making during the Covid-19 crisis Thursday 21st May, 11am Starting - - PowerPoint PPT Presentation

Homelessness and multiple disadvantage: Understanding factors that affect decision making during the Covid-19 crisis

Thursday 21st May, 11am – Starting shortly

www.homeless.org.uk Let’s end homelessness together

Homelessness and multiple disadvantage: Understanding factors that affect decision making during the Covid-19 crisis

With:

• Chair: Jo Prestidge, Homeless Link
• Bruno Ornelas, Voices of Stoke
• Fiona Bateman, CASCAIDr

www.homeless.org.uk Let’s end homelessness together

Homelessness and multiple disadvantage: understanding the factors that affect decision-making during the COVID-19 crisis

BRUNO ORNELAS & FIONA BATEMAN

21 MAY 2020 @cascaidr @voicesofstoke

 Why is not everybody able to stay in ?  Core underlying legal principles  The application of core statutory functions  Evidencing capacity  Effective support transitioning from temporary

accommodation

What we will cover

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Why is not everybody able to stay in? Overlapping factors

 There are many factors, often complex and overlapping  People experiencing multiple disadvantage often have

intersecting needs linked to homelessness, physical and mental ill health, addiction and histories of institutionalisation.

 The person’s institutionalised understanding of risk. Fear of

reprisal / harm from others etc. Informal exploitative support / coercion and control. A lack of information.

 Individual factors and/or systemic and structural

challenges

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Why is not everybody able to stay in? Hidden reasons

Some factors are often ‘hidden’ and undetected, like:

 Brain injuries (assessed at around 48%) in homeless adults  Executive impairment  Trauma, losses, complex grief, and a lack of choice

regarding the position they find themselves in.

 A need for information and clarity (specific knowledge)

but at best being provided with generic and possibly abstract information.

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Why is not everybody able to stay in? Self-care

Factors linked to self-care:

 Demotivation: self-image, negative cognitions  Different standards: indifference to social appearance  Inability to self-care: physical and practical

challenges 7

Why is not everybody able to stay in? Environment

Factors linked to environment:

 Influence of the past: childhood, loss, abuse,

bereavement

 Positive value of rough sleeping: emotional comfort, a

sense of connection, utility and familiarity

 Beyond control: mental and physical ill health,

executive impairment, addiction, lack of space 8

Every case must be assessed on the facts of that specific case, taking into account the duties in legislation, regulations and guidance. Practitioners must also be confident they can demonstrate, in Court if necessary, they have:

 Upheld principles that decision making is lawful, reasonable and fair  Protected against breaches of the adult’s human rights and

advanced the principles of the Equality Act 2010

 All decisions respect autonomy, where there is reasonable cause to

believe a person lacks capacity all decision are made with regards to the duties set out in the Mental Capacity Act 2005, practitioners also need to be mindful of external pressures than can impair free will

 Met obligations under the Data Protection Act 2018 and regulations

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Core underlying principles

Legal framework: Core statutory functions

 Housing Duties  Adult Social care, which includes the Wellbeing Principle

(section 1, Care Act 2014) and applies to:-

• assessment and care planning – including under the

Care Act easements

• safeguarding adults

 Health provision

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Poll (1)

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?

Mental Capacity Act 2005 (MCA) and Defensible decision-making

The Court of Protection is clear ‘views of a capacitous person are by definition decisive in relation to any treatment that is being offered to him so that the question of best interests does not arise.’

 S1(5) MCA requires that acts done on behalf of an incapacitated adult must be in their best

interests, see s4 MCA /chapter 5 of the Code. Ultimate responsibility for working out best interests (and the weight to be placed on the person’s wishes and feelings in determining this) rests with the relevant decision-maker for the issue in question. It is therefore a matter of professional judgement, but reasons must be in line with professional standards of care, documented and evidenced based.

 Acts/decisions made without reference to best interests won’t benefit from protection from

legal liability under s5 MCA: LB Hillingdon v Steven Neary [2011] the LAs failure to appoint an IMCA or immediately refer matter to the court and conduct an effective review of best interests amounted to a breach of art 5 and 8 ECHR.

 Alternative remedies: Public Health powers and Inherent Jurisdiction

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So, what is relevant information?

This depends on the decision to be made:

 Social distancing / self-isolating / consequences of non-

compliance

 Where to live  Medical Treatment

You can ask the question ‘Do you understand why I am concerned about the level of risk to your wellbeing?’

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How can you best evidence that someone may not have capacity to be involved ?

A need for information and clarity (specific knowledge) and avoid generic and possibly abstract information. How do you check if the person has understood what you are telling them? Be aware that:

 Information in and of itself, even if understood by the

individual, recognised and wholly accepted is not comparable to insight; it equates to an intellectual awareness only (Crosson et al., 1989)

 Failure to integrate intellectual awareness into action, where

knowledge becomes part of the person’s ‘new’ reality.

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How can you best evidence that someone may not have capacity to be involved ?

The use of an ‘articulate-demonstrate’ model:

 The person is first asked questions and then asked

to show how they would actually implement their decision, or specific components of this decision, may be helpful.

 This might include showing how they would do

social distancing or other practical things like, phone for help, get out quickly if there was a fire

• r this might involve obtaining reports from others

who might have witnessed these actions.

 This is like “Tell me, show me” questions when

doing a driving test i.e “Tell me and show me how you would check if the brakes are working before starting a journey?”

