Pathway teams provide individual care coordination for homeless people in hospital (Dorney-Smith et al, 2016), and use the opportunity of hospital admission to help patients into appropriate housing, support and care in the community. However, despite this expert support, not all discharges are timely or to ideal destinations. Medical respite is an American term for clinically-supported intermediate care for homeless people in the community. This includes peripatetic nursing and bed-based solutions, and can range from low-level supported housing to comprehensive clinical care. Such services provide a safe, recovery focused environment into which homeless patients may be discharged. Some already exist in the UK, and four are profiled later in this article. This article summarises the results of a local needs assessment for potential medical respite services that was undertaken to support the King's Health Partners (KHP) Pathway Homeless Team (that works across Guy's and St Thomas' (GSTT), King's and the South London and Maudsley (SLaM) Foundation Trusts). The work was funded by the Guy's and St Thomas' Charity, and included a literature review and review of current homeless medical respite service provision in the UK. The article outlines potential learning from the project, and offers recommendations for the future. Literature review Respite provision Mainstream intermediate care services are provided in the UK to help stop patients entering
Background Patient and Public Involvement in research is important for citizenship, accountability and transparency, and has the practical benefit of helping to ensure its quality and applicability. Involving members of the public in research is becoming increasingly commonplace, in the UK and internationally. It is essential that public involvement is inclusive of individuals and their diverse life experiences, including challenging experiences that may be associated with stigma and social exclusion. The involvement of people with lived/living experience of substance use and homelessness in research is increasing in response to increased recognition of the importance of inclusion and the benefits conferred to research. Main body In this commentary, we share our own experiences of being part of a Patient and Public Involvement group that was convened during a feasibility study of a peer-delivered harm reduction intervention. We are a diverse group but share experience of the field of substance use/homelessness, as people with lived/living experience, and as researchers and practitioners. We share our reflections and learning, as well as offer recommendations for researchers working in our field. Our group worked together to make a positive and deliberate contribution to the study. This did not happen by chance but required the development of mutual trust and respect, with each member having a commitment to support the group for its two-year duration. Short conclusion It is important for researchers to appreciate that meaningful Patient and Public Involvement is very valuable but requires a commitment from all involved. Regarding our field of substance use and homelessness specifically, it is essential that people with these experiences have opportunities to contribute to research and can do so in a meaningful way. People with lived/living experience are able to bring to life the rich tapestry of others’ experiences. However, the involvement must be neither tokenistic nor indifferent to the wider challenges common to these experiences.
The impacts on adult social work in England of the Covid-19 pandemic were sudden and are proving long-standing. In England, many social workers moved to home working and virtual contact with colleagues, managers, staff from other agencies and service users. A first national lockdown was followed by a lessening of restrictions, but a second wave started at the end of Summer 2020 and restrictions were re-introduced. This study draws on telephone interviews with a sample of twenty-two social workers working with adults in a wide range of roles and settings in ten local authorities and two National Health Service Hospital Trusts, interviewed August–October 2020. Following transcription, interview data were analysed thematically. Findings are reported under three emerging themes: using professional judgement, new and emerging case work and embedding change. These are compared with findings from studies of practice in children’s services and of surveys of social workers during the Covid-19 pandemic. Implications for practice, service users and research are explored.
This article reports social workers’ attitudes and approaches to working with people experiencing multiple exclusion homelessness (MEH) who self-neglect, and whether these people receive services, including safeguarding, differently from other populations. It draws on telephone interviews in 2020 with twenty-two social workers working with adults in a range of statutory local authority and National Health Service hospital roles in England. Interviews used two almost identical vignettes featuring self-neglect to prompt discussion and solicit experiences; one included homelessness and drug use to draw out any differences. Following transcription, interview data were analysed thematically. What emerged is a rich understanding of practice responses to self-neglect, but also uncertainties within contemporary social work: whether people who are homeless fall under the ‘umbrella’ of Adult Social Care and safeguarding; and whether self-neglect ‘fits’ under safeguarding. Additionally, participants described barriers to successful multi-agency support for people experiencing MEH, including stigma and exclusion from some statutory services. There was evidence that recent learning from Safeguarding Adults Reviews and local deaths has led to some examples of stronger multi-agency working in this context. The findings suggest more clarity is needed within the profession to ensure that people experiencing MEH benefit from strengthened social work input and safeguarding expertise.
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