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As the social care system ‐ and potentially the health care system and other public services ‐ move increasingly towards a model of personalised support, questions arise about whether and how it can work for people with multiple and complex needs. The evidence is that it is possible to achieve this, and that the outcomes and quality of life can be dramatically improved, but many councils and their partners have yet to move into this demanding activity, and face considerable obstacles in the form of conventional approaches to policy and practice if and when they do. This article draws on the findings of a special study undertaken for the Commission for Social Care Inspection. Alongside some of the difficulties of personalising support for people with multiple and complex needs are inspirational stories of innovative developments which have transformed the lives of people and their carers.

The purpose of this paper is to holistically explore the information needs of socioeconomically disadvantaged young first-time mothers and associated issues of complexity.

This paper used survey and semi-structured field interviews with 39 young mothers (aged 15–23) from UK areas of multiple deprivations.

Participants reported multiple and complex needs spanning interrelated topics of parenting, poverty and personal development. In the majority of instances, participants were either unsure of their ability to meet their needs or needed help with needs, and several described situations of considerable anxiety and stress. Multiplicity is identified and conceptualised as an important factor contributing to complexity, including three component elements: simultaneous occurrence of needs (concurrency), relationships between needs (interconnectivity) and evolving needs (fluidity). In various combinations, these elements influenced a mother's actions and/or ability to selectively attend to needs, with multiple needs often competing for attention, and compounding issues of cognitive load and affect.

This study draws attention to multiplicity of needs as an understudied topic within human information behaviour and calls for further research into how people recognise and attend to complex needs and influencing factors.

This study raises important questions regarding how we approach complexity of information needs in our design and delivery of information systems and services.

Evidences disadvantaged young mothers to have more extensive and complex information needs than previously understood, and identifies and conceptualised multiplicity as an important factor contributing to the complexity of information needs during major life transitions such as motherhood.

This study aims to understand how staff in homelessness services conceptualise readiness for change in the individuals they support and how this informs their decision-making in practice.

A qualitative design was used. Ten staff members participated in semi-structured interviews. Data were examined through inductive–deductive thematic analysis, using a social constructivist epistemological lens.

Five main themes were constructed: “multiple complex needs mean multiple complex changes”, “talk versus behaviour”, “change is not a linear trajectory”, “the role of consistent boundaried relationships” and “change is not solely within the individual’s control”.

This research challenges existing notions of “readiness for change” as located within individuals and a prerequisite for using support from services. It has implications for staff and services, particularly those which are time-limited and address only single problems; service users may not be ready for some changes, but it should not be assumed they are not ready for change in other areas of their life. The offer of supportive relationships may precede and contribute to readiness for positive changes. Support should be offered based not only an individual’s intra-psychic readiness for change but also how the system might actively work to promote hope that change can be achieved and maintained.

To the best of the authors’ knowledge, this is the first study to explore staff members’ conceptualisations of readiness to change in relation to individuals with multiple complex needs and how this might influence practice.

People with a dual diagnosis or other multiple and complex needs often require support from a range of services and agencies. Social policy has focused on achieving an integrated response from practitioners; however, service responses to this group frequently remain fragmented. Practitioners supporting these clients are likely to need knowledge drawn from multiple disciplines and awareness of complex and changing services. Research suggests the value of professional networks for knowledge transfer. The purpose of this paper is to describe one's approach to supporting integration and facilitating knowledge exchange through the development of “communities of practice”.

The paper describes a “communities of practice” model, as implemented by researchers from King's College London and Revolving Doors Agency through their Communities of Practice Development Programme. It outlines potential benefits of the model – identified through focus groups and survey responses of members, facilitator interviews and the authors’ observations as community of practice members. Finally, it discusses challenges and limitations of this approach.

Communities of practice are able to provide a forum for peer support and supervision to mediate feelings of role or service isolation and to sustain practitioner motivation. They can also facilitate inter-disciplinary and inter-agency knowledge transfer. However, the limited resources available to these local networks act as a barrier to developing their capacity to improve responses to people with multiple and complex needs.

The paper uses a case study approach to outline the potential for a “communities of practice” approach to be used to improve responses to people with multiple and complex needs.

This paper reports on a pilot project that helps women offenders and other women with multiple needs to access mental health care. The paper aims to increase understanding of the mental health needs of these women and the barriers they face in accessing and sustaining engagement with appropriate care.

Key principles and early findings are presented from the partnership project based in Anawim Women's Centre, in which a mental health nurse (MHN) is seconded to the centre one day a week. These are presented in light of research relating to the mental health needs of vulnerable women.

Early findings suggest mental health needs are largely trauma‐based and co‐occurring substance misuse problems are common. The MHN negotiated a pathway into secondary care with community mental health team managers but concerns continue about the ability of primary care services to meet the complex needs of these women. Principles for working with this group include: provision in a women‐only space; a focus on engagement; flexibility; holistic support and empowering women and voluntary sector staff.

Findings are based on eight months of one pilot project in which 22 women were seen.

Practical implications are outlined for commissioners and service managers of mental health care services for vulnerable women.

Research and experience suggest that women with multiple problems can struggle to engage with traditionally structured services and fail to access the holistic support they need. This paper increases understanding of this problem and suggests how these women might be better supported.

The purpose of this paper is to examine music as a therapy for complex needs and offending behaviour.

