Safety and Wellbeing Assessment Toolkit (Prototype)

Safety and wellbeing assessment toolkit

A strengths-based approach to assessing risk with people experiencing multiple exclusion homelessness

Disclaimer and licence for use

This Safety and Wellbeing Assessment Toolkit proforma (“the Tool”) is provided free of charge for use by practitioners, services, and organisations working with people experiencing multiple exclusion homelessness or disadvantage. The Tool is intended as a structured aid to professional judgement, not as a substituteforit.Responsibilityfortheassessmentofriskandthe actionstakeninresponserestssolelywiththepractitioner(s)and organisation(s) using the Tool.

The authors and contributors to the Tool accept no liability for any loss, harm, injury, or negative outcome, whether direct or indirect, arising from its use, misuse, or reliance upon it. Use of the Tool is entirely at the discretion of the user, who must ensure that it is applied in a manner consistent with their legal duties, safeguarding responsibilities, and organisational policies.

The Tool may be used freely in its original form, but it must not be copied, distributed, or adapted for the purpose of commercial gainwithout the prior writtenpermissionofthe authors. Byusing the Tool, you accept these conditions and acknowledge that the authors and contributors cannot be held legally responsible or liable in any way for the outcomes of its application.

Acknowledgements

Expert Citizens CIC thanks lived experience experts, colleagues, partners, and academic researchers for their knowledge, insights, and commitment that were vital in shaping this toolkit through a strengths-based lens

Lead author

Andy Meakin BA(HONS)MBA Director, Expert Citizens CIC

Key contributors Here Here Here Here

Safety and wellbeing assessment

A strengths-based toolkit for assessing risk in complex cases

Introduction to the toolkit

This toolkit has been created to support practitioners working with people experiencing multiple exclusion homelessness or other complex lives. It is deliberately strengths-based, moving away from deficit-focused or problem-led assessments, and instead encouraging conversations that highlight a person’s voice, aspirations, and protective factors. The assessment is designed to be used collaboratively, recognising that people bring with them skills, qualities, and relationships that can be mobilised to improve safety and wellbeing.

The aim is to create safe, inclusive ways of working together by building on what is already working well. Hazards and challenges are explored openly and without blame, with a focus on finding practical solutions Exclusion is only ever considered as a last resort, and only if all reasonable safe systems of work have been explored and cannot be achieved. The outcome should be a shared plan that supports the person’s safety, wellbeing, and meaningful participation.

Key principles

• Strengths-focused – The process emphasises existing resilience, coping strategies, and aspirations, ensuring that planning builds on what is already working well.

• Collaborative – The person’s voice and choices guide the assessment, and practitioners are encouraged to co-produce plans that feel meaningful and achievable.

• Holistic – Risks are explored alongside protective factors, support networks, and resources, ensuring that the picture of safety and wellbeing is balanced and inclusive.

• Contextual – Risk is considered not just at an individual level, but also within the environments, relationships, and systems that shape people’s lives.

• Professional judgement – The toolkit is an aid to reflection and decision-making. It does not replace professional judgement, statutory duties, or organisational procedures.

Intended use

This document is designed for use in complex cases, such as those identified by a Local Authority as being in the priority needs group or where a person is being managed or considered for referral through a Team Around the Adult (TAA) process.

It is most suited to practitioners who typically carry low caseloads of around 6–12 people, where there is time to complete a more detailed, reflective, and co-produced assessment. It is not intended for support workers carrying higher caseloads, where the very comprehensive nature of the document may not be practical in day-to-day use. Instead it is for use where there is a high degree of complexity, uncertainty, or disagreement between practitioners or professionals about the individual’s situation and as a result they may face exclusion from one or more key services increasing risk to the individual or community

Because it integrates guidance and reflective prompts throughout, the toolkit may also have value as a training aid in strengths-based thinking and approaches to assessing

risk. It can help practitioners to deepen their practice, learn to balance risks with protective factors, and strengthen confidence in working with uncertainty.

This tool is intended to inform practice, not replace it. It does not override professional judgement, statutory responsibilities, or any procedures required by law, policy, or organisational guidance. Rather, it is provided as a structured framework to support highquality, person-centred conversations about safety and wellbeing, and to ensure that these conversations are informed by compassion, reflection, and collaboration.

Using this toolkit in practice

Working together wherever possible

Ideally, this toolkit should be completed in partnership with the person at the centre of the assessment. The process is most effective when it is a conversation, not a form-filling exercise. Practitioners are encouraged to explore the questions in a flexible, sensitive way, following the person’s pace and priorities. The examples and “things to consider” prompts can be used to guide discussion, build trust, and help the person recognise their own strengths and protective factors

When collaboration is difficult

Sometimes a person may be unwilling or unable to engage in the full assessment. This may be due to fear, mistrust, trauma, or simply feeling overwhelmed. In these circumstances, practitioners could still use the toolkit to record what they know, drawing on professional observations, information from other agencies, and safeguarding concerns. The emphasis should remain on respecting the person’s autonomy while ensuring that risks are not minimised or overlooked. Even if the document cannot be co-produced in its entirety, it can still support reflective practice, provide a structured record of concerns, and inform multiagency discussions.

A living document

This toolkit is a developing prototype. We know it will not cover every situation and we hope that it will continue to evolve as people use it in their practice and professional development. Your feedback and experiences are important in helping us refine and strengthen it over time. Please share what works well, what feels challenging, and what could be improved.

It is important to remember that this toolkit is a guide, not a rulebook. It is designed to support professional reflection and decision-making, not to replace your own judgement, statutory responsibilities, or organisational procedures. Practitioners and organisations remain responsible for how the tool is applied in each case, and it should always be used in line with local safeguarding processes, policies, and legal duties.

If you have any feedback, please contact: info@expertcitizens.org.uk

Section 1: Your name and contact details

This section gathers the basic information needed to identify you in the assessment, ensure your voice is central, and record who supported you in the process. It also captures demographic information relevant to equality, diversity, and inclusion, so that we can better understand your needs, experiences, and rights Notes for practitioners are on the following page.

* Compulsory fields, all other fields are optional and context dependent

Practitioner leading this assessment details

Full name

Job title*

Organisation*

Telephone number

Email address

Dates of assessment

This is a detailed assessment where it’s likely that the picture will build over time.

Start date*

End date

Your details

Full name*

Preferred name

Date of birth*

Gender identity

Pronouns

Sexual orientation

Ethnic identity

Disability status

Religion or belief

First language

Nationality

Immigration status

Address

Key rough sleeping locations

Telephone number

Email address

Culturally competent and trauma-informed practice

This section gathers sensitive and personal information about identity, culture, and background. How these questions are asked, and how the responses are used, matters greatly. Practitioners should approach this part of the assessment with cultural humility, awareness of trauma, and an understanding of how overlapping identity factors can shape experience.

Culturally competent questioning

• Ask open questions in a respectful, non-assumptive way.

• Avoid imposing labels or categories always use the person’s own language to describe their identity.

• Be mindful of cultural differences in communication, disclosure, and expectations of services.

• Remember that identity factors can be protective as well as risk-related (e.g., cultural belonging or faith connections may strengthen resilience).

Trauma-informed disclosure

• Recognise that being asked about sensitive characteristics may feel intrusive, especially where trust with services has been broken in the past.

• Offer choice make clear that answering is optional, and explain why you are asking.

• Allow space for silence and don’t push for disclosure; respect the person’s boundaries.

• Acknowledge the courage it can take to share personal information.

