ASSERTIVE OUTREACH GOOD PRACTICE GUIDELINES Assertive Outreach Practice Guidelines

SPECIALIST HOMELESSNESS SERVICES ASSERTIVE OUTREACH GOOD PRACTICE GUIDELINES Assertive outreach practice guidelines This project was funded by NSW Family & Community Services Acknowledgements The development of the good practice guidelines is a project of the Industry Partnership, which is a partnership between Homelessness Reference Group NSW, DV NSW and Yfoundations. Belinda McDaid Matthew Talbot Homeless Service, St Vincent de Paul Society, Newcastle Erin Longbottom Nurse Unit Manager, Homeless Outreach Team, Homeless Health Service, St Vincent’s Hospital, Sydney Jamie Brewer Inner City Homelessness Place Manager, Family & Community Services, Sydney Tamara Sequeira Service Manager, Way2Home, NEAMI National, Sydney Trina Geasley Manager, Homelessness, Social Programs & Services, City of Sydney Council Workshop Participants Amira Moutad Allambi Care Belinda McDaid St Vincent De Paul Brett Sorby St Vincent De Paul Christina Mantakal Innari Inc Cindi Peterson Launchpad Darlene White Missionbeat Darryl Barleycorn New Horizons Erin Longbottom Homelessness Health Service Frances Short NSW FACS Glenn Garlick Missionbeat Gary Lockhart Youth Off the Streets Jamie Brewer NSW FACS Janine Tipu Wesley Mission Joel Smeaton Central Coast Primary Care John Swain Way2Home Karen Soper Mathew Talbot Kerri Scott Partners in Recovery 2 Assertive outreach practice guidelines Lee Bradfield Homelessness Health Service Lincoln Smith Launchpad Mary Gissling Newcastle City Council Natalie Carroll NSW FACS Nathan Williams Youth Off the Streets Paul Proctor Wesley Mission Petra Jenkins Salvation Army Ryan Gannon Wesley Mission Sheridan Fyson Mission Australia Susan Watt Allambi Care Tamara Sequeira NEAMI Trina Geasley Homelessness, Social Programs & Services, City of Sydney Council Vanessa Taylor St Vincent De Paul Zona Gabriel Central Coast Primary Care Interviews Belinda McDaid St Vincent De Paul Cindi Peterson Launchpad Erin Longbottom Homelessness Health Service Felicity Reynolds Mercy Foundation Joel Smeaton Central Coast Primary Care Kellie Wright Innari Inc Kerry Dolaghan Wentworth Community Housing Liz Gal Peer Support Worker Liz Skelton Collaboration for Impact Louise Temple Consumer Representative Michael Wright Paramatta Mission Tamara Sequeira NEAMI Trevor Walker Aboriginal Corporation for Homeless and Rehabilitation Services Trina Geasley City of Sydney Homelessness Unit Zona Gabriel Central Coast Primary Care Camilla Williams Way2Home Sonia Mkoloma Way2Home 3 Assertive outreach practice guidelines Contents 1 Introduction 6 1.1 Purpose 6 1.2 Who are the guidelines for? 7 1.3 Limits and Intended Application of the Guidelines 7 2 Relationship Between the AOPG Guidelines and the SHS Practice Framework 8 3 Primary Homelessness in NSW 8 4 Assertive Outreach Definitions and Concepts 9 4.1 What is Rough Sleeping? 9 4.2 What is Outreach? 9 4.3 What is a Street-Based Assertive Outreach? 9 4.4 What is the Purpose of Street-Based Outreach? 10 4.5 What Distinguishes it from Other Forms of Outreach? 10 4.6 What is a Hot Spot? 10 5 The Foundations of Street-Based Assertive Outreach 10 5.1 Practice Principles 10 5.2 Practice Models: Approaches to delivering street-based assertive outreach 13 5.2.1 Trauma-informed care 14 5.2.2 Person-centred practice 14 5.2.3 Prioritisation based on vulnerability 15 5.2.4 Early Intervention 15 5.2.5 No Wrong Door (NWD) 16 5.2.6 Collaboration 16 5.2.7 Coordinated Case Management 17 5.2.8 Housing First 25 5.3 Policies and Procedures 25 5.4 Understanding Your Client Group- Collecting Data 28 6 Engagement 29 6.1 Role and Attributes of the Assertive Outreach Worker 29 4 Assertive outreach practice guidelines 7 Assessment 30 8 Monitoring And Evaluation 31 Proposed Model for SHS Assertive Outreach (AO) for Primary Homelessness 32 Appendix 1 33 9 Assertive Street-Based Outreach Operational Policy 33 Introduction 33 9.1 Objectives 33 9.2 Purpose 34 9.3 Operational Criteria 34 9.4 Aims Of Engagement 35 9.5 Service Criteria 35 9.6 Referral 35 9.7 Assessment 35 9.8 Referral To The Assertive Outreach Team 36 9.9 Coordinated Case Management 36 9.10 Team Skill Set 36 9.11 Team Meetings 37 9.12 Managing Shifts 37 9.13 Work Health & Safety 38 9.14 Staff Supervision 38 9.15 Training And Development 38 9.16 Role Of Assertive Outreach Workers 38 9.17 Collaboration 39 9.18 Exits 39 9.19 Data Collection 40 9.20 Monitoring And Evaluation 40 10 Culturally Sensitive Practice Checklist 41 11 Trauma Informed Care & Practice Checklist 42 12 Working In Hot-Spots Checklist 44 13 References 46 5 Assertive outreach practice guidelines 1. Introduction The assertive outreach practice guidelines 1.1 Purpose provide a framework for Specialist Homelessness Services (SHS) to The key purpose for the practice effectively deliver