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How to provide effective support in the individual’s transition from temporary accommodation ? 16

 Integrate your own knowledge of brain injury (including

trauma) and develop communication plans i.e for communicating accommodation rules, COVID-19 social distancing and future re-housing plans. This could involve linking in with specialist professionals like Speech and Language Therapists and Occupational Therapists, Clinical Psychologists, Brain Injury specialists.

 Do “tell me and show me” checks / ‘articulate and

demonstrate’ models of assessment.

AND….

Poll (2)

17 Where might it help for you to have a bit more legal know-how to provide effective challenge (and /or advocacy) ?

With:

• Chair: Jo Prestidge, Homeless Link
• Bruno Ornelas, Voices of Stoke
• Fiona Bateman, CASCAIDr

Some time for questions...

www.homeless.org.uk Let’s end homelessness together

Useful Links & Resources

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Coronavirus (COVID-19) and changes to the Care Act 2014 – A briefing for homelessness providers and practitioners: https://www.voicesofstoke.org.uk/2020/04/23/coronavirus-covid-19-and-changes-to-the-care-act- 2014-a-briefing-for-homelessness-providers-and-practitioners/ Care Act Toolkit: https://www.voicesofstoke.org.uk/wp-content/uploads/2018/02/CareActToolKit.pdf Multiple Exclusion Homelessness: A safeguarding toolkit for practitioners https://www.qni.org.uk/wp- content/uploads/2020/05/SafeguardingToolkitDRAFT-PDF.pdf NRPF Guidance: http://www.nrpfnetwork.org.uk/guidance/Pages/default.aspx Care Act easement information: https://www.gov.uk/government/publications/coronavirus-covid-19-changes-to- the-care-act-2014/care-act-easements-guidance-for-local-authorities Social Care ethical framework: https://www.gov.uk/government/publications/covid-19-ethical-framework-for- adult-social-care/responding-to-covid-19-the-ethical-framework-for-adult-social-care Safeguarding protections: https://www.gov.uk/government/publications/coronavirus-covid-19-changes-to-the- care-act-2014/care-act-easements-guidance-for-local-authorities#annex-d-safeguarding-guidance Mental Capacity Act guidance: https://www.mentalcapacitylawandpolicy.org.uk/resources-2/covid-19-and-the - mca-2005/ Coronavirus (COVID-19). Clinical homeless sector plan: triage – assess – cohort – care: https://www.pathway.org.uk/wp-content/uploads/COVID-19-Clinical-homeless-sector-plan-160420-1.pdf COVID-19 and the MCA 2005 by Alex Ruck Keene: https://www.mentalcapacitylawandpolicy.org.uk/resources- 2/covid-19-and-the-mca-2005/ Mental Capacity – the key points – webinar by Alex Ruck Keene: https://www.mentalcapacitylawandpolicy.org.uk/capacity-the-key-points-webinar/ Capacity in the time of Coronavirus: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151525/

Further reading

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

Ornelas, B., Bateman, F., Meakin, A., Cornes, M., Pritchard-Jones, L. (2020). Multiple Exclusion Homelessness: A safeguarding toolkit for practitioners. Stoke-on-Trent: VOICES



Ornelas, B., Bateman, F., and Cornes, M. (2020). Coronavirus (COVID-19) and changes to the Care Act 2014 – A briefing for homelessness providers and practitioners. Stoke-on-Trent: VOICES



Ornelas, B and Bateman, F. (2020). COVID-19: Ending the Interim Accommodation Duty and Mental

• Capacity. Stoke-on-Trent: VOICES.



Ornelas, B., Schwehr, B., Davies, G. (2020). Unwise choices or uniformed decisions regarding housing options? The duty to make enquiries and the implied duty to support decision making. Stoke-on-Trent: VOICES.



Ornelas, B. (2020). Learning Lessons from Safeguarding Adult Reviews. Homeless Link



Ornelas, B., Schwehr, B., Davies, G. (2019). A Persistent and Unequivocal Refusal? The Ending of Interim

• Accommodation. Stoke-on-Trent: VOIC



Martineau, S. J., Cornes, M., Manthorpe, J., Ornelas, B., & Fuller, J. (2019). Safeguarding, Homelessness and Rough Sleeping: An analysis of Safeguarding Adults Reviews. London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London.



Cornes, M., Ornelas, B., Bennett, B., Meakin, A., Mason, K., Fuller, J., and Manthorpe, J. (2018). Increasing Access to Care Act 2014 Assessments and Personal Budgets Among People with Multiple Needs Linked to Homelessness and Exclusion: A Theoretically Informed Case Study. Housing Care and Support.



Ornelas, B and Cornes, M. (2017). The Care Act: A Toolkit for Advocacy. Homeless Link.



Mason, K., Cornes, M., Dobson, R., Meakin, A., Ornelas, B., and Whiteford, M. (2017). Multiple Exclusion Homelessness and adult social care in England: Exploring the challenges through a researcher-practitioner

• partnership. Research, Policy and Planning (2017/18) 33(1), 3-14.

About

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CASCAIDr is a charity aiming to open the floodgates to legal literacy, in the health and social care sector The CASCAIDr website is found at www.CASCAIDr.org.uk CASCAIDr can be contacted on info@cascaidr.org.uk if you’d like to volunteer to help in any way

VOICES is a part of the Fulfilling Lives programme which is a £112 million investment over 8 years supporting people who are experiencing multiple disadvantage. The programme funds local partnerships in 12 areas across England to test new ways of ensuring individuals receive joined up and person centred services which work for them.

VOICES is a partnership project led by

www.brighter-futures.org.uk