Responding to intersectional disadvantage

• People may face overlapping forms of discrimination or disadvantage, for example linked to race, gender, disability, sexuality, and poverty.

• Intersectional disadvantage can intensify barriers to accessing services, increase exposure to risk, and shape the types of support that feel safe or unsafe.

• Be alert to the ways that different aspects of identity interact, rather than viewing each in isolation.

Further resources

This toolkit cannot cover the full depth of equality, diversity, and inclusion practice. Practitioners are encouraged to draw on external resources, including: Equality and Human Rights Commission

https://www.equalityhumanrights.com/en

Social Care Institute for Excellence (SCIE)

https://www.scie.org.uk/strengths-based-approaches/

Homeless Link – Equality, diversity and inclusion resources

https://homeless.org.uk/knowledge-hub/bringing-the-equality-act-to-life/

Section 2: Your aspirations and values

This section begins by exploring what matters most to you and the direction you want your life to take. We focus on your hopes, priorities, and sources of motivation rather than on problems. By grounding the assessment in your values and aspirations, we create a positive foundation for trust, collaboration, and meaningful planning. This ensures that everything which follows is guided by your sense of purpose and what you want to achieve

What matters most to you right now?

This question helps us understand what is most important to you in this moment. It could be something big, like finding a safe place to live, or something smaller, like having a hot meal or feeling secure for the night. Starting here means we can focus on what really matters to you, rather than making assumptions.

Things to consider

Listen for urgent needs such as safety, food, or shelter. Notice if responses highlight immediate risks or safeguarding concerns. Ask gentle prompts about what would make today or tonight easier. Be sensitive to emotional cues that reveal underlying fears or priorities beyond the basics.

Example 1

Right now, it’s finding somewhere safe to sleep tonight. I don’t care if it’s perfect, just somewhere I’m not freezing, getting moved on, or worried about fights.

Example 2

Right now, I just want to feel safe when I sleep. Not having to stay alert all night or worry about men hassling me would mean everything.

Example 3

Spending time with my children each week matters most to me. It gives me purpose, helps me stay motivated, and reminds me why making positive changes is important to me.

What are your goals or hopes for the near future?

This is about looking a little further ahead and thinking about the changes you would like to see in your life. Your hopes might be practical, emotional, or about relationships. By exploring your goals, we can make sure any support you receive is moving in the direction you want to go.

Things to consider

Encourage the person to think about short-term changes that feel realistic to them. Goals may be practical (housing, health) or relational (family, connection). Probe for what motivates these hopes. Watch for barriers that may need support, such as discrimination, debt, or mental health challenges.

Example 1

I’d like a stable place indoors, even just a room. Somewhere I can lock the door, keep my stuff safe, and stop feeling like I’m surviving minute-to-minute.

Example 2

My main hope is to get a bed in women-only accommodation. Somewhere private where I can wash, keep my clothes safe, and start feeling human again.

Example 3

My goal is to secure stable accommodation and start a training course in catering. I want to build a routine that gives me independence and future opportunities.

What keeps you going when life is challenging?

Here, the focus is on what gives you strength when things are hard. It might be people you care about, activities that help you cope, or reminders of how far you have come. Naming these helps you recognise the inner resources you already draw upon and makes them a stronger part of your safety and wellbeing plan.

Things to consider

Explore coping mechanisms, both positive and harmful. Listen for references to self-harm, substance use, or unsafe strategies alongside strengths. Ask about sources of resilience like people, activities, or beliefs. Notice when someone minimises their strengths, and affirm their achievements or coping skills to build confidence.

Example 1

I tell myself I’ve made it through worse. Music in my headphones helps block the noise. Thinking about reconnecting with my kids one day pushes me on.

Example 2

I tell myself I’ve survived this far. Talking to other women at the centre helps me keep strong. Thinking about seeing my daughter again keeps me moving.

Example 3

Remembering how far I’ve come keeps me strong. I also find hope in encouragement from close friends, my creative hobbies, and knowing my resilience has carried me through before.

Section 3: Your strengths and protective factors

This section builds on the foundations of your aspirations and values by recognising the strengths and supports you already have. We explore your skills, qualities, achievements, and the people and resources around you. By identifying protective factors, we highlight what is already working well and can be built upon to increase your safety and wellbeing. This creates confidence, reinforces resilience, and ensures that future planning is grounded in your existing assets.

What are your personal skills, qualities, and achievements?

This question is about recognising what you are good at and the progress you have already made. Even in very tough times, you will have shown resilience, problem-solving, or personal growth. By naming these, you can see the strengths you bring with you, and we can build on them together.

Things to consider

Draw attention to survival skills, creativity, or resilience that might otherwise be overlooked. Explore achievements however small, as they show persistence. Affirm strengths openly. Be alert for hidden indicators of self-worth issues or self-criticism. Encourage examples from past experiences that demonstrate capability and progress.

Example 1

I know how to survive with nothing. I can talk my way out of trouble most times. I managed to quit spice for three months before.

Example 2

I’m resourceful. I can stretch little food to last, and I know how to keep myself alert. Staying off monkey dust and spice has been a big achievement.

Example 3

I’m a good listener, dependable, and calm under pressure. I’ve successfully managed to stay substance-free for six months and recently completed a volunteering placement that boosted my confidence.

What supportive relationships and social networks do you have?

Here we explore the people you trust and the networks that give you support. These might be friends, family, or even people you meet through services or community groups. These connections can be important sources of safety and encouragement, and recognising them makes it easier to strengthen and use them.

Things to consider

Listen for safe and unsafe relationships. Explore who the person turns to in good and bad times. Be sensitive to fractured family ties, which may carry emotional weight. Ask about both formal and informal networks. Note if isolation is present, as this increases risk.

Example 1

There’s a couple of lads I trust on the street who watch my back. The soup kitchen volunteers know me, and sometimes that makes me feel seen.

Example 2

There’s another woman I stick with at night because it feels safer. The day centre staff know me now, and I feel they usually listen without judgement.

Example 3

I have a strong relationship with my sister, who checks in daily. I also keep in touch with neighbours who encourage me and my local recovery community.

What are your positive coping strategies?

Everyone has ways of dealing with stress or challenges. This question looks at the things you do that help you cope in a safe or constructive way. By noticing what already helps, you can use these strategies more often and share them with others who support you.

Things to consider

Encourage discussion of both healthy and unhealthy coping strategies. Positive ones may include walking, writing, or talking; unhealthy may involve substances or avoidance. Validate any constructive approaches. Explore what has worked in the past. Be mindful of opportunities to build on existing safe strategies.

Example 1

When it’s too much, I walk. Keeping moving calms me. Sometimes I sit by the canal with a can and just breathe until things ease off.

Example 2

When I’m stressed, I walk until I’m calmer. I write things down in a notebook. Sometimes I sit in the café just to feel normal for an hour.

Example 3

When things feel difficult, I go for long walks, listen to music, or write my feelings down These activities help me process emotions and regain perspective positively.

What are your community, cultural, or faith connections?

This is about belonging and connection. It could be a community group, a cultural tradition or regular routine, or a place of faith that gives you comfort or identity. Recognising these links can remind you of where you feel accepted and supported, and help us strengthen your sense of community.

Things to consider

Explore places or groups that give belonging or identity. Listen for sources of pride, safety, or acceptance. Be sensitive to exclusion experiences that may limit trust. Ask open questions about traditions, spirituality, or groups they value. Consider whether barriers prevent them accessing these connections more often.

