Page 22 - Adult C Overview Report - FINAL

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a more holistic and collaborative model providing an overview and understanding of what

each individual agency knows and is undertaking. Problem solving is enabled more effectively
when agencies with different specialisms come together.

7.48. This approach may have led to better understanding of the following issues in Adult C’s case :
 Non engagement with services
 Management of chronic health problems and medication compliance
 The victim/perpetrator dilemma and power base being exerted
 Exploitation of finances and associated drinking partners
 Resolution of housing issues
 MARAC

7.49. Where a person is being discussed in TATI and MARAC meetings it is important that both
reference the other to avoid duplication or gaps. However, as MARAC may only consist of one
meeting regarding a person, TATI will be the ongoing coordination process that will need to
take MARAC actions into account.

7.50. It was of note that there was no involvement from senior managers in this case.
Multi agency working gives rise to a collective discussion and decisions to escalate and
include senior managers where risk is feeling unmanageable by frontline workers. It is of note
that the TATI model is led by senior management in Adult Social Care in order that the
oversight of complex cases is integrated into the meetings.

7.51. Whilst the TATI model (and similar in other Teeswide areas) addresses those with complex
needs where risk is escalating, this does not meet the need for a more integrated approach at
a lower level or where risk is more manageable. For those with mental health needs that
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meet the Care Programme Approach criteria, there is a solution utilising the multi-agency
element of this with the identified care coordinator to provide a key worker role. This would
not be the case for adults like Adult C who did not have enduring mental health illness or
needs.

7.52. In the area where Adult C lived and received services, there is a new commissioning model
proposed. The integrated service model for vulnerable people is being developed to bring
services together so that a coordinated response can be utilised for people like Adult C who
have complex needs. The model has set outcomes that will remove the risk of duplication of
services, multiple assessments and managing disengagement. The model is set to provide an
assertive outreach team offering intensive support for the most at risk and vulnerable to

21 The Care Programme Approach (CPA) is a way that services are assessed, planned, coordinated and reviewed for someone
with mental health problems or a range of related complex needs. http://www.nhs.uk/Conditions/social-care-and-support-
guide/Pages/care-programme-approach.aspx.

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