An intensive and innovative outreach service is making a life-changing impact on the streets of North London, say Adam Denny and Mike Coffey. Personalised and intensive support Adam says… Our teams are small but powerful – made up of outreach workers, a women’s specialist worker and dual diagnosis coordinator, as well as having a clinical prescribing element to provide rapid OST prescribing, opiate treatment support and health and wellbeing checks such as BBV testing. Most of our days are spent walking the streets and talking with rough sleepers about the support and treatment we offer, and attending the sleep sites and hostels of our clients to provide ongoing care. A key objective is to help stabilise the people we work with and reduce the barriers for them to access structured community support. This is a heavily marginalised group, and we work hard to use an accommodating and trauma-informed approach, which can have a hugely positive impact on their health and wellbeing. It can be challenging to help our clients maintain their OST prescriptions, because of the complexities of addiction, mental health and homelessness, but engaging individuals into treatment as soon as possible is vital to minimise the risk of overdose. Identifying people that may be struggling and providing them with the support they need to re-engage with treatment is also essential, especially when they’re released from prison or hospital. Joined-up approach We work closely with housing teams, hostels, community drug and alcohol support services and other outreach teams (such as Routes off The Streets in Camden and various outreach partners in Islington), prison and criminal justice partners, and community safety teams to help us build a full picture our clients’ history and needs. A day can quickly shift from meetings into supporting a high-risk individual by escorting them to an appointment, delivering an OST prescription to a pharmacy, or even calling an ambulance in an emergency situation – so being flexible and adapting to what our clients need is key! A day in the life Mike says… Today starts outside Angel tube station. I’m meeting my colleague and we’re on outreach patrol. We have a set of bedding-down addresses, a list of rough sleepers who may be facing challenges with drugs and alcohol, known hotspots, and clients who have fallen off-script or who aren’t engaging. Nearby a young man is sleeping at the back of a supermarket. He says he doesn’t drink or take drugs, so we have a discussion around him being offered temporary accommodation. The absolute priority is an initial conversation and to gain a level of trust. For those with accommodation, it’s easy to be open about who we are and what we’re doing. However, for those bedding down on the street, there are more risks associated with exploitation, robbery, and violence. For some rough sleepers it’s not a safe environment to discuss alcohol and drug use with someone who has just introduced themselves. However, our conversation with this young man is good natured, and I leave having developed enough rapport to say hello next time we meet – either on the street, or ideally in a hostel. Our next stop is a stairwell at a block of flats, and I almost miss a man huddled in a corner asleep under some blankets. We introduce ourselves but the man refuses to talk and would rather go back to sleep, so we leave him saying we’ll pop back another time. We make our way to a popular local site for rough sleepers. It’s here I meet one of my clients who has recently fallen off his methadone script. He has a bed space at a nearby hostel which he’s not been using. Feeling threatened It can be quite challenging for our clients to stay at a hostel/bedspace for many reasons. Common issues are owing money to, or feeling threatened by, other tenants, being unsettled by noise, or just not being happy living in a room with a set of rules to follow. I offer to make an appointment to get my client back on his script and after a flurry of phone calls, one is made at one of our clinics for the following day. I agree to meet my client at his hostel to take him to clinic, but suggest that I’ll look for him at the current vicinity if he’s not at his hostel, to which he agrees. I head to one of our office spaces where I meet with my colleagues on a video call and catch up with my notes from the morning’s outreach. I inform the team of my plan to visit a local hostel where a number of my clients are staying. I quickly make my pharmacy checks to see who is on script and check my email before leaving. I arrive at the hostel and sit with the keywork staff to discuss my clients before making room visits. I have a varied caseload with people who differ greatly in their personal challenges with drugs, alcohol and/or mental health. Working in a hostel environment is a good time to talk about current drug or alcohol use and to offer naloxone and safety advice. If the opportunity presents itself there are a number of conversations to be had such as general health and weight, are they using and if so, how much are they spending and do they feel safe. Next, I arrange to meet my colleague to visit some popular begging and bedding-down sites. We chat to a man who looks rather unkempt and is selling pictures and drinking beer in a doorway. He becomes animated when I ask if he requires support with drug or alcohol use and asks us to leave, so we oblige. Street Assessment We then attend an appointment for a street assessment, meeting a rough sleeper in the corner of a park. We find a park bench which is private and secure, and a long and detailed conversation begins. One of the challenges is to keep it concise, and answers to later questions can often be found in earlier discussions. As the assessment comes to an end, we arrange another clinic appointment for the next day and my colleague arranges to attend with this individual. We visit a client of mine at a hostel who is struggling with alcohol. Detox and rehabilitation are on the agenda, but it’s something my client doesn’t feel ready for. We’re working on completing alcohol diaries and extending the window between drinking each morning and starting to drink again in the afternoon. This window is a great time for them to think about eating some wholesome food and we talk about making egg and beans on toast and the sort of food they should be looking to eat. When our session is finished, my working day is nearly over. I hop off the train at Caledonian Road to check for one last client who is reported to be sleeping rough in the area, but I can’t find him. I make a mental note to check again later that week before heading home. Adam Denny is dual diagnosis coordinator and Mike Coffey is outreach practitioner at WDP INROADS is a street-based service that provides wrap-around intensive and holistic outreach support for rough sleepers aged 18+ with drug and alcohol issues and is commissioned by London Borough of Camden and London Borough of Islington. Visit www.wdp.org.uk/camden-inroads or www.wdp.org.uk/islington-inroads.