assertive outreach to guidelines is to equip SHS providers people who are sleeping rough in NSW. with the necessary tools and resources to deliver effective assertive outreach The methodology used to develop these responses to people who are sleeping guidelines included a literature review rough. The objectives of such a response of international and national practice seeks to address gaps in service provision models, consultations with assertive and to assist people to potentially exit outreach practitioners and peer workers primary homelessness. with lived experience of rough sleeping. The consultations were undertaken It is recognised that people experiencing by interviewing service providers and primary homelessness are less likely than conducting two workshops to explore other homeless people to access on-site assertive outreach practice issues. services; the lack of service utilisation may be due to individual reasons or The AOPG product is divided into two institutional barriers. In recognising the sections: complex challenges of supporting this • Practice Guidelines to provide direction cohort within the broader homeless to Specialist Homeless Services on population it is necessary to deliver the fundamental management and place-based services that are targeted operational aspects for effective to effective client engagement and delivery of assertive outreach services collaboration. Therefore, the concept to rough sleepers; of ‘outreach’ is used in the context of providing place-based outreach as • A resource manual providing opposed to alternative forms of outreach. explanatory notes on operational models, a framework for policies and A central aim of the guidelines is procedures and a literature review on to improve the health and housing international and national responses outcomes of people experiencing primary relative to assertive outreach and homelessness. It is hoped the tools people who are sleeping rough. and good practice models presented in the guidelines will assist Specialist Homelessness Services to effectively 6 Assertive outreach practice guidelines collaborate with the broader service • FACS Housing employees responsible network, to achieve improved health and for assessing Housing Pathways housing outcomes for people who are applications; sleeping rough. • Link2home employees wishing to The purpose of providing a literature increase their knowledge of the issues review on international and national affecting people sleeping rough, and assertive outreach models is to the models of service delivery to this build sector knowledge in line with homelessness cohort. contemporary evidence-based practice. Such information provides consideration 1.3 LIMITS AND INTENDED of the most appropriate models and APPLICATION OF THE GUIDELINES the necessity to adapt responses per individual needs, variances in urban and The elements highlighted in the guide- remote locations and enhance practice lines are considered as good practice capability. in the provision of assertive outreach to people experiencing primary homeless- 1.2 WHO ARE THE GUIDELINES FOR? ness. The determination of good practice is supported by the completion of a liter- The guidelines provide an overview of the ature review and conducting two work- key aspects to developing an assertive shops with sector practitioners skilled outreach program: evidence-based in the delivery of assertive outreach to practice models, required resources; people who are sleeping rough. collaboration with the broader service The guidelines are not exhaustive of every network, human resources, and effective aspect to operating an assertive outreach service delivery. The guidelines are aimed service. However, it is hoped the resource at sector employees engaged in the manual will assist the SHS sector with the following roles: necessary tools and information to en- • operational managers considering hance existing practice, or to expand their developing an assertive outreach response repertoire. program; • assertive outreach workers delivering services to people sleeping rough; • caseworkers providing case management services; 7 Assertive outreach practice guidelines 2. RELATIONSHIP BETWEEN THE AOPG GUIDELINES AND THE SHS PRACTICE GUIDELINES The guidelines are intended to approach and service collaboration complement the SHS Practice Guidelines to prevent and reduce homelessness and the Framework for Multi-Agency through the delivery of services within the Client Transition Planning to Reduce paradigm of the four core responses. Homelessness. http://www.housing.nsw.gov.au/__ data/assets/pdf_file/0003/326055/ This is achieved by incorporating Framework_for_MultiAgency_Client_ principles such as the person-centred Transition_Planning.pdf 3. PRIMARY HOMELESSNESS IN NSW In 2011, the

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