West Midlands Assets Seminar nov 2012


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A presentation from Tevor Hopkins from Asset Based Consulting (http://www.assetbasedconsulting.co.uk) on an Asset Based Approach to mapping Health and Wellbeing. This presentation was organised by the LGA to support West Midlands Health and Wellbeing Boards.

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West Midlands Assets Seminar nov 2012

  1. 1. The asset based approach to healthand wellbeing in communitiesMonday 5th November 2012Birmingham www.assetbasedconsulting.net
  2. 2. Trevor HopkinsFreelance ConsultantAsset Based Consulting
  3. 3. Never doubt that a small group of thoughtful, committedcitizens can change the world. Indeed, it is the only thingthat ever has. Margaret Mead – US Anthropologist 1901 - 1978
  4. 4. Introductions and outline• What are the „Deficit‟ and „Asset‟ approaches?• “A glass half-full” • Principles, Values & Key themes• “What makes us healthy?” • Evidence, Action, Evaluation• How could this help us strategically? • How to develop the JSNA to include asset mapping • Using Appreciative Inquiry to develop the H&WB Strategy • Co-production for health • Outcomes based commissioning• How could this help us locally? • Appreciative Scrutiny • Asset Based Community Development • Community Health Champions • Resilient Places
  5. 5. The dilemma . . . Clients and consumers have deficiencies & needs Citizens have capacities and gifts
  6. 6. A deficit approach• Much of the evidence currently available to describe health and address health inequalities is based on a deficit model• This is a „pathogenic‟ approach to health and well-being• The deficit approach focuses on the risks, problems, needs and deficiencies in individuals, families and communities• Professionals then design services to „fix‟ the problems• As a result the community and individuals can feel disempowered or can become dependent• People become passive recipients of expensive services
  7. 7. Features of a deficit approach• Policymakers see professional systems or institutions as the principal tool for the work of society• In Public Health practice this approach has focused on „risky behaviours‟ and „lifestyle factors‟• “The collective term for these behaviours is the subject of much debate, with professionals from different fields preferring different terminology, each having a view about what is pejorative and what is not.” (Clustering of unhealthy behaviours over time – King‟s Fund , August 2012)• Services are targeted at specific needs & problems, communities and individuals become „segmented‟
  8. 8. An assets approach• Values the capacity, skills, knowledge, connections and potential in individuals, families and communities• It is a „salutogenic‟ approach which highlights the factors that create and support resilience and well-being• It requires a change in attitudes and values• Professional staff have to be willing to share power• Organisational silos and boundaries get in the way of people-centred outcomes and community building• Never do for a community what it can do for itself
  9. 9. Features of an assets approach• Changing from servicing people‟s needs to facilitatingtheir aspirations• Redressing the balance between needs and assetsor strengths• A shift in emphasis from the causes to „the causes ofthe causes of the causes‟• A move from targeted to universal approaches• Solutions that are developed by people andcommunities not by specialists and professionals
  10. 10. Key messages 1.• Asset principles help us to understand what gives us health and wellbeing in a new way.• The theoretical and research evidence for the positive impact of community and individual assets is well known and at least comparable to that of more familiar behaviour and life-style determinants of health• Asset thinking challenges the predominant framing of health as the prevention of illness and injury rather than the promotion of wellness.• Asset working can promote mental well-being which is both a cause and a consequence of inequality and physical ill health.
  11. 11. Key messages 2.• Work to improve health enhancing assets has not only to focus on the psychosocial assets such as resilience and confidence, but also on the social, economic and environmental factors that influence inequalities in health and well-being.• Asset based approaches complement services and other activities that are intended to reduce inequalities in life chances and life circumstances and which meet needs in the community• Assets are simultaneously an input, a measure and an outcome. This has implications for the design and evaluation of asset based working.
