Blog

Research into reality: Implementing successful approaches to multiple needs

Lucy Terry

Soon after I started working as a researcher at Revolving Doors I began to look at the various models and programmes aimed at people with multiple needs. I realised that although ‘usual services’ often do not work for this group, there are lots of interesting programmes which can achieve amazing outcomes for people in this situation. These models depart from the ‘norm’ of service delivery, and often challenge conventional wisdom.

In our new briefing with Centre for Mental Health, we review the evidence for three of these models: Multisystemic Therapy, Wraparound and the link worker model. All three have important, distinctive elements. MST and wraparound are both aimed at young people with multiple needs, whereas the link worker model works with adults whose problems are often entrenched and who have experienced years of rejection and exclusion.

However, in doing the research, it became apparent that the models are similar in important ways. There are common features of their approach that set them apart from ‘usual’ services, for example:

  • They address multiple issues, recognising the mutually reinforcing nature of substance use, homelessness, offending and mental ill-health.
  • Service users are not expected to come to offices at a specified time in order to get help. Therapists in MST might come to the family home in the evening when it’s convenient; link workers might meet people at their home or where they socialise.
  • They do not automatically reject for non-engagement, recognising that their job is to show the client that they are consistently there for them and can be trusted
  • Rather than assigning hurtful labels, the models emphasise and respond to the strengths of their clients.

 

Improving outcomes and saving money

 

Although our review notes where more evidence is needed, there is promising evidence for all three models. All three models can reduce reoffending rates, often through addressing the influences on offending behaviour; and all three help improve mental health. The link worker model is particularly promising in reducing rough sleeping. There is also promising evidence that the models would save public money in the long term, with studies showing reduced contact with expensive public services such as the care system or emergency services.

 

Wider implications

 

So we have a good idea of what these approaches have in common, and promising evidence that they are effective. ‘Scaling up’ and translating this into reality for more people is the next challenge.

Commissioners need to consider the common features or potential ‘success factors’ when they design and contract for services, including Integrated Offender Management approaches, Troubled Families schemes, youth offending services, and programmes for the long-term unemployed – plus many more. Equally importantly, service managers need to be comfortable with giving highly skilled practitioners the flexibility to be creative and work around the client’s needs; organisational cultures need to challenge, not enable, harmful thinking and labels; and staff themselves will need support to maintain a positive, consistent relationship.

 

See for yourself

 

We hope that the briefing inspires commissioners, and key providers like the new Community Rehabilitation Companies, to recognise the worth of funding models like this, as well as understanding which key elements make them effective for those facing multiple needs. If you want to get an idea of how these services work in reality, the briefing highlights a number of places where they are being delivered – why not see for yourself?

 These sources also help give a sense of how delivery works in practice: