Come in from the cold: A review of the screening and assessment strategies for working with the socially excluded

This paper reviews the main strategies for screening and assessing the needs of the diverse range of socially excluded clients who come into contact with statutory and non-statutory agencies. A high level aim of contemporary UK health and social policy is to engage with those who are hard to reach with traditional health service provision. The initial contact and screening processes, therefore, are central to developing a relationship with the client and engaging him/her with the main stream community services. Many homeless and socially excluded people have multiple and complex needs but seeking accommodation provides a good opportunity to begin to engage the client with support services. Although substance misuse and mental health problems might not be immediately apparent, screening and subsequent assessment of these aspects of dual diagnosis should be provided in order for appropriate help to be made available. Ongoing monitoring of the client’s progress will provide an insight into the cues which indicate relapse. However, an important aspect of inclusion often involves gaining access to meaningful work. The neurocognitive ability of the client to undertake work and become socially integrated may be limited by problems in decision making and other cognitive skills. Appropriate support, in these cases, might involve an evaluation of neurocognitive deficits and the guidance to appropriate employment tasks. The encouragement of positive health behaviours, including improvements in nutritional status will all add to the increased possibility of coming in from the cold.