Lancashire Changing Futures - The Model of Care

The aim of this document is to provide a Lancashire focused evidence based whole system approach to supporting individuals and communities experiencing multiple disadvantage. Individuals experiencing multiple disadvantage, staff working in Lancashire support services, and the wider population regardless of profession or position will also benefit. In line with previous Models of Care Service Frameworks, the Lancashire Model has 4 tiers (with an extra focus on additional primary prevention and secondary prevention (at Tier 1).

Prevention Trauma Informed Practice

 

Family Hubs

Community

T1:

Lancashire Adults Experiencing MD and Community Responses (Low Risk Indicators)

Intervention

T2:

Lancashire Adults Experiencing MD and Brief Intervention Needed (Medium Risk Indicators)

Specialist:

T3:

Lancashire Adults Experiencing MD and Specialist/Statutory Intervention Needed (Medium/High Risk Indicators) 

Intensive

T4:

Lancashire Adults Experiencing MD and Intensive/Statutory Intervention Needed (High Risk Indicators)

Prevention here is defined as population level interventions that address the root causes of multiple disadvantage Tier 1 Services work with a wide range of adults and will from time to time encounter adults experiencing multiple disadvantage characteristics Tier 2 Services work with a wide range of adults including adults experiencing multiple disadvantage characteristics Tier 3 Services are aimed at adults experiencing multiple disadvantage characteristics who present with complex needs and medium risk factors Tier 4 Services are residential for individuals with a high level of presenting need and risk factors
Examples: Examples: Examples: Examples: Examples:

Trauma Informed Lancashire

Public Health Campaigns

Family Support Hubs (prevention work)

Schools

Colleges

The role of Tier 1 Services in this context includes the provision of their own services, and helping people access help.

These are local services, such as:

Primary health care services like GPs, Dentists and Pharmacy

Community Police

Soup Kitchens

Semi-structured support to a specific group, typically brief interventions and access via referral (self or professional) to a wide range of support services:

Department for work and pensions

Housing options

Hostels/temporary accommodation

Community Offender Managers (HMPPS)/IOM

Mental Health Initial Response Service (IRS)

Services in this tier offer longer term specialist and targeted support via assessment and care planning processes.

Lived Experience Navigators/Peer Workers

Specialist Community Substance Misuse Services

Adult Social Care

Specialist Mental Health Services (Primary Intermediate Mental Health Services/Secondary Community MH Services)

Domestic Violence Services

Statutory Services

All of these should be equal partners in a multiple disadvantage service

Specialist services in this tier include:

Inpatient drug and alcohol detoxification or stabilisation services

Drug and alcohol residential rehabilitation units

Residential drug crisis intervention centres

In-patient mental health services

Police custody

Prisons

 

This list is not exhaustive but serves to describe the services at each tier likely to be in contact with or working with people who are experiencing multiple disadvantage at that time.  Through co-production any area can identify its own stakeholders at each tier. 

Viewing a support system in tiers can assist with commissioning such programmes, in particular with workforce planning and capacity planning. Immediate access to Substance Misuse Services, Mental Health Support Services, Housing Services, Domestic Violence Support Services proved effective in the delivery model for Changing Futures. As the pyramid shows, ascending up the tiers is more specialist, which inevitably needs resourcing and investment.

With improved and trauma informed screening or signposting, it is envisaged that more people experiencing multiple disadvantage will find the help they need earlier and so engage more fully