area will:

• Recognise that the coordinated intervention is unlikely to be sustainable in the long-term unless the local area can develop systemic changes, and be committed to doing this as a partnership. This will require firm commitments from the board and operational group, as well as wider services and decision makers in the local area.
• Develop a systems change plan that sets out the shared vision and ambition of the partnership and how it plans to develop sustainable changes to local services and systems. This is likely to include some of the cultural, strategic, commissioning, economic and legal issues discussed in the ‘flexible responses’ and ‘service improvement and workforce development’ elements.
• Consider developing an agreed set of values that will guide and shape the work of the partnership on systems change and hold partners accountable. This will help to ensure that the work is sustainable and not reliant on the enthusiasm of key individuals.
• Think creatively about where the long-term solutions lie in creating change to the way the local area responds to people experiencing multiple disadvantage. There may be roles for the wider community or the private sector. A successful partnership will consider how to make the most of local resources and opportunities when supporting people to make lasting change to their lives.
• Consider where the power lies in creating change. In order to empower people to change their lives, partnerships should be prepared to share power in all aspects of their work. This includes the partnership’s work on systems as well as services. There should be a clear role in systems change for people with experience of multiple disadvantage and those who support them.