Supporting homelessness – a unique caseload

Leigh Andrews, Head of Speech and Language Therapy Development at Change Communication, highlights the challenges faced by individuals experiencing homelessness

As SLTs working with people experiencing homelessness, we have a unique caseload. We rarely have a full case history available to us for the people we meet, and we may not be able to find out their first language. Sometimes we are not even sure of a person’s identity.

We know that the strongest predictor of adult homelessness is childhood poverty (Bramley and Fitzpatrick, 2018). It is always a surprise to me that the homelessness sector talks so little about class, when being poor and working class is a risk factor for homelessness. If you are an SLT working with children and young people, homelessness and inequalities are likely to be present in your work. As in many other health-related areas, we also see a range of intersecting characteristics which, due to discrimination, make things worse for some groups than others (Chikwira, 2023).

I worked in homelessness settings for 15 years before training as an SLT. Not once, in all that time, did I ever meet a SLT working with any of the people I supported.

Speech and language therapy can be difficult to access due to health inequalities in just the same way as other types of healthcare.

The Change Communication charity was created to try to meet that need while simultaneously helping the homelessness sector understand more about communication, and the communication sector understand more about homelessness. Along the way, we also wanted the NHS to recognise that people experiencing homelessness needed speech and language therapy as much as anyone else, and we would support them to develop services to that end.

Lots of SLTs interested in my area of practice ask me about my ‘average’ day, or the kind of communication disorders we deal with, but it’s not that straightforward in my world.

I can sum up my days and the things we deal with in three words:

• uncertainty

• creativity

• gratitude

Because we may not know much about the person, their background or their language needs, we must be creative and ask:

“What can I do to help end this person’s homelessness? What communication difficulties do I, the client, and others experience when we interact, and what might help make those interactions be less stressful and more effective so that their homelessness can be understood, and accommodation and support identified?”

We work with people who have experienced rough sleeping and often the clients we work with will have sofa surfed or lived in temporary accommodation. We regularly visit clients living in hostels as well as prisons, day centres, public buildings and cafes.

They have generally had difficult early lives and experienced poverty, but that’s not the case for everyone. Some may have worked in the past and may be proud of their skills from that time.

Our clients are mainly aged over 25, and about 20% are female. About half the people we work with are living with addiction.

A formal standard clinical communication diagnosis is often impossible but providing care, understanding and help is not.

Over the years, our clients may have had difficult experiences when they have approached services that are tasked to help them, so we remember and are grateful for any small trust they put in us. They may trust us enough to meet for a few minutes or to answer a question or two. They may trust us to change things a little today, or next week.

Our team is always grateful and overjoyed when people trust us enough to agree to meet us again. They may allow us to ask about their reading and writing, then feel comfortable with us sharing any support strategies with their hostel keyworker. They may agree that contacting their GP to flag concerns about eating and drinking is a good idea after we notice a cough. They may even sit and let us ask the 40 questions on a form during a clinical assessment and be delighted when they get 100% right.

SLTs can support people in all sorts of circumstances with communication and swallowing difficulties in positive, life enhancing ways, but it isn’t always easy work, which is why we must support each other to do this when things get tough.

This article was re-purposed for World Homeless Day 2024 from our summer 2024 Bulletin cover feature – read the full article where Leigh also shared some positive actions SLTs can take to tackle health inequalities. You can also find out more about the role of SLTs in homelessness and read our joint policy statement with the Homelessness Clinical Excellence Network.

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References:

• Bramley, G., and Fitzpatrick, S. (2018). Homelessness in the UK: who is most at risk? Housing Studies, 33(1), 96–116.

• Chikwira, L. (2023). Back to basics – understanding lived experience and intersectionality in health and care. King’s Fund.