Guidance

Recommendations

Recommendations

People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.1 General principles

1.1.1 Recognise that more effort and targeted approaches are often needed to ensure that health and social care for people experiencing homelessness is available, accessible, and provided to the same standards and quality as for the general population.

Co-design and co-delivery of services

1.1.2 Recognise the value of co-designing and co-delivering services with people with lived experience of homelessness, to improve the quality of health and social care (see the section on the role of peers). See also the section on involving people in service design and improvement in NICE's guideline on people's experience in adult social care services and NICE's guideline on community engagement.

Supporting engagement with services

1.1.3 Promote engagement by providing services that:

  • are person-centred, empathetic, non-judgemental

  • aim to address health inequalities

  • are inclusive and pay attention to the diverse experiences of people using the service.

1.1.4 Consider using psychologically informed environments and trauma-informed care. Recognise that people's behaviour and engagement with services is influenced by their traumatic experiences, socioeconomic circumstances and previous experiences of services.

Sustaining engagement with services

1.1.5 Recognise the importance of longer contact times in developing and sustaining trusting relationships between frontline health and social care staff and people experiencing homelessness (see also recommendation 1.2.9 in the section on planning and commissioning).

1.1.6 Promote shared decision making, building self-reliance and using strengths-based approaches to care (also known as assets-based approaches). See also NICE's guideline on shared decision making.

1.1.7 Recognise that people experiencing homelessness, especially those with experience of rough sleeping, need services that provide a long-term commitment to care to promote recovery, stability and lasting positive outcomes (see the section on long-term support).

Supporting re-engagement with services

1.1.8 Be aware that some people experiencing homelessness may find it difficult to look after themselves because of their circumstances and may find services difficult to engage with. For people who disengage from or refuse health and social care services:

  • actively support re-engagement

  • enable people to re-engage with services at the same point as they left, if appropriate.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on general principles.

Full details of the evidence and the committee's discussion are in:

Communication and information

1.1.9 Follow the recommendations on communication and information in NICE's guidelines on:

1.1.10 Health and social care staff working with people experiencing homelessness should:

  • be empathetic, non-judgemental and use recovery-oriented language that avoids jargon and acronyms

  • use communication methods based on the person's preferences, for example, phone call, text message, email, letter, face to face

  • send clear information about contacts or appointments and reminders that reach people in time, and follow up people who do not attend.

1.1.11 Take into account each person's communication and information needs and preferences, and their circumstances. For example:

  • provide translation and interpretation services if needed

  • ensure that written information is available in different formats and languages, including Easy Read

  • provide extra support for people with low literacy levels or with speech, language and communication difficulties

  • consider the person's access to phone or internet.

1.1.12 Consider involving an advocate to support communication, even when this is not a statutory requirement. This may be someone nominated by the person or an independent advocate who can, for example:

  • support people to overcome stigma and previous negative and traumatic experiences

  • help people with low literacy levels to access information and services

  • reinforce information about available services and appointments.

1.1.13 Give people experiencing homelessness information about:

  • their rights to health and social care services, including for those with no or limited recourse to public funds

  • how to access health and social care services, including:

    • primary care services and how to register with a GP without a permanent address

    • specialist health services that can be accessed directly, such as maternity, blood-borne virus, drug and alcohol recovery, mental health, sexual health, and family planning services

    • outreach services

    • local authority services, including housing services and social care

  • voluntary and charity sector services.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on communication and information.

Full details of the evidence and the committee's discussion are in evidence review C: views and experiences of health and social care for people experiencing homelessness.

1.2 Planning and commissioning

These recommendations are for commissioners of health and social care and housing services.

Planning integrated multidisciplinary health and social care services

1.2.1 Commissioners of health, social care and housing services should work together to plan and fund integrated multidisciplinary health and social care services for people experiencing homelessness, and involve commissioners from other sectors, such as criminal justice and domestic abuse, as needed. These services should contribute to the government's aim of ending rough sleeping and preventing homelessness.

1.2.2 Recognise that people experiencing homelessness often need additional resources and a more targeted service delivery to:

Local homelessness health and social care needs assessment

1.2.3 Conduct and maintain an up-to-date local homelessness health and social care needs assessment and use this to design, plan and deliver services according to need. Include thorough engagement with service providers (including voluntary and charity sector service providers) and experts by experience.