This study utilised the rapid evidence assessment (REA) approach to collect and assess the current data pertaining to music as a therapy for complex needs and offending behaviour. Within the REA this study used a thematic analysis as the analytical framework to manage and explore the wealth of data collected during the REA.

The results of this study are presented in two parts – first, the application of music as a therapy for complex needs and second, music as a therapy for offending behaviour. These two sections explore music therapy as an effective intervention method for offending behaviour and/or complex needs. Psychopathy as a complex need is a subsidiary theme that is also investigated within this section.

To present music as a therapy as an effective method of therapy and intervention for those with offending behaviour and/or complex needs, thus, leading to further research in the field.

To incorporate music therapy into working with offending behaviour; to incorporate music therapy into interventions for those with complex needs, such as psychopaths; to recognise a need for developing innovative approaches/methods to address gaps in treatment; and to recognise music therapy’s potential as a programme utilised alongside cognitive-behavioural therapy.

There has been a significant amount of academic attention given to researching music as an effective therapy for select groups such as those with autism, anxiety, dementia and depression. The scope of this attention has extended to examine the link between music, cognition and emotion. The limitation of this work is the lack of research that has focussed on music as a therapy as an intervention for complex needs and offending behaviour, to which this study will begin to redress.

The purpose of this paper is to investigate how users with particularly complex needs including intellectual disability (ID) reacted to the changes and restrictions during the COVID-19 pandemic in 2020.

As few studies of changes during the pandemic include users with ID and multiple, complex needs, the authors adopted a qualitative approach, using a semistructured interview guide. Ten participants were leading ID nurses in residential facilities in community settings. The interviews were taped, transcribed and analyzed using a thematic analysis.

The thematic analysis generated six main themes, including both user and staff perspectives: daily routines, activities, facilitation of tasks and well-being, from the users perspectives, and use of working hours and positive staff experiences, from the staff perspectives.

Ten residential facilities constituted a convenience sample of services for users with multiple, complex needs. Thus, the authors do not know whether the findings are representative. Further research should include user opinions based on the findings of this study.

The users represented in this study appeared to experience less stress during the pandemic, contrary to the expectations of professional caregivers. The findings indicated more well-being among users. It was noted that receiving services at home, largely flexible schedules, staying in bed a little longer in the morning and avoiding stressful situations, such as travelling in minibuses, was appreciated by the users.

Daily schedules with activities throughout the day should be considered for users as represented in this study. Stressful events should also be considered.

The knowledge about pandemic experiences of users with ID and additional complex conditions and hence comprehensive needs is still sparse. This study may add to this knowledge.

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.

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.

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.

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.

The shift in policy discourse towards individualism is affecting service provision and access, which has become increasingly conditioned on individual agency and the “deservingness” of the recipient. Gendered and intersectional experiences of homelessness and excluded populations less likely to be living on the streets remain overlooked and unaddressed. This study thus aims to uncover what drives “invisibility” in services for women experiencing multiple disadvantage and the gendered constraints the women are facing when exiting and navigating multiple disadvantage.

The paper draws on in-depth interviews with women who face severe and multiple disadvantage and their support staff. Data is also gathered through survey data and observations with a wide range of frontline service providers, as well as support notes and numerical progress data recorded by one of the service providers.

Contradicting the common assumption that people act as rational actors in their interaction with services, the author found that women’s decisions to (dis)engage may be blinded by forces of multiple disadvantage and mistrust. These are often developed as a result of systemic and gendered constraints that limit women’s capabilities and exercise of choice. Barriers in service access often amplified the personal barriers they were facing and reinforced women’s decisions to not engage with services.

The author hopes that this paper sheds light on the particular set of barriers women with multiple disadvantage face, which will be vital to reach women who face severe disadvantage and provide more effective policies, care and support.

This study gives voice to a particular hidden population: women with multiple disadvantage. It contributes to existing frameworks on agency and choice by understanding gendered barriers behind service engagement and how services themselves may be contributing to women’s invisibility.

This paper aims to explore the barriers to accessing mental health support for people experiencing multiple disadvantage along with some potential solutions for attempting to overcome these. It draws on evidence and learning from 12 voluntary sector-led partnerships in England funded by the National Lottery Community Fund’s Fulfilling Lives programme.

Qualitative research was undertaken with frontline staff, senior leaders, volunteers, beneficiaries and stakeholders from Fulfilling Lives partnerships. This comprised focus groups (21 participants) and individual face-to-face interviews (41 participants), both of which explored barriers and local solutions to accessing statutory mental health services. Following a thematic analysis of transcripts, research participants and stakeholders were invited to a face-to-face workshop to review and validate emerging findings (34 participants).

People experiencing multiple disadvantage face significant barriers in accessing support for their mental health. These include a complex system that is difficult to navigate, long waiting lists, high eligibility thresholds and models of support that lack flexibility. Fulfilling Lives partnerships have had the funding and the flexibility to trial different approaches. Promising solutions to barriers include the use of navigators, person-centred support and multi-agency networks and training. However, overcoming systemic barriers remains the most difficult challenge.

Fulfilling Lives was a rare example of substantial and long-term (eight years) funding to work with people experiencing multiple disadvantage. This provided a unique opportunity to try different approaches and gather learning. The programme evaluation provides insights into the experiences of people facing multiple disadvantage and those who support them and offers evidence-based suggestions for policy and practice.