Example 1

I get food and company at the day centre. There’s always someone to chat with, play games, or just sit in the warm when it’s rough outside.

Example 2

I go to a women’s drop-in every Tuesday. There’s hot food, showers, and people who understand. It’s one of the only places I don’t feel judged.

Example 3

I feel connected to my local community group, where I volunteer weekly. The activities give me belonging, positive relationships, and the chance to contribute to something bigger than myself.

What resources and services do you rely on?

Here we look at the services, groups, or supports that you already use. It might be a food bank, a day centre, a GP, or a support worker. Knowing these helps to see what is already in place, so we can make sure they continue to work well for you and fill any gaps if needed.

Things to consider

Map out key supports already in use. Ask about practical services such as food banks, healthcare, or housing support. Note overreliance on emergency provision, which may indicate unmet need. Explore whether access feels easy, respectful, and safe. Check for any gaps or missed entitlements.

Example 1

I rely on the night shelter when I can get in, the food bank when money’s gone, and outreach workers who bring hot drinks and advice.

Example 2

I rely on the food bank, the women’s outreach van, and the charity shop for warm clothes. The community nurse checks in on me sometimes too.

Example 3

I rely on my housing support worker, my GP for medical advice, and a local food cooperative that provides affordable, healthy meals when finances are stretched.

Section 4: Your current support and resources

This section maps the practical and personal supports in your life. By identifying who you trust, what organisations you work with, and the places or activities that help you feel safe, we build a picture of your support network. Recognising these resources makes it easier to draw on them in difficult times, coordinate support effectively, and avoid duplication or gaps in help.

What family, friends, or peers do you trust?

This question is about the people in your life you feel safe turning to. They may offer emotional support, practical help, or simply be someone you can rely on. Recognising who these trusted people are helps strengthen your support network and gives you more options when things feel difficult.

Things to consider

Probe for trusted relationships that bring safety or reassurance. Listen carefully for experiences of betrayal, abuse, or coercion. Acknowledge when trust is limited, and explore how even one safe connection helps. Be aware of safeguarding risks if unsafe individuals are described as part of support.

Example 1

My mate Jase checks I’m alright most nights. He’ll share food if I’ve got nothing. Apart from him, I don’t really trust many people right now.

Example 2

I don’t speak to my family right now. I trust one friend I met on the street we look out for each other and share what we can.

Example 3

I trust my best friend Mark, who always listens without judgement. My aunt is another safe person I can turn to for advice and emotional reassurance.

What professionals or organisations do you engage with?

Here we focus on the services or professionals you are already in contact with. This might include outreach workers, housing staff, or healthcare teams. Knowing who is already involved can make support more joined-up and prevent you from having to repeat your story.

Things to consider

Ask who feels helpful or unhelpful. Explore frequency and quality of contact. Notice reluctance or mistrust of services, which may signal trauma from past experiences. Be alert for missed opportunities to link with relevant agencies. Listen for gaps in support, especially around health, housing, or safety.

Example 1

I sometimes see the outreach worker on Thursdays. The soup van team know me. I’ve been to the council a few times, but it feels like a battle.

Example 2

I’ve started seeing the women’s outreach worker. I sometimes use the day centre for showers and food. The housing team at the council feels harder to approach.

Example 3

I’m linked with a keyworker at the local recovery service, my GP practice nurse, and a housing charity who support me in managing my tenancy and wellbeing.

What places or activities help you to feel safe or supported?

This is about where you go or what you do that gives you a sense of safety, calm, or connection. It could be a library, a café, or even just walking in a certain place. By noticing these safe spaces and activities, you can make them a more regular part of your life.

Things to consider

Encourage reflection on where the person feels calm or protected. Ask what makes those spaces feel safe. Explore whether access is regular or disrupted. Watch for unsafe places being described as the least risky option. Probe for everyday activities that bring comfort or distraction from stress.

Example 1

The day centre feels safest because I can rest without hassle. I feel calmer sitting in the library when it’s open. Warm spaces help me breathe easier.

Example 2

I feel safer sleeping near the CCTV cameras, even if it’s noisy. The women’s drop-in is the only place I fully relax. Reading borrowed books helps me escape.

Example 3

Spending time at the library helps me feel calm. Attending the local wellbeing café on Fridays gives me connection, and walking in the park reduces stress.

What practical resources do you have?

Here we look at the basic things you can currently count on, such as accommodation, money, food, a mobile phone, clothing, or other belongings. These resources can make a big difference to your safety and wellbeing. Understanding what you already have in place helps us work together to protect or strengthen them.

Things to consider

Explore current stability in housing, income, or possessions. Listen for signs of debt, benefit issues, or precarious living arrangements. Ask how reliable these resources feel and what might threaten them. Safeguarding concerns may emerge if survival relies heavily on unsafe arrangements, like exploitative relationships or illegal work.

Example 1

Right now, I’ve got a sleeping bag, a locker at the centre for my stuff, and some benefits, though it doesn’t stretch far after debts, gear, and essentials.

Example 2

I’ve got a sleeping bag, a small phone, and my benefits card. I keep spare clothes in a backpack. That’s about all I can carry right now.

Example 3

I currently have stable supported accommodation, a weekly income from benefits, and access to Wi-Fi, which helps me manage appointments and stay connected with support networks.

Section 5: Your early warning signs

This section focuses on recognising the signs that show when things might be becoming harder for you. These may be things you notice in yourself or things that others see. Identifying early warning signs is a strength, not a weakness. It means you can take action sooner, and those around you can respond quickly and supportively. This awareness lays the groundwork for your personal safety and support plan.

What signs do you see in yourself that mean you might be struggling?

This question helps you notice the changes in yourself that show when things are getting harder. It might be changes in your mood, behaviour, sleep, alcohol or substance use, or other day-to-day routines. Recognising these signs early can help you take action before things feel overwhelming.

Things to consider

Ask how the person recognises their own decline. Encourage examples of changes in behaviour, sleep, or mood. Listen for signs of self-neglect, suicidal thinking, or increased risk-taking. Affirm that noticing these patterns is a strength. Explore what usually happens next when these signs appear.

Example 1

I stop eating properly, snap at people, and keep moving all night. I can feel myself slipping when I just don’t care if something bad happens anymore.

Example 2

I notice I stop eating, get more jumpy around men, and feel like crying all the time. When I stop washing, I know I’m slipping down.

Example 3

When I’m struggling, I notice I don’t eat properly, lose interest in cooking, and find myself avoiding phone calls or shutting down from conversations with others.

What signs are there that others might notice when you’re struggling?

Sometimes the people around us notice things before we do. This question asks about what others might see when you’re finding things tough. By sharing this, people who care about you can step in with support in the right way and at the right time.

Things to consider

Encourage reflection on how changes may be visible to friends, workers, or peers. Ask how others usually respond. Listen for social withdrawal, conflict, or increased substance use. Notice if the person feels ashamed or embarrassed about being seen as struggling. Reinforce that help-seeking is valid.

Example 1

People probably see me getting more wound up, drinking more, or avoiding everyone. I go quiet, stop joking around, and sometimes disappear from the usual spots.

Example 2

People say I look more withdrawn, don’t speak much, and keep moving spots. I stop laughing with others and sometimes go missing from the drop-ins altogether.

Example 3

Friends often notice I become quieter, stop attending group activities, and withdraw from social contact. They might also notice me looking more tired or distracted than usual.

What situations tend to increase stress or risk for you?