1.2.4 Local homelessness health and social care needs assessments should:

  • quantify and characterise the population experiencing homelessness or at risk of homelessness, including health inequalities, diversity and inclusion issues and specific needs and identify trends

  • assess the quality and capacity of existing mainstream and specialist service provision to inform the need for service development and investment

  • assess access to and engagement with current services by people experiencing homelessness

  • identify opportunities for more integrated service delivery

  • take into consideration relevant findings from Safeguarding Adults Reviews.

Recording housing status

1.2.5 Work with health and social care providers to improve recording of housing status so that the information can be used by services to:

  • best meet people's needs and

  • plan, audit and improve services.

Developing services

1.2.6 When developing services for people experiencing homelessness, commissioners should:

  • work together to strategically plan and deliver health and social care across larger areas, recognising that people move between areas

  • work with other relevant services, such as prison and probation services and domestic abuse services

  • enable long-term support for those who need it (see the section on long-term support)

  • ensure that health and social care services are designed to meet the level and type of local need (see the section on models of multidisciplinary service provision)

  • define and measure outcomes, including health and social outcomes and service use

  • consider the likely benefits of using long-term contracts for providers

  • support statutory bodies to fulfil their legal responsibilities and use their powers

  • encourage and enable the contribution of peers (experts by experience) in supporting people experiencing homelessness and delivering and designing more effective services (see the section on the role of peers).

1.2.7 Consider providing services and support aimed at the needs of particular groups of people experiencing homelessness, as appropriate, such as:

  • women (also see the NICE guideline on pregnancy and complex social factors)

  • young people

  • older people

  • disabled people

  • people with no or limited recourse to public funds because of their immigration status

  • LGBT+ people

  • people from different minority ethnic or religious backgrounds.

1.2.8 Develop strategies across services to improve access to health and social care for people experiencing homelessness. See the section on improving access to and engagement with health and social care.

1.2.9 Ensure that there are processes to:

  • support people experiencing homelessness to register with a GP and

  • document and address any problems with GP registrations for people experiencing homelessness.

1.2.10 Consider reducing caseloads and lengthening contact time for health and social care practitioners working with people experiencing homelessness to enable them to use approaches that sustain engagement with services.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on planning and commissioning.

Full details of the evidence and the committee's discussion are in:

1.3 Models of multidisciplinary service provision

Homelessness multidisciplinary teams

1.3.1 Provide care through specialist homelessness multidisciplinary teams across sectors and levels of care, tailored according to local needs.

1.3.2 Homelessness multidisciplinary teams should act as expert teams, providing and coordinating care across outreach, primary, secondary and emergency care, social care and housing services. Homelessness multidisciplinary teams may include:

  • experts by experience (see the section on the role of peers)

  • healthcare professionals with relevant specialist expertise (for example, drug and alcohol treatment, mental health, primary care, emergency care, palliative care)

  • social workers

  • housing options officers or homelessness prevention officers

  • outreach and homelessness practitioners

  • voluntary and charity sector professionals

  • staff with practical expertise in accessing benefits and entitlements for people experiencing homelessness.

1.3.3 Homelessness multidisciplinary teams should have protocols and systems in place for communication and sharing information to support integrated working within the team and between services.

1.3.4 Homelessness multidisciplinary teams should:

  • identify people experiencing homelessness through outreach or when they present to health and social care services

  • support mainstream providers to identify and refer people to the homelessness multidisciplinary team

  • undertake and support assessments for safeguarding, physical and mental health, alcohol and drug treatment needs, and social care, including informing Care Act assessments (see the section on assessing people's needs)

  • support mainstream providers to ensure safe, timely and appropriate hospital discharge and engagement with onward care (see the section on transitions between different settings).

1.3.5 Homelessness multidisciplinary teams should:

  • offer person-centred case management by a designated practitioner within the multidisciplinary team and ensure continuity of care for as long as it is needed by the person

  • offer wraparound health and social care support that encompasses the person's needs, including:

    • physical health

    • mental health and psychological support (such as psychological therapies)

    • physical rehabilitation (such as occupational therapy and physiotherapy)

    • drug and alcohol treatment

    • social care

    • palliative care

    • communication support

    • practical support, such as help with benefits, housing and referral for legal advice.

