To read this content please select one of the options below:

Multiple exclusion homelessness: is simplicity the answer to this complexity?

Robin Miller (Health Services Management Centre, University of Brirmingham, Birmingham, UK)
Steve Appleton (Contact Consulting, Witney, UK)

Journal of Integrated Care

ISSN: 1476-9018

Article publication date: 16 February 2015




The purpose of this paper is to explore integration and complexity through the evaluation of a case study service which supports multiply excluded homeless people.


A mixed methods theory based evaluation. Data gathering included semi-structured interviews with external stakeholders, analysis of referral and outcome data, focus groups with frontline staff members and managers, and interviews with people living in the service.


The service was highly rated by its stakeholders due to its ability to meet the immediate needs of many individuals and to facilitate access and engagement with community and specialist resources. However, not every individual responded to the support that was an offer, and a number were unable to access the service due to the nature of their needs or a lack of capacity in the service. Whilst the service was able to engage community and specialist services this often appeared to be within the parameters set by these services rather than flexibly around the needs of the individual.

Research limitations/implications

The research is based in one case study service and findings may not be transferable to different local contexts and providers. However, the findings are consistent with previous studies.

Practical implications

It is possible for commissioners to intervene in the complexities that multiply excluded homeless people experiences through the introduction of a new service. However, this is unlikely to address all of the gaps and fragmentation that people in these circumstances face. It is therefore important that partners are sensitive to such limitations and have a shared willingness to respond to continuing gaps and shortfalls.

Social implications

Despite specific national policies people continue to experience multiple exclusion homelessness which suggest that more still needs to be done to prevent people from this extremely disadvantaged social circumstance. Whilst specialist services can provide excellent support the response is still fragmented for some people meaning that work to better integrate their responses must continue.


The paper contributes to the evidence base of support models for multiple excluded homeless people and the factors that can enable a housing support service to respond to such needs. It also provides comment on the relevance of the concept of complex adaptive systems to the study of integration.



This evaluation was funded by Midland Heart Housing Association. The authors would like to acknowledge the support of the customers, staff and stakeholders of the Complex Needs Service. Particular thanks go to Kevin Wedge and Mel West. The views expressed in this publication are those of the authors and not necessarily those of Midland Heart.


Miller, R. and Appleton, S. (2015), "Multiple exclusion homelessness: is simplicity the answer to this complexity?", Journal of Integrated Care, Vol. 23 No. 1, pp. 23-34.



Emerald Group Publishing Limited

Copyright © 2015, Emerald Group Publishing Limited

Related articles