  12. 12. A glass half-full:How an asset approachcan improve communityhealth and well-being http://www.assetbasedconsulting.co.uk/Publications.aspx
  13. 13. The Principles• Assets: any resource, skill or knowledge which enhances the ability of individuals, families and neighbourhoods to sustain health and wellbeing.• Instead of starting with the problems, we start with what is working, and what people care about.• Networks, friendships, self esteem and feelings of personal and collective effectiveness are good for our wellbeing.“Focusing on the positive is a public health intervention in its own right”Professor Sarah Stewart-Brown, Professor of Public Health at Warwick Medical School speaking at a conference on „Measuring Well-being‟ 19 January 2011 at Kings College
  14. 14. Values for an Asset Approach• Identify and make visible to health-enhancing assets in a community• See citizens and communities as the co-producers of health and well-being rather than the recipients of services• Promote community networks, relationships and friendships• Value what works well• Identify what has the potential to improve health and well-being• Empower communities to control their futures and create tangible resources
  15. 15. Key themesThe defining themes of asset based ways of working arethat they are:• Place-based• Relationship-based• Citizen-led...and that they promote social justice and equality
  16. 16. “What makes us healthy?”The assets approach in practice: • Evidence • Action • Evaluationhttp://www.assetbasedconsulting.co.uk/Publications.aspx
  17. 17. Evidence 1.• There is growing evidence for the importance of health assets, broadly defined as the factors that protect health, notably in the face of adversity, and for the impact of assets based approaches• Individuals do not exist in isolation; social factors influence individuals‟ health though cognitive, affective, and behavioural pathways.• The quality and quantity of individuals social relationships has been linked not only to mental health but also to both morbidity and mortality. It is comparable with well established risk factors for mortality
  18. 18. Evidence 2.• Stress buffering – relationships provide support and resources (information, emotional or tangible) that promote adaptive behavioural or neuoroendocrinal responses to acute or chronic stressors e.g. illness, life events.• Social relationships may encourage or model healthy behaviours, thus being part of a social network is typically associated with conformity to social norms relevant to health and social care. In addition being part of a social network gives individuals meaningful roles that provide self esteem and purpose to life.
  19. 19. Action 1.• Assets require both whole system and whole community working.• Instead of services that target the most disadvantaged and reduce exposure to risk, there is a shift to facilitating and supporting the wellbeing of individuals, families and neighbourhoods.• It requires all agencies and communities to collaborate and invest in actions that foster health giving assets, prevent illness and benefit the whole community by reducing the steepness of the social gradient in health.
  20. 20. Action 2.• Asset mapping• Toronto framework for mapping community capacity• Joint Strategic Assets Assessment• Timebanking• Social prescribing• Peer support• Co-Production• Supporting healthy behaviours• Community development to tackle health inequalities• Network building• Resilient Places• Appreciative Inquiry• Asset based service re-design• Assets – embedding it in the organisation• Workforce and organisational development
  21. 21. Evaluation• To evaluate health asset based activities requires a new approach. Instead of studying patterns of illness, we need ways of understanding patterns of health and the impact of assets and protective factors.• Methods that seek to understand the effects of context, the mechanisms which link assets to change and the complexities of neighbourhoods and networks are consistent with the asset approaches.• The participation of those whose assets and capacities are being supported will be a vital part of local reflective practice.
  22. 22. How could this help us strategically? • How to develop the JSNA to include asset mapping • Using Appreciative Inquiry to develop the H&WB Strategy • Co-production for health • Outcomes based commissioning
  23. 23. Community asset mappingThe actual and potential assets of: • Individuals – heart, head & hand • Associations • OrganisationsIn a community this can also include: • The physical assets • The economic assets • The cultural assets
  24. 24. Analysis of community assets Potential AssetsSecondary Assets Primary Assets
  25. 25. http://www.idea.gov.uk/idk/core/page.do?pageId=18364393
  26. 26. Community asset mapping/JSAA http://www.assetbasedconsulting.co.uk/Publications.aspx
  27. 27. Appreciative Inquiry“Good organisations know how to preserve the core of what they do best. Preserving the right thing is key. Letting go of other things is the next step” David Cooperrider
  28. 28. PrinciplesReflection – remembering times when our culture, values and identity made us proud.Affirmation - inquiring into those strengths and how we can use them to create the futureAction – practical planning towards the future
  29. 29. Characteristics• Appreciative - AI looks for the „positive core‟ of the organisation and seeks to use it as a foundation for future growth• Applicable - AI is grounded in stories of what has actually taken place in the past and is therefore essentially practical.• Provocative - AI invites people to take some risks in the way they imagine the future and redesign their organisation to bring it about.• Collaborative - AI is a form of collaborative inquiry. It always involves the whole system or a representative cross-section of the whole system.
  30. 30. The appreciative cycle Deliver DefineDesign Discover Dream
  31. 31. ...building the path as we walk it
  32. 32. CITY OF STOKE-ON-TRENT MANDATE FOR HEALTH AND WELLBEING 2020 STOKE-ON-TRENT IS A VIBRANT, HEALTHY AND CARING CITY, WHICH SUPPORTS ALL PEOPLE TO LIVE FULFILLING, INDEPENDENT AND HEALTHY LIVES Vibrant City: Everyone will live,Healthy City: All children enjoy work and play in an the best start in life and environment which supports everyone will live longer and them to live healthy and fulfilling healthier lives. lives. Caring city: Everyone is supported to live independent lives with fair access to high quality integrated health and social care services when needed.