1.3.6 Homelessness multidisciplinary teams should engage in reflective practice, including opportunities to share experience and learning with other relevant teams, including homelessness multidisciplinary teams, and to review complex or difficult situations.

1.3.7 Homelessness multidisciplinary teams should directly contribute to local needs assessments, service quality improvement, and reviews of complex or difficult situations including Safeguarding Adults Reviews.

1.3.8 Homelessness multidisciplinary teams should advise homelessness leads, when needed, in nearby areas that do not have a homelessness multidisciplinary team and share examples of good practice.

Homelessness leads in mainstream services

1.3.9 In areas assessed as not needing a full-time homelessness multidisciplinary team because of low numbers of people experiencing homelessness, establish links with multidisciplinary teams in nearby areas and designate homelessness leads in all relevant mainstream services, for example, in primary, secondary and emergency care, palliative care and in adult and child social services.

1.3.10 The homelessness leads should:

  • support their organisation to provide appropriate care for people experiencing homelessness and implement this guideline

  • have detailed local knowledge of specialist services to support the care of people experiencing homelessness

  • work with and coordinate care with homelessness leads in other mainstream services

  • consult homelessness multidisciplinary teams in nearby areas, as needed.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on models of multidisciplinary service provision.

Full details of the evidence and the committee's discussion are in:

1.4 The role of peers

1.4.1 Involve peers (experts by experience) in delivering and designing services, for example by:

  • directly delivering health and social care interventions, for example, as part of outreach

  • providing a user perspective to influence the design and development of services

  • providing training for health and social care staff

  • carrying out participatory research and data collection, for example, to support service audits, needs assessments and quality improvement.

1.4.2 Offer peer support to people experiencing homelessness, for example to help with:

  • understanding how others with similar experiences have changed their lives (role modelling)

  • developing self-efficacy

  • navigating services

  • supporting attendance at appointments

  • providing peer advocacy at appointments or in A&E

  • forming trusting relationships with practitioners and improving communication.

1.4.3 Support peers to deliver services effectively and maintain their own wellbeing and development by providing:

  • training, supervision and governance structures appropriate to the role and tailored to the person's needs

  • psychological and social support, for example reflective practice, according to their changing needs and circumstances

  • tailored support for professional development, including access to further training and inclusive employment opportunities.

1.4.4 Take into account the experience, background and language skills of peers and how these can be used to meet the needs and preferences of people experiencing homelessness.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on the role of peers.

Full details of the evidence and the committee's discussion are in:

1.5 Improving access to and engagement with health and social care

Supporting access to and engagement with services

1.5.1 Design and deliver services in a way that reduces barriers to access and engagement with health and social care, for example, by providing:

1.5.2 Do not penalise people experiencing homelessness for missing appointments, for example, by discharging people from the service. Consider seeking specialist help, such as peer supporters or independent advocates, to support the person to attend appointments and re-engage with care after missing appointments (see the section on the role of peers).

1.5.3 Ensure that people can access help when needed, including through emergency care, and avoid policies that withdraw support and close cases after a standard duration, unless a safe transfer of care to another service has been agreed with the person or the person agrees that they no longer need the service.

1.5.4 Commissioners and service providers should follow the recommendations on improving access to services in NICE's guideline on common mental health problems.

1.5.5 Ensure that people experiencing homelessness with multiple health or social care needs are not excluded from services because of restrictive eligibility criteria. For example, people with mental health problems are not denied access to mental health services because they have drug and alcohol treatment needs (see also NICE's guideline on coexisting severe mental illness and substance misuse).

1.5.6 Ensure that people experiencing homelessness who are assessed as frail and in need of social care and support get long-term care packages, including residential care or supported housing, irrespective of their age.

1.5.7 Ensure that paper or digital forms needed to access health or social care or to get help with NHS costs are readily available and that people are supported to fill them in, including providing translation when needed.

1.5.8 Ensure that people experiencing homelessness can access online health and social care information and are supported to use online services, for example by providing internet access at places where people experiencing homelessness spend time, such as day centres or hostels.

1.5.9 Primary care service providers should ensure that people without an address can register with a GP practice, in line with the NHS Primary medical care policy and guidance manual.