Here we focus on the kinds of circumstances that are most difficult for you. These might be certain places, people, or events that raise your stress or put you at risk. By identifying these situations, you can prepare for them and find ways to reduce their impact.

Things to consider

Ask about triggers in daily life, such as crowds, conflict, or letters from authorities. Notice which situations spark fear, anger, or hopelessness. Be alert for references to unsafe environments, exploitation, or abuse. Explore whether the person avoids or faces these situations, and how support could reduce stress.

Example 1

Big crowds, arguments on the street, and when people try to nick my stuff. Letters about debts or benefits I don’t understand really set me off too.

Example 2

Nights are the worst, especially drunk men hanging around. Arguments in hostels or being told to “move on” by security make me panic. Benefits letters confuse me too.

Example 3

Being around conflict or noisy environments makes me anxious. Unexpected letters about debts or appointments I feel unprepared for can quickly raise my stress and trigger negative thoughts.

Section 6: Your personal safety environment

This section brings everything together into understanding the practical steps that you take or can take to keep you safe when challenges arise. It includes both your own strategies and the involvement of trusted people and professionals. By documenting your environment we can co-produce a clear plan, to ensure that support is ready when you need it most and that you remain central to all key decisions.

What helps you stay safe when things get tough?

This question asks about the strategies you already use to look after yourself when life feels hard. It could be moving to a safer place, talking to someone, or using calming activities. These strategies are important tools that can go into your safety plan.

Things to consider

Encourage the person to describe practical actions they already use. Listen for safe strategies like moving location, self-soothing, or routines. Notice if some strategies carry risk, like substance use. Affirm existing strengths. Ask what makes these strategies work and whether they could be strengthened further.

Example 1

I move to quieter spots if it’s kicking off. Keeping earphones in helps me stay out of trouble. Having a hot drink calms me when I’m spiralling.

Example 2

I try to stick close to well-lit areas and other women if possible. Headphones help block things out. Having hot food and somewhere indoors calms me down.

Example 3

Having a routine, sticking to daily walks, and calling my sister helps me stay grounded. Writing down my thoughts before bed helps me manage stressful days safely.

What people can you contact for urgent help?

Here we identify the people you could reach out to quickly if you felt unsafe or in crisis. It might be friends, family, workers, or services. Having these contacts clear and written down gives you reassurance that help is available when you need it most.

Things to consider

Identify reliable people or services the person trusts in a crisis. Ask about availability day, night, or weekends. Note any reluctance to call authorities or professionals, which may reflect past harm. Explore whether they feel confident contacting these people and what would make it easier.

Example 1

If things go bad, I can find Jay. Sometimes I go to the day centre or speak to the outreach worker if I catch them on rounds.

Example 2

I can ring the women’s outreach worker if it’s serious. The day centre staff told me I could go there if I feel unsafe during the day.

Example 3

If I feel unsafe, I can call my sister, my keyworker, or the outof-hours helpline. I also know I can visit the community centre for support.

What practical steps can you take to keep yourself and others safe?

This is about the actions you can take day-to-day to reduce risks. It could include avoiding conflict, staying in well-lit areas, or keeping your belongings secure. These simple steps help you stay safe and build confidence in managing challenging situations.

Things to consider

Invite the person to share the small actions they take to reduce risks. Ask about boundaries, routines, or avoidance of conflict. Listen for unsafe behaviours that increase vulnerability. Encourage them to reflect on what works best for them. Reinforce that safety includes their wellbeing and dignity.

Example 1

I keep my bag close, avoid arguments, and walk away if someone’s off their head. I stick to lit areas at night even if it’s noisy.

Example 2

I keep to busy streets at night, hide valuables deep in my bag, and avoid drinking much because it makes me vulnerable. I don’t tell strangers where I’m sleeping.

Example 3

I avoid conflict by walking away, use grounding techniques when stressed, and share concerns early with my support worker to prevent small issues becoming bigger risks.

What actions has your support or professional network agreed to take?

This question focuses on what others have promised to do to support your safety and wellbeing. It might be regular check-ins, help with housing, or storing important documents. Having these commitments written down gives you clarity and reassurance that you are not facing things alone.

Things to consider

Clarify commitments made by workers, family, or peers. Ask whether these feel reliable and realistic. Notice gaps between promised and delivered support. Be mindful of safeguarding risks if the person relies on unsafe individuals. Encourage open discussion about what support they most want from others.

Example 1

Outreach said they’d check in weekly. The day centre staff help me with forms. My keyworker promised to call about emergency housing options this week.

Example 2

The outreach worker said she’ll help me apply for a women’s hostel place. The nurse checks my health weekly. Day centre staff promised to store documents safely.

Example 3

My keyworker agreed to weekly check-ins. My housing support helps with budgeting. My GP team offered regular wellbeing reviews, ensuring my health needs are managed effectively.

Section 7: Your assessment of hazards, challenges, and risk

This section examines potential risks to your goals or safety, focusing on you. We'll assess both the severity and likelihood of these hazards. A hazard is something that could cause harm to you or someone else. This is to keep you and other people safe, ensuring that you can continue to get help and support to achieve the goals we’ve discussed.

We will consider and use the following definitions:

The severity of potential harm

Minor (1)

Harm, if it happens, would cause little or no lasting impact. It may involve temporary discomfort, frustration, or inconvenience that can be managed without outside help. The person is likely to recover quickly with their own coping strategies or minimal support.

Low (2)

Harm could cause some short-term difficulties or distress, but it is not expected to have a serious or lasting effect. It may disrupt routines or affect wellbeing for a few days, but recovery is likely with usual supports in place.

Moderate (3)

Harm would have a noticeable effect on health, safety, or wellbeing. It may involve significant stress, unsafe situations, or a setback in progress. Without timely support, this level of harm could lead to longer-term consequences or increased risks.

High (4)

Harm would seriously affect the person’s safety, health, or ability to cope. It may involve violence, exploitation, serious illness, or loss of housing. This level of harm could cause lasting impact and would likely require urgent and ongoing support to recover.

Severe (5)

Harm at this level would be life-threatening or life-changing. It includes risk of serious injury, abuse, or death, or the complete loss of safe accommodation or key relationships. The impact would be extreme and immediate, with long-term or permanent consequences for safety and wellbeing.

The likelihood of potential harm

Rare (1)

It is very unlikely the harm will occur within the review period. Circumstances or protective factors make this risk possible in theory, but highly improbable in practice. The person and their support network have strong systems in place to prevent it.

Unlikely (2)

The harm is not expected to happen in the review period but cannot be fully ruled out. The risk could arise if there are significant changes in circumstances, but current protections and strategies make it improbable.

Possible (3)

The harm might happen during the review period. There are some warning signs or vulnerabilities that could lead to the risk materialising if pressures increase or protective factors weaken. It is neither certain nor remote, but a genuine possibility.

Likely (4)

The harm is expected to happen at least once during the review period unless effective actions are taken.The situation, environment, or patterns of behaviour make this outcome probable. Protective factors may slow the risk but are unlikely to prevent it.

Almost Certain (5)

The harm is very likely to happen during the review period, possibly more than once. Evidence and experience strongly suggest that without immediate and significant intervention, the harm will occur. Protective factors are weak or absent, and the risk is pressing.

Risk of harm score matrix

For each hazard identified, give a score on the five point scales described above. To arrive at a score for risk, multiple the severity of harm by the likelihood of harm to arrive at a risk of harm score between 1 and 25.

The matrix below provides a visualisation.

