Gaps and barriers

Understandably, and probably rightly, we expect services to be focussed primarily on the things that they themselves do, and so can do something about. But this may be less true of service users, who are likely to see any one service as just one of many they must negotiate, in their progress.

With the best will in the world, the most motivated staff and the most enlightened thinking, sometimes the constraints on services are simply not in the control of the service itself. The gaps between services, or the barriers to acceptance from other services, or simply overloaded and unavailable services for moving on, can restrict or distort the scope of working with their users' needs.

In the case of outreach services, nevertheless, negotiating gaps and barriers for individual (and potential) service users may often be the cornerstone of your offer. As a result, outreach workers, just as much as their clients, will have an acute awareness of where these obstacles lie.

But how is this lived experience communicated and passed up through various chains of command and filters, to inform local commissioners and funders of what needs to change?

In the case of those areas that have experimented with system brokerage, there was at least the intention to fast-track this communication, usually with a small and selected sample of those with the most complex problems, who are taken to be indicative of the whole.

 

It is for this reason that the PIEs 2.0 model explicitly refers to co-working with other agencies over the needs of individuals as an issue for psychologically informed services. The very fact that we are dealing with complex needs in itself suggests the need for consultation with and/or co-ordination of the efforts of multiple more specialist services, to meet the needs of individuals.  The stress on relationships, as being central to any kind of working as a PIE, suggests that it is not simply the proponents of Housing First that question the constant 'staircase' ( or 'pass-the-parcel') approach that has characterised much thinking on service provision in the past.

New thinking on the lasting impact of early trauma suggests the importance of attachment, and valuing continuity of support, surmounting unhelpful barriers. ( see Gaps and Barriers ) to maximise continuity and minimise the extent to which the service users themselves are expected to negotiate such transfers.  It is for this reason too that the PIEs 2.0 rates very highly those services that are engaging pro-actively with the whole system, particularly at locality level, where gaps and barriers exist, to use your knowledge of the user to feedback to those responsible for the whole, who negotiate contracts with other services.

So important is this issue for services that the Pizazz assessment framework - both the Pizazz on paper, and the on-line version, the PIE Abacus - specifically encourages those assessing a service to identify where there are hindrances to the service's work that are outside their control, to flag this up both to management and to local funders.  The guidance is explicit that a low score in some areas, such as this, should NOT be seen as a weakness of the service, but as an indicator of what holds them back.

Gaps and barriers are not the only hindrance, however. An ill-considered narrowing of contracts and outcome measures, or overly-restrictive, micro-managing service specification can also tie the hands of a service and severely curtail its capacity to be responsive to the needs of service users. For more on the role of funders in commissioning for PIEs see HERE.

Johnson R: Do 'complex needs' need 'complex needs services'? (Part One)

Johnson R: Do 'complex needs' need 'complex needs services'? (Part Two)

Johnson R (undated) Key learning from history of the CPA in mental health as a lead professional model for complex needs HERE

Service users' PIE assessments (page) HERE

Lankelly Chase: Behaving like a system HERE

Zaxk Ahmed on Participatory appraisal in Tower Hamlets HERE

Lipsky on street level bureaucrats HERE