  33. 33. Strategic Outcomes Healthy City: Children will enjoy the best start in life and everyone will live longer and healthier lives Vibrant City: Everyone will live, work and play in an attractive environment which supports them to live healthy and fulfilling lives Caring City: Everyone is supported to live independent lives with fair access to high quality integrated health and social care services when neededStarting Well: Developing well: Working Well: Living Well: Ageing Well: Staying well:Children flourish Everyone is able to Business thrives in Everyone lives in a good Everyone has a positive Everyone has achieve their the city and quality home, in an area experience of ageing in access toand feel loved, potential and enjoy everyone has which they like and in an the City and people are preventative healthvalued and safe maximum environment in which they opportunity to be supported to live and wellbeing independence and involved in feel safe across all independent, inclusive services and are positive mental meaningful activity generations and fulfilling lives supported to live wellbeing (work, volunteering, throughout the life healthy lives caring) course Achieved through: Achieved through: Achieved through: Achieved through:Achieved through: Achieved through: X% less children Improved levels of % of greenspace in the x % reduction in % increase in live in poverty satisfaction with City is rated good quality Increase in literacy smoking volunteering/comm life and is accessible and numeracy in prevalence X% unity champions Reductions in activity All major plans for adult population x% reduction in Improvement in number of NEETs regeneration of the City improved health obesity teachers Reduction in identifying Reductions in sickness absence are subject to an HIA related quality of x% reduction in children as pupil absence rates % reduction in fuel life for older people hospital ready for school Reduction in the % increase in poverty % reduction in hip readmissions for X% children number of 15 year number of people % reduction in statutory fractures in older LTCs breastfed until at olds who smoke with LTC in homelessness people Reduction in least 6 – 8 Reduction in employment – social connectedness Reduction in number of excess weeks of life number of hospital including people % self-reports of number of falls and winter deaths % reduction in admissions as a with a mental feeling safe in the injuries in over 65‟s low birth weight result of self-harm, illness or learning community babies unintentional and disability deliberate injuries in under 18‟s
  34. 34. Co-production“Co-production means delivering public services in an equaland reciprocal relationship between professionals, peopleusing services, their families and their neighbours. Whereactivities are co-produced in this way, both services andneighbourhoods become far more effective agents ofchange.” The Challenge of Co-production – David Boyle & Michael Harris, December 2009“Services do not produce outcomes – people do.” Co-production and social capital; the role that users and citizens play in improving local services – Jude Cummings and Clive Miller – October 2007
  35. 35. Further reading on co-productionhttp://www.neweconomics.org/publications/public-services-inside-out http://www.nesta.org.uk/events/assets/features/the_challenge_of_co-production
  36. 36. The principles of co-production• Recognises people as assets• Build on peoples existing capabilities• Promote mutuality and reciprocity• Build peer support and social networks• Break down barriers• Facilitate rather than deliver
  37. 37. Co-production of health & well-being
  38. 38. Co-production for health• Exploit the opportunities created bythe integration of public health andlocal government.• Use the new structures, approachesand democratic accountabilities todeliver public health outcomes and areduction in inequalities.• Maximise the new commissioningstructures to improve health outcomesand reduce inequalities when moneyis tight. http://www.sph.nhs.uk/sph-documents/local-government-colloquium-report
  39. 39. Key messages• Use the transition to start to develop a new co-production model forhealth and wellbeing.• Establish focused, agreed priorities which have meaningfuloutcomes for all partners.• Use intelligence dynamically, creatively and succinctly and inrelevant forms for different audiences.• Promote an asset based approach to communities to understandand harness their assets and resource.• Adopt a new approach to partnership and leadership whilst buildingon what has worked.• The public health workforce has to change – a new business modelneeds adopting that is pragmatic, practical and delivers solutions tocommissioners and providers.