Likelihood

severity of harm X likelihood of harm = risk of harm

The impact of time on risk of harm

When assessing the likelihood of harm occurring, this should be considered in the context of the review period. Therefore, the key question is: How likely is it that the harm will occur between now and the next review? Always remember that risk is a factor of the severity of potential harm and the likelihood of the harm occurring in a specific time period

The frequency of review should be proportionate to the assessed level of risk. Higher scores require more intensive oversight. Critical risks may need to be monitored continuously or reviewed hourly to ensure urgent interventions remain effective. For high risks daily or weekly reviews may be necessary. Where there is moderate risk, a review every few weeks may be sufficient, provided protective measures are in place and remain stable. For low risks, monthly reviews can help to avoid unnecessary intrusion. Negligible risks may only require review on a three-monthly basis. Of course, the assessment should always be reviewed where new information or changes in circumstances indicate necessity. In all cases, practitioners should exercise professional judgement and bring reviews forward immediately if the individual’s situation significantly deteriorates or improves

Interpretation of the risk of harm

The risk of harm score combines the severity and likelihood of potential harm to give an overall indication of urgency and required response. The semantic scale descriptors below are designed to support consistent interpretation across cases, ensuring that risks are neither overstated nor minimised. Practitioners should use the scale as a guide to frame professional judgement, recognising that even lower-scoring risks may escalate quickly in the context of multiple exclusion homelessness. The score must always be considered alongside the individual’s circumstances, protective factors, and lived experience

Critical

risk (scores of 15 – 25)

Harm is very likely and / or would have severe consequences if it occurs. The risk demands urgent intervention and ongoing management, as failure to act could lead to life-changing or life-threatening outcomes.

High risk (scores of 9 – 12)

The likelihood and / or severity is significant, meaning harm could be serious or disruptive. Active risk-reduction measures and close monitoring are required.

Moderate risk (scores of 6 – 8)

There is a realistic possibility of harm with a noticeable effect on safety or wellbeing. The risk requires planned controls and regular review to prevent escalation.

Low risk (scores of 3 – 5)

There is a limited chance of harm, and the impact would generally be minor or shortlived. Risk can be managed with standard measures and oversight.

Negligible

risk (scores of 1 – 2)

The combination of low severity and low likelihood means harm, if it occurs at all, will be of little significance. No special action is needed beyond routine monitoring.

Normalisation of Risk

There is a danger of practitioners and others becoming desensitised to high levels of harm because they appear so frequently in people’s lives.

Experiences such as rough sleeping, substance use, exploitation, or poor health can wrongly come to be seen as normal or inevitable. This is particularly the case where blame or fault is attributed to the individual, e.g., as a result of a concluding that the person’s situation in the result of a lifestyle choice, rather than as a potentially urgent wellbeing or safeguarding concern.

This normalisation of risk can lead to underestimating the seriousness of a situation and failing to act promptly, potentially leaving people exposed to preventable harms.

It is important to remember that risks identified, however common it may seem in the context of homelessness, could represent a real and potentially life-changing threat to an individual’s safety and wellbeing.

Therefore, practitioners must guard against minimising risks, and instead respond with the same level of concern and protective action that would apply in other settings.

Practitioners and others should also be mindful to avoid ‘group think’. Group think occurs when a team of people unconsciously prioritises consensus over critical evaluation, leading to risks being minimised or overlooked. In the context of homelessness, frequent exposure to high-risk situations can cause practitioners and others to collectively downplay dangers, reinforcing normalisation of risk and reducing protective action.

Strengths-based safety and wellbeing focused risk assessment

This section brings together previous sections about what matters to the person, their existing strengths, and any hazards or challenges. The aim is to create a clear, shared view of risk and the actions that follow. For each hazard, practitioners and (wherever possible) the person coassess severity and likelihood on the five-point scales, then multiply these to give a risk-of-harm score that guides urgency and oversight.The table prompts concise entries on how the hazard could affect the person or others, the specific actions agreed to reduce harm, and the planned review period. Use the scores as a guide, not a substitute for judgement, ensuring responses are proportionate, review periods are shortened as risk rises, and protective factors are actively strengthened over time.

Potential hazard or challenge (reference)

How this could affect me or others

of harm Likelihood of harm Risk of harm Existing strengths or protective factors Agreed actions to reduce harm Review period

Responses to the assessed risk of harm

The risk of harm scores are not only a measure of concern but also a prompt for action. How practitioners respond should be proportionate to both the severity and likelihood of harm, within the review period of the assessment, ensuring that risks are neither underestimated nor overlooked.

This section sets out clear guidance on review scheduling, mitigation planning, and escalation pathways so that support can be mobilised quickly and appropriately. It emphasises that risk assessment is a dynamic process. As circumstances change, responses must be adapted, protective factors strengthened, review periods amended, and professional judgement exercised.

Considerations for promoting safety and wellbeing

Managing situations where harm is likely

If the likelihood of harm is “likely” or “almost certain” (4 or 5) at any level of severity

• Reduce the review period to see if the likelihood of harm in the review period can be reduced

• Look for strengths, like trusted individuals or services to involve in agreed actions, that can reduce the likelihood

If the severity of harm is “high” or “severe” (4 or 5) and the likelihood is “possible” or worse (>3)

• Reduce the review period and reassess likelihood to ensure the situation can be closely monitored (e.g., in extreme situations a person could need constant supervision or hourly welfare checks and reviews for example)

• Agree extra safety planning actions and put contingency measures in place to reduce the likelihood of harm (e.g., safe places, increased outreach)

If the severity of harm is “moderate” (3) but the likelihood of harm is “likely” or higher (4 or 5)

• Reduce the review period, e.g., to fortnightly rather than monthly, and reassess likelihood

• Consider and agree practical steps to reduce exposure to the hazard, e.g., keeping away from places or people, increased support contact, or regular welfare checks

This guidance cannot cover all circumstances. It cannot provide specific actions, as these depend on individual situations.

The guiding principle is that higher risks of harm require closer monitoring, shorter reviews, and earlier involvement of managers or safeguarding leads, while lower risks may be managed through routine oversight and support.

Alongside professional oversight, it is vital to recognise the individual’s active role in their own safety and wellbeing planning. People bring insights, strengths, resources, and coping strategies that contribute to risk management.

Supporting individuals to exercise choice, voice concerns, and build capabilities enhances safety, dignity, and resilience. Valuing personal agency enables practitioners to collaborate with individuals on plans that are meaningful, sustainable, and more likely to succeed.

Your judgement matters. Use scores and the matrix as a guide, not a replacement. If something feels unsafe or overwhelming, regardless of score, escalate it. If in doubt, speak up.

Checklist for involving a supervisor or manager

Use these prompts to aide your decision-making about when to involve a supervisor or manager. Tick the box if the condition is met. Of course, this does not replace any policies that you are required to follow either legally or by your organisation.

Decision to escalate to a supervisor support checklist

Any risk of harm score is 12 or higher, or is rapidly escalating

Exploitation indicators (e.g., coercion, cuckooing, etc.) see section 8

Domestic abuse concerns

Suicide or self-harm risk is moderate or higher

Refusal of essential medical care

Concerns about capacity or consent (including fluctuating capacity, disagreement about best interests, proceeding without consent)

Cross cutting safeguarding issues (e.g., links to children’s safeguarding, MARAC, MAPPA, “Team Around The Adult” meetings, or the national referral mechanism for modern slavery, etc.)

