What can service providers do to improve access ... - The PATH project

Discussion What can service providers do to
improve access to services for people
with multiple and complex needs?
4 discussion
This chapter describes the
limitations of the evidence
base informing the review and
summarises the key themes
emerging from the review.
4.1 gaPs in the evidence
The amount of evidence around services for people with
multiple and complex needs varies according to the type of
need/combination of needs considered. The authors recognise
that this review could not be comprehensive and there may
well be literature that wasn’t identified during the review.
While there is a considerable amount of evidence around
good practice with groups of people such as the homeless,
offenders and substance misusers, there appear to be gaps in
the evidence for specific groups and combinations of needs.
For example, there was limited or no evidence relating to
specific areas such as: older people with complex needs;
lesbian, gay, bisexual and transgender people with complex
needs; recent immigrants with complex needs; those with
literacy difficulties among their complex needs; victims of
domestic abuse with multiple needs; and people in rural areas
with multiple needs.
4.2 quaLitY of evidence found
As discussed in section 3.1, a large proportion of the evidence
found in the review represented the general views of service
providers on what constitutes good practice, as opposed to
evidence from formal evaluations. Much of what is described
in this review, therefore, represents ‘expert opinion’. Also of
note, where evaluations were undertaken, the length of follow
up was often limited. The timing of the evaluations was an
issue with the majority being short term follow up studies.
While in most instances this was because the intervention
had only been running for a short period (usually around one
year), there is a need for long term follow up of interventions
to identify if initial results are sustained.
4.3 KeY themes and common issues
Despite the limitations in the evidence base, several key
themes emerged and a number of factors that promote
positive engagement and outcomes were highlighted as
good practice across the different groups of people and
combinations of needs.
A large number of issues underpinning successful practice
involve treating the client as an individual. Whether this is a
holistic approach from services to the client’s needs; helping
them with practical and emotional as well as health problems;
providing support to the level required by the client; and/or
recognition of the need to build self esteem and confidence
in the move to independence from services. Link workers
providing individual support to clients to the level required by
the client has been a successful intervention across a range
of multiple needs.
The nature of those with the most complex problems
creates the need to recognise that some people are more
difficult to help and require a high level of support, sometimes
long term support. For some, merely maintaining engagement
with a service may be considered a success. For those
with complex needs who are not ready to get involved with
services, support with other issues can be offered until they
are ready.
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