1.5.10 Ensure that frontline health and social care staff who come into contact with people experiencing or at risk of homelessness are able to fulfil their duties under the Homelessness Reduction Act 2017.

1.5.11 Ensure that frontline health and social care staff are able to identify when a person needs to be referred for specialist homeless health and social care, and that processes are in place to support timely referral.

1.5.12 Consider moving people up waiting lists for health and social care appointments if they are experiencing homelessness because their circumstances may mean they are at higher risk of deterioration and premature death.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on supporting access to and engagement with services.

Full details of the evidence and the committee's discussion are in:

Outreach services

1.5.13 Take health and social care services to people experiencing homelessness by providing multidisciplinary outreach care in non-traditional settings, such as on the street, hostels or day centres.

1.5.14 Offer outreach services that include support for people who:

  • have primary healthcare needs

  • have drug and alcohol treatment needs

  • have mental healthcare needs

  • fear engaging with services, for example, because of previous negative experiences from providers, discomfort using male-dominated services or concerns about eligibility including immigration status

  • may lack mental capacity or need support to recognise their care needs and engage with providers.

1.5.15 Use outreach to identify health problems earlier, promote health and support engagement with care, for example by:

  • supporting access to national screening programmes

  • assessing people for long-term conditions, infectious diseases and mental health needs

  • providing preventive health opportunities, such as vaccination, drug and alcohol treatment services, harm minimisation, smoking cessation and nutrition advice.

1.5.16 Offer collaborative, assertive outreach to start and maintain engagement with health and social care for people experiencing homelessness with coexisting severe mental health and drug or alcohol treatment needs. See also the section on maintaining contact with services in NICE's guideline on coexisting severe mental illness and substance misuse.

1.5.17 Consider assertive outreach for all people experiencing homelessness who could benefit from support but who find services difficult to engage with.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on outreach services.

Full details of the evidence and the committee's discussion are in:

1.6 Assessing individual needs

1.6.1 Be aware that health and social care practitioners have a statutory and professional duty to identify immediate risk of harm to self or others. See also the section on assessment and treatment under the Mental Health Act in NICE's guideline on service user experience in adult mental health.

1.6.2 Assess the health and social care needs of the person experiencing homelessness. When carrying out the assessment:

  • take into account their capacity, rights to autonomy and self-determination, and any safeguarding issues and

  • avoid unnecessary and potentially distressing repetition of their history if it is already on record

  • involve peers or advocates as appropriate (see also the section on the role of peers).

1.6.3 Include in the assessment:

  • A comprehensive assessment of the person's physical and mental health needs (including acute and long-term conditions) and social care needs. This should take into consideration their housing and benefits situation, bearing in mind the need to address health inequalities, and be responsive to diversity, and inclusion needs.

  • Asking if the person has children or dependents and assessing how this affects their needs.

  • Understanding the historical context of their situation, including past psychological trauma and experience of services.

1.6.4 In assessments to inform a health and social care plan for people who might benefit from high levels of support, use a multidisciplinary approach to enable a comprehensive and holistic assessment of their needs, involving:

  • the person, and their advocate if one is nominated or appointed

  • input from professionals with specialist expertise and practitioners who have detailed knowledge of the person's health and social care needs, including staff working in homelessness and housing services.

1.6.5 Use hospital admissions as an opportunity to offer a comprehensive, holistic needs assessment, including referral, if indicated.

1.6.6 Use the multidisciplinary assessment to inform the local authority-led care and support needs assessment, under the Care Act 2014 (see the section on care and support needs assessment and care planning in NICE's guideline on people's experience in adult social care services).

1.6.7 Review the person's needs, strengths and aspirations whenever their circumstances change or whenever they request a review, rather than using standard review periods.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on assessing people's needs.

Full details of the evidence and the committee's discussion are in evidence review C: views and experiences of health and social care for people experiencing homelessness.

1.7 Intermediate care

1.7.1 Provide intermediate care services with intensive, multidisciplinary team support for people experiencing homelessness who have healthcare needs that cannot be safely managed in the community but who do not need inpatient hospital care. These may be for people who are:

For a short explanation of why the committee made this recommendation and how it might affect services, see the rationale and impact section on intermediate care.

Full details of the evidence and the committee's discussion are in evidence reviews A and B: effectiveness of approaches to improve access to and engagement with health and social care and joined up approaches.

