Severe and multiple disadvantage (SMD)
What do the people of Stockton-on-Tees need?
Barriers to support
People experiencing SMD face significant barriers in accessing the support that they need to improve their lives, both at an individual and a system level.
Individual-level barriers
Understanding the pathways that lead to complex lives is crucial for developing effective, non-judgmental support models. A qualitative study by Sandu (2021) found that young people experiencing SMD often had poor early relationships, leading to deep-seated shame and distrust of professionals. Many described themselves using highly negative terms and developed protective behaviours that distanced them from support, particularly where the support offered lacks consistency and persistence. This highlights that disengagement from support is not a personal choice, but a survival response to trauma.
System-level barriers
It is well-documented that system level factors contribute to poor outcomes for those experiencing SMD (8, 9). The responsibility is usually placed on individuals to navigate a complex and disjointed system which requires them to:
- repeat their story
- convey the right need to the right professional
- seek help for each singular factor affecting their lives
This leads to care which is un-coordinated, involves several professionals from several services, and demands engagement from the individual in a variety of different interventions at the same time.
Improving support
Evidence-based principles underpinning good practice
Evidence supports approaches that are:
- person-centred - support should be person-led (for example, directed by the person receiving the support) and tailored to match the person's specific needs and strengths
- relational - consistent and trusting relationships are the foundation for providing effective support (these often take time and persistence to build, requiring approaches that are person-led, open-ended, long-term, non-judgmental, and utilise small caseloads)
- trauma-informed - support should be provided through a trauma lens, recognising that people may have experienced trauma which can impact how they feel, think and behave, and responding accordingly
- flexible - offering support in a flexible way, and encouraging other services to work more flexibly too, enables people to access support that might not otherwise be available or accessible to them
- peer support-based - support from peers is consistently identified as helpful in relation to different models and approaches, particularly in the way that they support the development of trusting relationships but also through the provision of a positive role model
Examples of good practice
The best approach to implementing these principles in practice will always be shaped by the local context. Whilst no single model fits all, various examples of good practice exist. For example, Changing Futures is a £98.1 million programme which gave funding to 15 areas across England to improve outcomes for people experiencing multiple disadvantage, with various different approaches trialled. Evaluation of the programme offers valuable transferrable learning.