Information sharing disputes with the person or between practitioners and professionals

Legal or media interest in the case

Multi-agency disagreement about thresholds, roles, or risk ownership

Repeated unplanned discharges, evictions, or service exclusions - despite unmet needs

Any “gut feeling” or professional curiosity about imminent harm not yet captured

Before speaking with your supervisor

Stabilise immediate significant risks, e.g., contact emergency services if necessary

Gather essential information, e.g., this document, recent incident records, current plans, and contact details for other key practitioners or professionals

Referrals for a Care Act assessment

Referrals of safeguarding concerns

After the discussion with your supervisor

Update sections 7 and 9 of this document as necessary

Communicate changes to key practitioners and professionals that are involved or need to be involved

Make necessary any referrals agreed, e.g., for a Care Act assessment or to raise a safeguarding concern

Take any immediate actions agreed and update case notes as necessary

Section 8: Your safeguarding considerations

Safeguarding adults experiencing complex lives, such as multiple exclusion homelessness, means recognising that safeguarding risks such as exploitation, violence, or self-neglect often arise from their wider environment. These harms may be hidden, overlooked, or seen as part of daily life. Contextual safeguarding looks beyond the individual to consider peer groups, places, and systems that shape safety and wellbeing.

A safeguarding referral may be relevant in circumstances such as:

Circumstances to consider

Self-neglect

• Living in unsafe or unhygienic conditions (e.g., squats, derelict buildings).

• Refusing essential medical care despite serious risk to health.

• Repeated overdoses, unsafe injecting, or exposure to exploitation.

Exploitation or coercive control

• “Cuckooing” (where others take over accommodation, often linked to drug supply).

• Financial exploitation by peers, drug dealers, or strangers.

• Sexual or other criminal exploitation in exchange for shelter, drugs, or ‘safety’

Physical or emotional abuse

• Assault or intimidation by others in hostels, on the street, or in exploitative relationships.

• Coercive control or being forced into criminal behaviour.

Neglect by others

• Failures by services or informal carers to meet essential needs (e.g., not providing medication, food, or necessary health interventions).

Complex and cumulative risk factors

• Multiple hospital admissions for preventable conditions.

• Repeated evictions or exclusions from services, leaving the person without safe options.

• Profound mental illness or cognitive impairment reducing capacity to protect themselves.

Other considerations

Normally, adults should be asked to consent to a safeguarding referral. Respecting choice and autonomy is central to good practice. However, if there is a risk of serious harm to them or to others, or if there are concerns that they may lack the mental capacity to give informed consent, professionals may need to proceed without it in order to protect the individual.

Safeguarding concerns are not always obvious. A presenting issue, such as rough sleeping, substance use, or offending, may hide underlying risks including trafficking, domestic abuse, or severe cognitive decline. These issues can remain invisible unless practitioners look beyond immediate circumstances to consider what else might be happening in a person’s life.

Because risks are often complex and interlinked, a safeguarding referral should not be seen as the only option. Multi-agency collaboration is often vital, with approaches such as Multi-Disciplinary Team (MDT) meetings, outreach case conferences, and “Team Around the Adult” models helping to bring together different perspectives and expertise to create a coordinated response. Finally, it is important to distinguish between chronic risk-taking behaviours and safeguarding thresholds. Not every high-risk circumstance amounts to a safeguarding issue. However, when self-neglect, exploitation, or other forms of harm significantly reduce an individual’s ability to protect themselves, this does meet the threshold for a safeguarding intervention.

Safeguarding checklist

This safeguarding checklist is designed to support, not replace, professional judgement when working with adults experiencing multiple exclusion homelessness or disadvantage. It offers a structured prompt across six domains Use it collaboratively and in a traumainformed, strengths-based way, centring the person’s voice and wishes wherever possible.

In the notes, you can record specific evidence, history and patterns, and the rationale for decisions, including where a concern is raised without consent because of serious harm or risks to others. This is not a tick-box or threshold tool; it helps organise information, surface uncertainty, and support defensible decision-making

Where the picture remains unclear, seek supervision and multi-agency discussion, and agree interim safety planning while enquiries progress and risks are actively reviewed.

To reiterate, this checklist is provided to help practitioners navigate uncertainty and support decision making. It does not in any way replace professional judgement, local policies, or safeguarding systems.

Care and support needs

Does the person appear to have care and support needs (e.g., mental ill-health, learning disability, cognitive impairment, physical disability, chronic illness, or substance dependence)?

And, are their needs preventing the person from protecting themselves from abuse or neglect, including self-neglect?

Experience of abuse or neglect

Is the person currently experiencing, or at risk of, abuse or neglect, including self-neglect (e.g., signs of physical, sexual, financial, or emotional abuse)?

Is there evidence of exploitation or coercive control (e.g., controlling behaviour, cuckooing, forced labour, coerced crime, or coerced sex)?

Self-neglect and health concerns

Is the person’s living situation (e.g., rough sleeping, squats, unsafe accommodation) putting them at serious risk?

Are they refusing essential medical treatment despite clear danger to life or wellbeing?

Is substance use leading to repeated overdoses, severe malnutrition, or other life-threatening risks?

Brief evidentiary notes

Brief evidentiary notes

Brief evidentiary notes

Capacity and consent

Does the person have capacity to make informed decisions about their safety and wellbeing? And, if they have capacity, do they consent to a safeguarding referral?

If they do not consent, is there a risk of serious harm or impact on others that justifies proceeding without consent?

Complexity and cumulative risk

Are there multiple, overlapping risks (e.g., mental health, exploitation, substance use, rough sleeping) that place the person in sustained danger?

Have there been repeated hospital admissions, evictions, or service exclusions due to unmet needs?

Are risks escalating despite existing support?

Multi-agency context

Have risks been discussed in a multi-disciplinary team, case conference, or “Team Around the Adult” setting?

Is there agreement that safeguarding is the most appropriate next step?

Brief evidentiary notes

Brief evidentiary notes

Brief evidentiary notes

Under the Care Act 2014 (England), a safeguarding concern should be raised where three criteria are met. Based on your knowledge of the person and their situation, you can use the checklist below to assess whether these have been met to inform your decision:

Criteria for raising a safeguarding concern

(1) Does the person have care and support needs, whether or not these are being met by the Local Authority?

And …

(2) Is there reasonable suspicion of abuse, neglect (including self-neglect), exploitation, or coercive control?

And

(3) As a result of those care and support needs, is the person unable to protect themselves from the risk or experience of abuse, neglect (including selfneglect), exploitation or coercive control?

Brief evidentiary notes

Section 9: Your safety and wellbeing support plan for the review period

This section develops your assessment into clear, co-produced actions for this review period It links your strengths and protective factors to specific, practical steps you will take, what others will do, and the resources needed. It also draws through the hazards and warning signs from the risk assessment, so responses are proportionate, and focused on what matters to you. Record how often the plan will be reviewed and who is involved. Treat this as a living plan that is updated in accordance with the agreed schedule or whenever circumstances change, so support stays timely, joined-up, and anchored in your voice and choices

What I want to achieve

Why this matters to me

Related strengths and protective factors that will help me

Example

(1) Sleep indoors most nights over the next four weeks; so I can rest and sort out my health.

feel unsafe outside. I’m exhausted. Being indoors will help me to keep appointments.

I’ve got a good relationship with the staff at the day centre. I know how to keep out of trouble I just walk away

My sister sometimes puts me up.

Related hazards or challenges that could stop me (reference the risk assessment)

Exposure to adverse weather while rough sleeping (high risk ref.2)

Conflict around shared spaces (moderate risk: ref.1)

Early warning signs, triggers, or red flags

What I will do to achieve this (i.e., my actions and preferences)

Net eating. Not sleeping. Getting agitated with people and avoiding them. I get stressed about letters from the DWP or the Council.

