Entrenched Rough Sleeper Social Work Team

Entrenched Rough Sleeper Social Work Team

The Entrenched Rough Sleeper Social Work Team was established as a standalone team, under the Complex Needs Service within Adult Social Care, in September 2023.

This was with the recognition that people entrenched in sleeping rough do not fit into traditional services. We needed a new way of working.

Our unique team is made up of highly skilled social workers who apply a huge breadth of experience and theory to support some of Manchester’s most severely disadvantaged, multi-excluded and traumatised people.

Practitioners work with this highly complex cohort who have been seen sleeping rough over an extended period of time. These people often refuse to come indoors or find it difficult to stay indoors. They are known to key partners as the Target Priority Group (TPG).

Each member of the team brings their own specialisms, sharing their knowledge, skills, information, advice, guidance and new ways of working, both with each other, and with partners across Manchester and nationally.

People do not choose to be entrenched rough sleepers. There is always a complex story behind the person. These people are living on the outskirts of society. They are constantly in survival mode, living hour by hour. They must consider how they will wash, eat, sleep, and manage their life on the streets – in that community. It is a highly intense and difficult way to live.” Team member

Our specialist social workers take a trauma informed and multi-disciplinary approach of professional curiosity and compassionate enquiry to find out what is going on for the person. They meet each person where they are atwithout judgement to empower them to live the life that they choose.

Our practice is underpinned by a trauma-informed approach. There are six key principles of trauma-informed practice: Safety; Trust; Choice; Collaboration; Empowerment and Cultural Consideration. This is how we apply them: 


  • Making someone feel emotionally safe and able to express themselves without judgement.
  • Physical safety, for example accommodation, or meeting in a café (an open space where people feel free to leave). 
  • Asking people, “What would make you feel safe?” and not making assumptions around that. If you feel constantly unsafe, how can you make any changes to your life or rational decisions? 


  • Under promise, over deliver. Remember, people might distrust services due to past traumas (e.g. interactions with police). 
  • Hang-in there. Persist. Go back to the person again, and again, and again, and again, until they are ready. 
  • Once you have built trust you can challenge people and their behaviours. Not everyone will change – accept that.


  • Give the person options and information to make informed choices, to improve the quality of their lives, whatever lifestyle that is and whatever priorities they choose
  • Timing is key. Meet the person on their own terms, giving them control and equalising the power dynamic.


  • The person is the professional in their own lives. Work with them to ensure their voice is heard.
  • Collaborate with other agencies with the understanding that we are not always the right person to lead. 
  • Identify what the person wants and then give them responsibility to get there. This can provide a sense of achievement and ownership. People begin to take control of their lives. 


  • Empower people so that they realise they can do things, for example, “Meet me at the doctors”, then next time they can do it on their own. 
  • Build self-esteem and encourage people to recognise their own strengths. This can build their resilience. 

Cultural Consideration

  • Work with the whole person and everything they bring. Their identity and community.
  • Being mindful of people’s backgrounds and histories and how that will impact their present life
  • Class, race, gender, sexuality and other components will intersect to shape people’s experiences. Different support will be required, depending on person’s needs. 

On a weekly basis, we meet with agencies involved with entrenched rough sleepers in Manchester. This includes; the Rough Sleeping Support Service, Greater Manchester Police, Anti-Social Behaviour and Abuse Team, Mental Health Team, Salford Housing, Probation, Reach Out to the Community, Change Grow Live, Urban Village and M-Path. We discuss a target priority group of people entrenched in sleeping rough and agree actions.

Our specialist Social Workers

  • Skills, knowledge and interest in working with Multi Exclusion Homelessness (MEH).
  • Adult Social Care integration into the Homelessness Directorate as part of the Rough Sleeper Support Service which was known as Outreach Inreach Team.
  • Preventative work and earlier intervention to reduce crisis escalations and unnecessary/ repeat referrals to other teams.
  • Partnership working, forming an evidenced based approach of ‘team around the person’ some of the most severe multi-disadvantaged and multi excluded people in our society.
  • Legal literacy in Care Act (2014), Mental Capacity Act (2005), Human Rights Act (1998) Equality Act (2010) (where NRPF), Safeguarding and team round the person approaches.
  • Offering timely advice, legal literacy, links to risk sharing and training for other colleagues/ teams in relation to MEH.
  • Bridge building by combining cultural perspectives of homelessness outreach and adult social care.

Executive Functioning Wheel 

Evidence from research indicates 50% of people sleeping rough have acquired brain injuries and approximately 85% have experienced significant trauma resulting in PTSD. These conditions impact the brains executive functioning. The Entrenched Rough Sleepers Social Work Team use the Executive Functioning Wheel with people we consider might have an element of neuro-divergence, recognising these subtle nuances as a hidden disability. It allows us to assess someone’s capacity from a position of professional curiosity and compassion, to understand behaviours rather than blame somebody for something they might have little control on. 

The people we work with are highly complex. It is important however to understand that if you remove alcohol, drugs and chaos, you might still be left with a person who struggles with the activity presented on the wheel (for example issues with impulse control, or not making appointments). 

What we learn about people’s executive functioning, using this wheel, shapes our support plans and our approach with the person and allows us to make reasonable adjustments. The environmental, emotional and social support is critical to  people feeling safe and providing stability. Using the tool in discussion with partners allows us to share our awareness, so that there is a wider-system understanding and approach to inform reasonable adjustments for the person. 

Neuro-divergence can be linked to sustained trauma throughout someone’s life. For example, people in fight or flight mode during childhood, can impact their cognition in later life. Many of the people we work with experience multiple traumas before they are on the streets and continue to do so once they are sleeping rough. It is important to consider this when working with people. Trauma can impact cognition and therefore executive functioning. 

Executive Functioning Tool in Practice

The unveiling of Beryl. What you need to know to end rough sleeping: https://youtu.be/yoy1aDqMmbk

Beryl is based on evidence from the first MCC Adult’s Services and the NHS Research and Development Forum North-West partnership. This research is becoming widely recognised nationally and publicised by the National Institute for Health and Research.

Blue Light Thinking

The Blue Light approach is a harm reduction and assertive outreach model. The model is built on the following principles: 

  • Take every opportunity
  • Not everyone will change
  • Change is not the only option
  • Whole system approach
  • Holistic approach
  • Recording unmet need
  • Learning lessons 

Beyond the people we work with, we talk to, learn from and teach our partners, impacting on wider practice so that we are all working in the same way.  

Our Blue Light thinking links to the Cycle of change – if we can get the basics right, we can move on to promote change. 

Cycle of Change

We use the Cycle of Change tool to understand, measure or explain where someone might be in the change process. The stages are:

  1. Precontemplation: The individual may not be aware that a problem exists or have no intention of changing their behavior.
  2. Contemplation: The person becomes aware of the problem and acknowledges the need for change but has not yet made a commitment to act.
  3. Preparation: The individual is motivated to act and actively plans and prepares to address the problem. This stage often involves gaining buy-in and increased self-efficacy.
  4. Action: The person is actively engaged in modifying their behavior and implementing the changes they have planned.
  5. Maintenance: In this stage, sustained change occurs, and the new behavior replaces the old one. It isimportant to note that the maintenance stage is considered transitional, as the person continues to work on sustaining the changes made.
  6. Relapse: Despite efforts to maintain the new behaviour, the person may experience a setback and fall back into their old patterns of behaviour.

When we look at someone’s motivation, it can be small, incremental changes. Each time a person goes through the cycle, they can learn from each relapse and grow stronger. With each iteration, the hope is that the relapse becomes shorter or less devastating, leading to continued progress and growth.