Manchester City Council

Manchester City Council

Multi agency prevention and support (MAPS)

Briefly describe the initiative/ project/service; please include your aims and objectives

In January 2020, Manchester tested a new approach to support some of the city’s most complex and vulnerable residents living in one of Manchester’s neighbourhoods. This project aimed to work with residents who have complex support needs and to bring the right services together to plan a coordinated approach to support them. The pilot was called Multi-Agency Prevention and Support (MAPS). MAPS identified residents with complex support needs who were unable to access services, this could be due to not meeting service criteria or from loss of engagement with services. Without the right support people can often present repeatedly at different services, generating multiple ‘contacts’ but not receiving the right support. MAPS enabled us to bring these cases to a forum and be discussed in detail with multiple partners from a range of services with both local knowledge and specialist service insight.

The multi-agency approach included services from across Manchester City Council, Manchester Local Care Organisation(including Adult Social Care), Greater Manchester Mental Health, Greater Manchester Police, Housing Providers, Drug and Alcohol services (Change, Grow, Live), Domestic Violence and Abuse services, Be Well service (VCSE) and other partners who are members of the Bringing Services Together for People in Places (BSTPIP) programme.
The aim of MAPS was to improve partnership working and help to reduce demand on front line services by supporting residents to access the appropriate service.

The objectives for the MAPS pilot were to:

– Bring services together to work with high demand residents in the neighbourhood and utilise the breadth of knowledge and expertise in the area.
– Share information and insight to better inform planning.
– Discuss cases and build action plans to create person-centred approaches.
– Share resources and working ‘together’ to better support our neighbourhoods.
– Leave no adult behind and develop a community where everyone is a valuable asset.
– Improve relationships and communication between services.
– Reduce unmet demand and repeat calls on services.

MAPS started as an in-person weekly case management forum, due to social distancing measures it become a virtual meeting conducted via M365 Teams. Each partner has access to their own system, providing live updates and information on cases. Actions are agreed during the meeting and are reported to the chair at the next meeting. Joint actions are often set which require two or more partners to work together. Undertaking the pilot during lockdown has been challenging, however the collaboration and relationships built throughout the process have resulted in some extremely effective outcomes.

Through improved sharing of information and taking a strength-based approach, services created a better understanding about individuals they were working with. Services could then plan activity to encourage the resident to access the right support. We were able to directly manage demand on services and ensure that relapses were managed at the earliest opportunity. The pilot also built better working relationships between services, providing direct links and new communication channels between the partners. By improving communication, we were able to ensure that issues were managed quickly and precisely, further reducing demand on front line services. Manchester has now rolled out MAPS to two other neighbourhoods in the city and plans to roll this forum out to each neighbourhood across the city over the next year.

In Summary, the MAPS project was designed to help our most complex and vulnerable residents lead better and more stable lives. What we didn’t determine as an extra outcome was the strong working relationships of partners within neighbourhoods working together to support both our complex residents and the community in which these residents reside. By considering not only the person and the impact they have on the place. We are now considering the place and the impact that can have on a person.

What are the key achievements?

– Strong working relationships built across multiple organisations.
– Better place vs person approach within each neighbourhood.
– Trauma informed workforce that considers the persons journey rather than their impact.
– Effective use of resources and support within the neighbourhood.
– Better outcomes for residents and communities.
– Better awareness of the offer within neighbourhoods.
– Community identity is increasing.
– Visible workforce within the community – ‘things being done when they say they are’.
– Significantly less procedures and pinch points within organisations when trying to address an issue.
– Clear and concise reporting and management of the forum.
– Complete and accurate information recording.

The following case example illustrates a MAPS case in action: XX was a single female living in her house with her abusive son. Due to illness she was taken into hospital. She was referred to MAPS for support due to Domestic Violence & Abuse, financial abuse and significant illness. XX was referred by her Social Worker who required assistance, ensuring that when she returned from hospital to her home that she was safe, had the appropriate support and was able to manage living independently. MAPS partners assisted and advised: Independent Domestic Violence and Abuse services & Women’s Aid support to address Domestic Violence & Abuse including financial and emotional support. Care coordinator discussed with GP to ensure appropriate medication, adaptations and modifications were provided to assist with independent living. Be Well agreed to provide day to day support with independent living with social services Southway housing are assisting with downsizing and moving into a more suitable property in a different location Police are monitoring the address for any further instances of Domestic Violence & Abuse. Her son is not allowed to attend the address and XX is aware that should he return she can call the police at any time and they will attend. Had MAPS not interacted it is likely that she would have returned to her son at the address to suffer further abuse, without the additional support in place.

Learning from pilot:

The MAPS pilot has been evaluated for its impact and has provided valuable learning to influence wider system thinking about how the city can support vulnerable residents. Recently acknowledged by leaders across the partnership: ‘MAPS builds on Manchester’s track record of reforming public services with strong evidence showing sustained improvements in outcomes for thousands of families. MAPS brings together all the key partners in each neighbourhood to provide multi-agency support for those people that need it most, based on what is important to them, and how they live their lives. We are now rolling out this approach at scale across the city, working with many more citizens, helping to build a more progressive, equitable, inclusive, sustainable and thriving city’ James Binks, Director of Policy, Performance and Reform

What are the key learning points?

Over the past year there has been a lot of time to consider key learning points. The impact of the pandemic has been considerable and has required the process to adapt in order to continue to function. There have been some challenges to delivering the meeting virtually and there would be benefits to being able to meet in-person. In addition, added pressures have been felt with working with complex individuals during a pandemic and the restrictions that have been in place. Outcomes may have been significantly impacted as a result of fewer in-person services and interventions.

However, the key learning points are as follows:

– Creating and ensuring a trauma-informed neighbourhood. Adverse Childhood Experiences (ACE’s) play a significant role in the cohort of residents seen during the MAPS pilot. Having ACEs awareness and being trauma-informed enables a better understanding of the person’s journey, rather than their impact on the community. When a person’s journey has been considered, effective support can be introduced.
– Ensuring that the MAPS workforce is trained to understand ACEs became a priority within the forum. Members of the pilot were trained in ACEs in September 2020 and although the impact of this training has not yet been evaluated, there has been a significant shift in the approach that partners have taken towards the actions that have been set for them. It is already evident that thought processes and conversations within the forum are now significantly more focused on the person and what support they can provide rather than just addressing the issues that they may be causing.
– Maintaining a strong collaborative multi-agency support team.

At the beginning of the process, attendance to the case forums was very consistent. However, over the months during lockdown attendance has been difficult to maintain as capacity for services has become stretched. To maintain commitment and momentum we have re-engaged services and created a suite of content to share with providers that describe the process, confirms why it is important and how we hope to achieve better outcomes. From this, we have also engaged senior leaders to assist with this messaging and we are now starting to see more engagement from partners across the board. With the hopeful reduction of restrictions in the coming months and a reengaged workforce, we should see significant improvements in attendance. Gaps in service provision exist – particularly for single adults with complex support needs. The pilot has overall highlighted the need for more support in the city for adults who have complex support needs. Learning and evaluation from the MAPS pilot has highlighted this across the partnership with senior leaders committed to trying to address this gap.

Additional Comments

The following illustrates the experience of the MAPS pilot:

‘Many cases that have been referred are extremely complex, displaying chaotic lifestyles which has resulted in the need for various interventions in the past, some with limited success. MAPS has now brought together a range of partners and has encouraged the sharing of information and joint action, which in turn has and is proving to be beneficial for some of the individuals that have been referred into the meeting’ MAPS member.