1.8 Transitions between different settings

1.8.1 Homelessness multidisciplinary teams or leads should support people experiencing homelessness through transitions between settings (such as the street, hostels, Housing First and other supported housing, hospital, mental health services, social care, residential or community drug and alcohol treatment, and custody) and consider providing time-limited intensive support, which includes:

  • having a key practitioner coordinating care

  • building a relationship of trust

  • providing links to services in the community

  • gradually lowering the intensity of support, as appropriate.

1.8.2 Practitioners in any setting supporting people experiencing homelessness should:

  • ensure that all handovers of care responsibilities are planned and coordinated, and relevant information is shared if agreed

  • offer pre-emptive, structured support before, during and after transitions

  • recognise that people may be vulnerable during periods of transition, but also that there may be opportunities for intervention.

1.8.3 Clinical teams, working with hospital discharge teams and specialist homelessness multidisciplinary teams, where available, should have procedures to:

  • minimise self-discharge and

  • prevent discharge to the street.

    If self-discharge or discharge to the street happens, review the circumstances and implement learning.

1.8.4 For people moving between different care settings, follow the recommendations in NICE's guidelines on:

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section for transitions between different settings.

Full details of the evidence and the committee's discussion are in:

1.9 Housing with health and social care support

These recommendations are for commissioners and service providers working together across health, social care and housing services.

1.9.1 Recognise that providing accommodation suitable for the person's assessed health and social care needs (see the section on assessing people's needs) can support access to and engagement with health and social care services and long-term recovery and stability.

1.9.2 Provide wraparound health and social care support that is flexible to the person's changing needs and circumstances, and helps them maintain suitable accommodation.

1.9.3 Recognise the need for a range of accommodation types that are suitable for the varied needs of people experiencing homelessness, such as self-contained accommodation and accommodation with specialist onsite support for people who are particularly at risk or who might otherwise benefit from higher levels of support.

1.9.4 Be aware that moving to independent accommodation in the community with tenancy responsibilities can be an extremely challenging, stressful and isolating experience for some people. Provide emotional and practical support for as long as it is needed.

1.9.5 When a person experiencing homelessness moves into new accommodation, help them to assess the risks associated with their new living arrangement, while also recognising their strengths, and plan ways to mitigate the risks.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on housing with health and social care support.

Full details of the evidence and the committee's discussion are in:

1.10 Safeguarding

Also see the NICE guideline on domestic violence and abuse.

1.10.1 Designate a person to lead on safeguarding the welfare of people experiencing homelessness, including engagement and face-to-face practical safeguarding support.

1.10.2 Where a social worker is embedded in the homelessness multidisciplinary team, local authorities should consider appointing them to lead on safeguarding enquiries about people experiencing homelessness.

1.10.3 Local authorities should consider having a lead for people experiencing homelessness on the Safeguarding Adults Board.

1.10.4 Safeguarding Adults Boards should ensure that specific reference is made to people experiencing homeless in their annual reports and strategic plan.

1.10.5 Safeguarding Adults Boards should share recommendations and key learning related to homelessness from Safeguarding Adults Reviews with key stakeholders.

1.10.6 Safeguarding Adults Boards should establish ways of analysing and interrogating data on safeguarding notifications about people experiencing homelessness so that they can check that local safeguarding arrangements offer the necessary protection.

1.10.7 Commissioners and service providers should support health and social care staff to understand and apply laws relevant to people experiencing homelessness and who are in need of safeguarding. This should include ensuring that they can recognise signs of abuse and neglect (including self-neglect) and how to make a safeguarding referral.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on safeguarding.

Full details of the evidence and the committee's discussion are in evidence reviews A and B: effectiveness of approaches to improve access to and engagement with health and social care and joined up approaches.

1.11 Long-term support

1.11.1 For people who struggle to engage with services, plan long-term engagement to help meet the person's needs at their own pace.

1.11.2 Give priority to building a relationship of trust, for example by:

  • taking time with the person, particularly at the beginning of the relationship

  • being prepared to meet in an informal setting, such as a park or café (with appropriate lone worker policies in place)

  • having regular contact

  • ensuring consistency of practitioner, so that they meet with 1 person or a small team

  • aiming to meet immediate expressed needs to encourage long-term engagement.