Attend the day centre for food, check-in on bed availability and make sure my phone is charged

If I have to sleep outside stick to well-lit places covered by CCTV, like the library, tell the rough sleeping team, and make sure I’m warm enough.

Call my sister or keyworker if I feel like giving up. Make sure their numbers are in my phone.

What others will do to help me achieve this (i.e., named people and services)

My outreach worker (Joe Smith) will help me with ID and application forms for accommodation, these need to be in by Friday, and register with a GP. The day-centre will keep my documents safe and text me if a bed becomes free in the hostel.

The outreach nurse will see me at the daycentre and dress my leg wound.

Practical support or resources that I will need (i.e., ID, a phone, benefits, etc.)

I’ll need to keep my phone safe and charged and let my outreach worker or the day centre know if I lose it.

I’ll need photo ID and a place to keep my things safe.

I’ll need at least £10 phone credit each week.

I’ll need a weekly bus pass to attend appointments with housing and the doctor.

Almost every night spent indoors this month

ID obtained and stored safely

Leg wound managed and not worsening

Applications made for accommodation

Phone kept active and charged

Nights spent outdoors are spent in the safer places agreed

No conflicts with others in emergency or temporary accommodation

Four weeks from the date of this assessment Tuesday, 4th November 2025 Weekly reviews will take place at the day centre. The next review will be 14th

Section 10: Your review period and follow up

This section sets out how often the assessment will be reviewed, who will be involved, and what escalations or additional actions are required. It ensures that risk is monitored over time and that the right people and organisations are engaged in supporting safety and wellbeing.

Review period

Based on the level of risk identified in this assessment and the person’s circumstances: The safety and wellbeing of the individual should be reviewed and this assessment updated with any significant changes:

Constant supervision

Hourly

Daily

Weekly

Other (please specify)

Reason for chosen review period

Fortnightly

Monthly

Every two months

Every three months

How risk is changing over time

Since the last review, in my professional opinion the overall level of risk is:

Reducing

Protective factors are increasing, hazards are being managed, and risks appear to be lessening.

Stable

Risks remain at a similar level, with no major changes in protective factors or hazards.

Escalating

Risks are increasing, protective factors are weakening, or new hazards have emerged.

Supporting notes and rationale

Multi-agency working: People and organisations to be involved

List the people, services, and organisations who are or should be involved in the next review or ongoing support. This could include positive contributions from family or peers.

Name

Job title or relationship Organisation (if applicable) Email and telephone

Escalation pathways checklist

Please indicate any escalation or referral required as a result of this assessment (tick all that apply):

Escalation to supervisor or manager

Multi-disciplinary team (MDT) meeting

“Team Around the Adult” (TAA) meeting

Safeguarding referral (adult or child)

Referral to housing services

Other escalations or referrals (please specify):

Multi-Agency Risk Assessment Conference (MARAC)

Multi-Agency Safeguarding Hub (MASH)

Multi-Agency Public Protection Arrangements (MAPPA)

Referral to health services (e.g., GP, mental health team, substance use services, etc.)

No escalations are necessary at this time

Supporting notes and rationale

Section 11: Your information sharing agreement

This assessment contains personal information about you. We want you to feel clear and in control of how that information is used and shared. The aim is to ensure your safety, wellbeing, and access to support, while protecting your privacy and rights under the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018.

Why we collect and share your information

The personal information recorded in this assessment may be shared for the following purposes:

• To help you get the right support at the right time.

• To keep you safe and well, especially if you are at risk of harm.

• To join up services, so you don’t have to keep repeating your story.

• To meet our legal responsibilities, such as safeguarding.

Who we may share your information with

Information will only be shared with organisations or individuals directly involved in supporting your safety and wellbeing or that of the community:

• Housing services, outreach teams, or accommodation providers.

• Health professionals, such as doctors, nurses, or mental health workers.

• Social care teams and community safety teams, including safeguarding services if there are concerns about your wellbeing or the wellbeing of someone else

• Other trusted organisations who are directly involved in supporting you.

We will only share information that is relevant and necessary.

Your choice and your rights

Giving us your permission to share the information in this document will help us to support your safety and wellbeing.

• We will ask for your permission first before sharing your information, unless the law requires us to share information without it.

• You can say yes or no to sharing, and you can change your mind at any time.

• You have the right to see the information we hold about you, and to ask us to correct anything that isn’t right.

• You can also ask us to stop sharing your information, unless the law says we must.

When we may share without your permission

We may still share information without asking you if:

• We believe you, or someone else, is in serious danger.

• We need to protect your life or prevent serious harm

• The law requires us to (for example, safeguarding duties or court orders).

Your decision

Please tick one box below to show your choice:

Yes, I agree that you can share my information with other people and services who are working to support me. Or …

No, I don’t agree right now.

I understand that information may still be shared without my permission if there is a risk of serious harm, to protect life, or if the law requires it.

Signature

Name (Print)

Date

Practitioner checklist

Lawful basis for sharing information

When deciding to share personal information from this assessment, please indicate which lawful basis (or bases) under UK GDPR applies. Tick all that are relevant.

Consent

Informed consent given – The person has freely agreed to the sharing of their information, after being told what will be shared, with whom, and why.

Consent refused or withdrawn – The person has not agreed, or has withdrawn their consent. Other lawful bases may still apply.

Other lawful bases

For where consent is not given or cannot reasonably be obtained.

Vital interests – Sharing is necessary to protect someone’s life or prevent serious harm.

Legal obligation – Sharing is required by law (for example, safeguarding duties under the Care Act 2014, child protection, or court orders).

Public task – Sharing is necessary for a public authority or body to carry out its official functions in the public interest (for example, health or social care duties).

Legitimate interests – Sharing is necessary for the legitimate interests of the individual, the organisation, or others, provided these do not override the person’s rights and freedoms.

Special category data (if applicable)

Where sensitive information (e.g., about health, ethnicity, religious beliefs, or sexual orientation) is shared, please confirm which additional lawful condition applies:

Explicit consent given.

Vital interests – Necessary to protect life where the person cannot give consent.

Substantial public interest – Necessary for safeguarding, preventing crime, or meeting legal obligations in health and social care.

Provision of health or social care – Necessary for medical diagnosis, treatment, or social care provision.

Continued …

Practitioner declaration

I confirm that I have considered the lawful basis for sharing this information, explained it to the person where appropriate, and limited sharing to what is necessary and proportionate.

Signature

Name (Print)

Job title

Organisation

Email

Telephone

Date

Appendix 1: The research and theory informing this toolkit

This toolkit’s style is deliberately person-led, trauma-informed and recovery-oriented, privileging safety, choice, and collaboration while avoiding deficit labelling. That stance reflects core trauma-informed frameworks in homelessness services (Hopper, Bassuk & Olivet, 2010) and cautions against superficial or coercive approaches by centring power, inequality, and co-production (Sweeney & Taggart, 2018). Its emphasis on identity and meaning mirrors recovery research led by experts-by-experience (Law & Morrison, 2014).

The structure follows an evidence-based sequence: start with what matters to the person and their strengths (Rapp & Goscha, 2006; Law & Morrison, 2014); map natural supports and everyday contexts (Firmin, 2017); surface early-warning signs; assess risk as time-bounded severity and likelihood; and co-produce practical plans with contingencies and proportionate review. This aligns with best practice in positive risk-taking and defensible decision-making, where tools aid, but never replace, professional judgement, and least-restrictive options are preferred (Department of Health, 2007; Morgan, 2013; Kemshall, 2010).

