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The model "8 Steps of Reintegration into Society" is an innovative approach to Health Protection and Care. It was designed by the Institution in Affairs of Care and Well-Being of the Netherlands. The work will be conducted on three levels:

1. Projects designed to provide the homeless with practical assistance.

2. Projects designed to strengthen cooperation and networking between NGOs.

3. Projects designed to develop national and local policy.

The following describes the first level of projects aimed at the practical aspects of working with homeless.

Working with the homeless population is frequently difficult and complicated:

- Homeless people often lead an anonymous life-style which is difficult for others to understand;
-  In most of cases the homeless are refused the assistance necessary for their reintegration into normal society;
- The problems experienced by the homeless are numerous and complicated and include a lack of housing and money, mental illness, alcohol and drug use/abuse, solitude, and health problems.

Currently, the Netherlands is experiencing a shortage of capacity in their social welfare structures, especially as these structures relate to the problem of homelessness.  Despite a stable economic situation in the country and a modern social welfare system, the frequency of homelessness is increasing because many people still lack the many skills necessary to survive in a modern society.  Such people often become homeless and are subsequently forgotten by society.  

Another problem experienced by the Netherlands is a problem of poor service quality for homeless individuals. The services for the homeless are inadequate as compared to the services available for such at risk groups as youth and people living with mental illness.  Those who work with the homeless population also do not have the technical equipment to assist them in their work.  In addition, addressing and solving the issues concerning homelessness is more difficult and often requires extra time and effort.  

“8 steps” is designed to support the people who are already receiving some organized assistance as well as those who are resistant to help that requires a significant amount of structure.  

“8 steps” is a systematic project with two goals:

1. Reintegration into society.

2. Improvement of the level of life of homeless people. For most of them it is impossible to reach full independence and reintegration into society. They need qualified assistance from professionals and volunteers. 

The most important part of working with the homeless is to provide consultations and supervision. Case managers are people who support the homeless clients and this work demands personal involvement with the problems the client is experiencing. Case managers must display empathy and must be experienced in the skills necessary to gain the trust of clients.  The relationship between the case manager and the client is extremely important.   

The number “8” is a main figure in this approach because it describes the 8 steps of work with clients and the 8 components of well-being.  

The 8 components of well-being describe 8 aspects of a person’s life.  During consultations with case managers, clients discuss these 8 components and describe their current situation regarding each one.

The 8 components of well being are:

- Financial status (income, debts, money management)
- Place of residence and how this influences life style and behavior
- Social behavior in relationships with family, friends, and society
- Mental status (mental illness, alcohol and drug use and abuse)
- Motivation (religious views, life principles)
- Physical status (i.e.  use of medicine)
- Practical skills (i.e. house keeping)
- Literacy, administrative skills- Hobbies, job history, educational level

Knowing about these 8 components of well-being for each client assists case managers because this takes into consideration all aspects of a client’s life, not only problems, but strengths and possibilities.  This is a new approach for the Netherlands because traditionally case managers focused only on the problems of their clients.

The number “8” also describes the 8 stages clients must pass through during the reintegration process.  Many case managers in the Netherlands are using these stages in their daily work with clients.  Though currently the stages are not in written form it is important to the success of the reintegration of the client that these steps are documented and used as an agreement between the case manager and the client so they will work to reach goals together.

The 8 stages are: 

First stage – Appeal
Second stage – First Interview
Third stage – Entrance
Fourth stage – Evaluation
Fifth stage – Supervision Plan
Sixth stage – Fulfilment of the Supervision Plan
Seventh stage – Results Evaluation
Eighth stage – Reintegration

Stages 4 through 7 repeat themselves until the client is ready to successfully reintegrate back into society. 

First stage: Appeal

This is the first contact between client and case manager. During this stage clients are evaluated and it is determined whether or not the client can move to the second stage.  The client will be asked standard questions about their age, children, and main problems. If there are no obstacles the client will move to the next stage

Second stage: First interview

The goal of the second stage is to determine if the client is compatible with this structured program.  To determine this, the case manager and client discuss the following topics:

- Reasons for appealing to this “8 step” structure
- Client’s history
- Main problems
- Expectations for assistance
- Assistance which can be provided by the structure

During and following the first interview, the case manager documents the discussion.  Notes from the discussions will be used to determine if the client will be successful moving through these stages and working with other case managers.  If this model will not be successful for the client, the case manager will advise the client about other options available to assist them.   

Third stage: Entrance

This stage includes three aspects over a period of two weeks:

1. Preparation of a room for the client

2. On the day of arrival meeting with other clients and becoming familiar with the daily structure

3. After arriving clients often need time to relax. Additionally, financial and medical questions must be resolved

Fourth stage: Evaluation

The duration of this stage lasts from 2 to 4 weeks. During the client’s first week their personal case manager is in contact with them at least once a day. They usually discuss one or more of the 8 components of well-being. Other social workers also observe the client’s behaviour and document their observations.  The case manager then uses this information along with the results of the first interview to create an initial plan for the client that includes duties and tasks to be accomplished by the client.  These duties and tasks all relate to the 8 principles of well being.  

The case manager will then create a report that addresses each of the 8 components of well being while taking into consideration the strengths and needs of the client. The client’s own vision and perspective is very important. The client will also receive a copy of this report. 

Fifth step: Supervision Plan

Based on the analysis of the client’s problems, the case manager, together with the client, create a plan for individual supervision.  This plan includes several goals which the client must achieve within the next several months.  These goals must be simple, concrete, and realistic.  This goals will be documented and include the people responsible for the goal’s achievement and a timeline of activities required for achievement of the goals.  Others involved in assisting the client will also receive a copy of this plan. 

Sixth step: Fulfillment

The goals of this stage are dependent upon the content of supervision plan. This stage can last up to 6 months. During this time the case manager and client will meet at least once every two weeks. Other case managers also document their observations during this stage.   

Seventh step: Results Evaluation

During this stage the case manager and client together discuss whether the client has achieved the goals described during earlier stages.  If goals were achieved the client and case manager discuss how the client was successful.  If goals were not achieved they discuss the reasons they were not and how to go about achieving them. 

After the Results Evaluation a new description of tasks for the client and a new supervision plan are created by the client and case manager taking into consideration new realities or new situations that may have arisen.  Therefore, stages 4 through 7 will repeat until the client and case manager determine that the client is ready for a new home and new structure.     

Eighth step: Reintegration

This is the final stage for the client.  Physical and emotional preparations are made to help the client successfully reintegrate into society.  As the client is leaving this “8 step” program they are asked to provide feedback to case managers about their impressions of the program.  Clients provide an evaluation of the support they have received, quality of meals, and quality of living conditions.  Every year the client’s evaluations are analyzed and used to improve the quality of the program’s work.