1.11.3 Recognise that people experiencing homelessness do not always follow a linear recovery journey and that apparent progress may hide risks.

1.11.4 Consider providing 'open-door' services that people can self-refer to and access after any initial support ends, to reduce the risk of becoming homeless again because of unmet health, care and support needs.

1.11.5 Recognise that some people experiencing homelessness experience frailty at an earlier age (both physical and cognitive) than the general population and their long-term care should be tailored to meet this.

1.11.6 If a person experiencing homelessness is likely to be approaching the end of their life, for example, if death would not be unexpected in 6 to 12 months, discuss palliative care needs with the person and the multidisciplinary team, and provide coordinated palliative care to meet the person's needs.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on long-term support.

Full details of the evidence and the committee's discussion are in:

1.12 Staff support and development

1.12.1 Consider providing training for all health and social care practitioners, at a level suitable for their professional role, covering:

  • understanding the health and social care needs of people experiencing homelessness, and their rights to access services

  • homelessness as part of equality and diversity training, including being responsive to health inequalities, diversity issues and inclusion needs and understanding the impact of discrimination and stigma, and how intersectional, overlapping identities can affect people experiencing homelessness

  • psychologically informed environments and trauma-informed care

  • legal duties and powers

  • legal entitlements for migrants.

1.12.2 Healthcare professionals working within secondary care mental health services should follow the recommendations in the section on competence in NICE's guideline on coexisting severe mental illness (psychosis) and substance misuse.

1.12.3 Consider regular and ongoing support, professional supervision and reflective practice for staff working with people experiencing homelessness.

For a short explanation of why the committee made these recommendations and how they might affect services, see the rationale and impact section on staff support and development.

Full details of the evidence and the committee's discussion are in:

Terms used in this guideline

This section defines terms that have been used in a particular way for this guideline. For other definitions, see the NICE glossary and the Think Local, Act Personal's Care and Support Jargon Buster.

Assertive outreach

A proactive and persistent approach to outreach that involves repeated contact with people who are initially unable to or unwilling to engage.

Care navigation

Helping people navigate the complex health and social care systems to overcome barriers in accessing services. This could be done by case workers, other practitioners or peers supporting the person, or by designated care navigators.

Health inequalities

Systematic, unfair and avoidable differences across the population and between different groups within society in relation to health and social outcomes. They arise because of the conditions in which people are born, grow, live, work and age. These conditions influence people's opportunities, health and wellbeing.

Homelessness leads

People working in mainstream health and social care services who, as part of their role, lead on homelessness issues within their service. Homelessness leads are designated in areas assessed as not needing a full-time homelessness multidisciplinary team.

Homelessness multidisciplinary team

A multidisciplinary team involves a range of professionals across disciplines as well as agencies working together to assess and support the needs of a person experiencing homelessness.

Inclusion needs

A need to have equal access and opportunities to participate in society and not facing barriers to services, social situations, different spaces and environments; being treated with dignity and not experiencing discrimination or intolerance due to the person's identity. See also health inequalities.

Intermediate care

A range of integrated services that: promote faster recovery from illness; prevent unnecessary acute hospital admissions and premature admissions to long-term care; support timely discharge from hospital; and maximise independent living. Intermediate care is given on a time-limited basis, but duration can vary depending on the person's needs.

Low-threshold services

Services that avoid restrictive eligibility criteria and make minimal demands on the client.

Mainstream services

Services designed to be delivered to the general population.

Outreach

Bringing health and care services to people who might not otherwise have access to or engage with existing services, provided in a mobile way in the locations where people are, for example on the street, in temporary accommodation facilities and in day centres. This can be done by mainstream services or dedicated outreach teams.

Peers

People with lived experience of homelessness who are using their experience to support people experiencing homelessness through different means such as direct support, advocacy, research and co-production of services.

People experiencing homelessness

In the context of this guideline, people experiencing homelessness is defined as people aged 16 and over who:

  • are sleeping rough (people without homes who sleep outside or somewhere not designed for habitation)

  • are temporary residents of hostel, B&B, nightly-paid, privately managed accommodation and other types of temporary accommodation

  • use day centres that provide support (such as food, showers, clothing and advice) for people experiencing homelessness

  • are obliged to stay temporarily with other people

  • are squatting

  • are newly homeless.