Its content is contextual and safeguarding-literate. Harm is located in places, peer groups and systems as well as individuals, requiring multi-agency responses, lawful informationsharing, and clear escalation routes (Firmin, 2017). Prompts on self-neglect, exploitation, capacity and consent, and proceeding without consent where justified, operationalise repeated Safeguarding Adults Review lessons on normalisation, threshold confusion, drift, weak coordination and poor recording (Braye, Orr & Preston-Shoot, 2015; Preston-Shoot, 2023; Martineau et al., 2019; Martineau & Manthorpe, 2020).

The toolkit is tuned to multiple exclusion homelessness and multiple disadvantage. It recognises intersecting trauma, mental ill-health, substance dependence and institutional contact (Fitzpatrick, Johnsen & White, 2011; Bramley et al., 2015), and the inclusion-health imperative to reduce preventable morbidity and mortality through proactive, joined-up care (Aldridge et al., 2018).

It also responds to the gendered, often hidden nature, particularly of women’s rough sleeping, by prioritising safety, choice and, where applicable, gender specific options (Bretherton & Pleace, 2018). Practical enablers (ID, phone credit, travel), low-caseloads, and reflective use consider evidence that access barriers and throughput models undermine outcomes (Bramley et al., 2015; Aldridge et al., 2018).

Finally, the approach to Care Act access and systems change, clear rationales, eligibilityaligned referrals, persistent advocacy, and interprofessional communities of practice, draws on case-study evidence that co-designed tools can help to unlock professional assessments, personal budgets, and other resources for people facing MEH in a resource limited environment (Cornes et al., 2018; Mason et al., 2018).

This toolkit attempts to translate a robust, multi-disciplinary evidence base into person-led, place-aware, defensible practice, through a tool that can be used exceptionally in situations of high uncertainty, complexity, or disagreement to arrive a person-centred and defensible coproduced multi-agency decisions in conditions of high risk. In addition, this toolkit also has a use case as a training aid in the considerations and thinking necessary to guide strengths-based practice when tackling multiple exclusion homelessness

References

Aldridge, R. W., et al. (2018). Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: A systematic review. The Lancet, 391(10117), 241–250.

Bramley, G., et al. (2015). Hard edges: Mapping severe and multiple disadvantage. Social Policy & Administration, 49(7), 862–882.

Braye, S., Orr, D., & Preston-Shoot, M. (2015). Learning lessons about self-neglect? An analysis of serious case reviews. The Journal of Adult Protection, 17(1), 3–18.

Bretherton, J., & Pleace, N., (2018). Women and Rough Sleeping: A Critical Review of Current Research and Methodology. University of York, Centre for Housing Policy.

Cornes, M., Ornelas, B., Bennett, B., Meakin, A., Mason, K., Fuller, J., & Manthorpe, J. (2018). Increasing access to Care Act 2014 assessments and personal budgets among people with experiences of homelessness and multiple exclusion: a theoretically informed case study. Housing, Care and Support, Vol. 21 Issue: 1, pp.1-12.

Department of Health (2007). Best Practice in Managing Risk: Principles and evidence for best practice in the assessment and management of risk to self and others in mental health services.

Firmin, C. (2017). Contextual Safeguarding: An Overview of the Operational, Strategic and Conceptual Framework. University of Bedfordshire.

Fitzpatrick, S., Johnsen, S., & White, M. (2011). Multiple exclusion homelessness in the UK: Key patterns and intersections. Social Policy & Society, 10(4), 501–512.

Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services. The Open Health Services and Policy Journal, 3, 80–100.

Kemshall, H. (2010). Risk rationalities in contemporary social work policy and practice. British Journal of Social Work, 40(4), 1247–1262.

Law, H., & Morrison, A. P. (2014). Recovery in psychosis: A Delphi study with experts by experience. Schizophrenia Bulletin, 40(6), 1347–1355.

Manthorpe, J., Klee, D., Williams, C., & Cooper, A. (2014). Making Safeguarding Personal: developing responses and enhancing skills. Journal of Adult Protection, 16(2), 96–103.

Martineau, S. J., Cornes, M., Manthorpe, J., Ornelas, B., & Fuller, J. (2019). Safeguarding, homelessness and rough sleeping: An analysis of Safeguarding Adults Reviews. London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London.

Martineau, S., & Manthorpe, J. (2020) 'Safeguarding Adults Reviews and homelessness: making the connections', Journal of Adult Protection, 22 (4): 181–197.

Mason, K., Michelle, C., Dobson, R., Meakin, A., Ornelas, B., & Whiteford, M. (2018). Multiple Exclusion Homelessness and adult social care in England: Exploring the challenges through a researcher-practitioner partnership. Research, Policy and Planning (2017/18) 33(1), 3-14.

Morgan, S. (2013). Risk decision-making: Working with risk and implementing positive risk-taking. Advances in Psychiatric Treatment, 19(4), 250–258.

Preston-Shoot, M. (2023). Human stories about self-neglect: told, untold, untellable and unheard narratives in safeguarding adult reviews. The Journal of Adult Protection, 25(6), 321–338.

Rapp, C., & Goscha, R. (2006). The Strengths Model: Case Management with People with Psychiatric Disabilities. Oxford University Press.

Sweeney, A., & Taggart, D. (2018). (Mis)understanding trauma-informed approaches in mental health. Journal of Mental Health, 27(5), 383–387.

Appendix 2: About Expert Citizens CIC

Expert Citizens CIC is a lived-experience-led social enterprise working to inspire lasting change in services and communities across the UK Our mission is simple yet powerful We aim to ensure that the voices of people with lived experience of multiple disadvantage are heard, valued, and acted upon

We believe that lived experience is expertise. By drawing on personal insight, we work alongside organisations, professionals, and communities to improve support for people facing complex challenges such as homelessness, mental ill-health, addiction, offending, domestic abuse, and poverty. Our approach is rooted in co-production by designing and delivering solutions in partnership with those who have experienced the very systems we seek to improve.

Our portfolio of services reflects this ethos:

The Insight Academy

A pioneering learning programme offering accessible, co-produced training and professional development. With lived experience at its heart, the Academy equips practitioners, managers, and volunteers with the knowledge, skills, and empathy to make a real difference.

Insight Quality Framework & Awards

A unique quality benchmarking and recognition scheme that celebrates organisations committed to embedding lived experience into their culture, practice, and governance.

Research, consultancy, and evaluation

Bespoke services to help organisations understand impact, strengthen practice, and design better systems. Our research is informed by lived experience, ensuring recommendations are both credible and grounded.

Membership & volunteering

A growing community of people with lived experience who contribute their skills, insight, and passion Members are at the heart of all we do, shaping programmes, delivering training, and acting as ambassadors for change.

Across all our work, we champion collaboration and strengths-based approaches that improve not just individual practice, but whole systems. Organisations that work with us tell us they become more person-centred, empathetic, and effective. Volunteers and members describe finding confidence, purpose, and a renewed sense of belonging.

Expert Citizens CIC is proud to have earned a reputation for innovation, authenticity, and impact. Whether through training, evaluation, or partnerships, we help services to listen differently, act differently, and achieve better outcomes

Find out more

To explore our work, discover opportunities to collaborate, or get involved as a volunteer, please visit our website at www.expertcitizens.org.uk.