It also includes people with a history of homelessness (as defined above) who are at high risk of becoming homeless again because of ongoing severe and multiple health and social care needs.

Psychologically informed environment

Service provision and practice that takes into account individuals' psychological and emotional needs, and their experiences of trauma. It includes building organisational awareness of psychological and emotional needs; physical environment and social spaces; staff training and ongoing support; service evaluation and learning; and reflective practice. For more information and resources, see the Homeless Link's webpage on trauma informed care and psychologically informed environments. See also trauma-informed care.

Recovery-oriented language

Language that is person-centred, respectful, non-judgemental and strengths based. It conveys a sense of hope and commitment to the potential of every person and their recovery journey. It includes non-verbal aspects of communication and aims for consistency between verbal language and body language. If recovery is unlikely, this approach might focus on exploring what is important to the person and what living well means to them.

Reflective practice

A process to:

  • reflect on previous practice

  • talk about why they made the decisions they made, and why they acted or behaved in particular ways

  • talk about their emotional responses to their actions and the actions of others

  • engage in continuous learning.

Reflective practice may also provide insight into personal values and beliefs, and help understand how these influence action and decision making.

Safeguarding

The collective responsibility and process to protect the health, wellbeing and human rights of people at risk, enabling them to live safely, free from harm, abuse and neglect. See also the Think Local, Act Personal's Care and Support Jargon Buster definition for safeguarding.

Safeguarding Adults Board

A statutory multi-agency group set up by a local authority made up of different professionals from a local authority, the NHS and police to prevent abuse or neglect of adults who have care and support needs, and to make sure that action is taken if abuse occurs. See also the Think Local, Act Personal's Care and Support Jargon Buster definition for Safeguarding Adults Board.

Safeguarding Adults Review

A statutory multi-agency learning process arranged by a Safeguarding Adults Board that reviews cases if:

  • there is reasonable cause for concern that partner agencies could have worked more effectively to protect an adult and

  • serious abuse or neglect is known or suspected and

  • certain conditions are met, in line with section 44 of the Care Act 2014 and related statutory guidance.

Severe and multiple disadvantage

Multiple and overlapping disadvantages that are often persistent and interrelated and affect a person's life. These disadvantages include the experience of homelessness, harmful drug or alcohol use, criminal justice involvement, poor mental health, and the experience of domestic violence and abuse. People experiencing severe and multiple disadvantage have often experienced underlying adverse childhood experiences, poverty, psychological trauma, stigma and discrimination. People with these experiences may have had sporadic and inconsistent contact with services or been serially excluded from services. People who experience severe and multiple disadvantage tend to have much poorer physical and mental health, have higher social care needs, and die at a much younger age than people without severe and multiple disadvantage.

Social care staff

People working in social services and social care providing practical and emotional support to improve people's wellbeing and quality of life. This includes both local authority social workers with legal responsibilities to assess and protect people at risk of harm as well as frontline social care practitioners that may work in residential care, hostels and homelessness services in either the public sector or voluntary and charity sector.

Social determinants of health

Social factors and wider determinants that influence health and wellbeing. These include circumstances in which people are born, grow up, live, work, and age, and the social and economic policies and systems, political agendas, social norms, environmental factors and other wider forces.

Strengths-based approaches

Sometimes called assets-based approaches. These involve the person who uses services and the practitioners who support them working together to achieve the person's intended outcomes, in a way that draws on the person's strengths. The quality of the relationship between those providing support and those being supported is particularly important, as are the skills and experience that the person using support brings to the process (see Social Care Institute for Excellence's Care Act guidance on strengths-based approaches). See also NICE's quick guide on evidence for strengths and asset-based outcomes.

Trauma-informed care

An approach to planning and providing services that involves understanding, recognising and responding to the effects of all types of trauma. It emphasises physical, relational and emotional safety, and helps survivors of trauma to rebuild narratives of connection, control and empowerment. See also psychologically informed environment.

Wraparound health and social care support

A multidisciplinary team-based collaborative approach to support the person experiencing homelessness holistically, taking into consideration their individual needs, including physical and mental health needs, drug and alcohol treatment needs, care and social needs, and practical needs, in addition to their housing needs.