  40. 40. Outcomes-based commissioning• The transformative potential of co-production and assets approaches is not best served by traditional procurement models.• The approach of co-production can be incorporated across the entire commissioning framework.• Providers are usually contracted to deliver a service defined by its inputs and outputs with little reference to wider outcomes• There is little or no requirement to identify and build on assets and capacity within the community• Commissioning should be designed around outcomes
  41. 41. Combining commissioning & co-production• The commissioning framework defines long-term outcomes• Potential providers are incentivised to be innovative and flexible about achieving outcomes• Co-production is specified as an approach that providers must develop• New providers can emerge• Commissioners can specify that providers develop preventative approaches to service delivery• Wider social and environmental outcomes can be built into the assessment of value for money
  42. 42. Bringing it togetherKirklees Mental Health Partnership used an outcomes-based specification for themental health advocacy service and mental health carers‟ options service.• The providers were required to base the service on the „principles of co-production‟ and recognising „the assets of the individual‟.• The specification sets out a number of expectations of the service. It set out that:people will not be seen as passive recipients of the service; that they have „assetswith value and expertise‟; they will be enabled to „explore their potential to thefullest, push the boundaries, take risks and maintain or regain increasing controlover their daily lives‟.• The six co-production principles underpin the specifications, and each onedetails the expected outcomes under those headings.• The service is monitored through a consultative forum with 50 per centrepresentation of service users and 50 per cent from the different agencies, usingquantitative data on client details, a framework of personal, community andeconomic outcomes www.yhip.org.uk/silo/files/mental-health-carers-options-service--service-specification.doc
  43. 43. How could this help us locally?• Appreciative Scrutiny• Asset Based Community Development• Community Health Champions• Resilient Places
  44. 44. Appreciative Scrutiny• By using a solution focusedperspective participants in theinquiry could see how successfultobacco campaigns have beenwith non-smokers.• Public sector tends to focus onnegative behaviour and lookingat ways to change this, ratherthan looking at the positives.• That Appreciative scrutiny canenergise officers, politicians andresidents when working togetheron an issue. http://www.cfps.org.uk/domains/cfps.org.uk/local/media/downloads/L12_658_CIFPS_Appreciative_Scrutiny_FINAL_Sept_2012_for_web.pdf
  45. 45. Asset Based Community DevelopmentThe C2 Connecting Communities Project • Co-learning: through conversations and open discussions communities and staff• Locating the energy for change: through came to realise that they both have theface-to-face conversations, door knocking, same aims and they need each other if theymeetings with local groups and are to realise those aimsassociations, finding the (small) group ofpeople who could initiate and lead the • Learning from similar areas that have beencommunity successful: residents and agency staff visited other estates to see what could be• Listening events: co-hosted by the done and to be inspired by the possibilitiescommunity and the agencies, the – they now host many visits from developingprofessionals listened to what was positive communitieson the estate, what the community thoughtthe priorities were and what needed to • Challenging the negative image of thechange estate, held by both residents and staff, so that they all believed they could make• Creating places and spaces for residents changesto connect, build relationships, haveconversations and share knowledge, and • Supporting the community to lead theencouraging local activities such as street partnership and to determine what theparties, outings, raffles and so on priorities were and what would work. http://www.healthcomplexity.net/content.php?s=c2&c=c2_background.php
  46. 46. Community Health Champions• Altogether Better has developed anaward-winning, evidence basedapproach to engaging and supportingindividuals in communities to becomeCommunity Health Champions.• Their ambition to to work to createsocial value by unlocking the assetsand resources of individuals andcommunities to create healthiercommunities and better quality healthservices.• Work together to activate the fullpotential of Community HealthChampions to improve the health andwell being of their communities http://www.altogetherbetter.org.uk/amazing-stories-collection
  47. 47. Resilient Places“At the beginning of autumn, the Jewish communitycelebrates the festival of Succos, translated asTabernacles - with its many colourful laws and customs.One of those customs involves using a type of pine, atype of fern, called cypress.This story begins as much as twenty years ago at theend of Succos. As we had done for many yearspreviously, we discarded all the cypress we had usedfor the festival and thought no more about it.Unbeknown to us, a branch of cypress has escaped theblack bin bag, and seeded itself in the crack betweenthe paving stones in our garden. Without anyoneknowing a tree began to grow which is now over 30 feettall.The years passed. Our family grew, our communitygrew and the tree grew. Good times came and wentand times of trial and difficulty came and passed.Throughout it all, I tried my hardest, somehow trying tocontrol a life that no-one can ever control.The tree is a gift G-d sent me to teach me just that. Itgrows and flourishes without me. I didn‟t plant it, I didn‟ttend it, yet its beauty and power is there for everyone tosee. It‟s G-d‟s way of reassuring me that He can do somuch without me and that He takes control of thatcontrol which will always elude us.”
  48. 48. Resilient Places Postscript – An „ill wind‟A day after the picture on the front of this report was taken, it was gone. The tree, which had inspired MrsGardner, her friends and family for so many years had been felled. Unseasonably bad weather in early April2012, including strong winds, had unsettled the roots and it was threatening to fall down in the direction of theadjoining College buildings. The photograph shows it was already starting to lean.A pessimist would doubtless say this was something of a „bad omen‟, giving a lie to the appreciative messageinspired by the tree‟s remarkable development from the seeding of a discarded branch. However it isinteresting to note the diametrically opposite view was taken.Mrs Gardner and others involved in the consultation process, remarked on the poignancy of the tree‟s demiseso soon after it was used as a powerful metaphor for the consultative process on improving health and well-being in a cohesive, faith-based community. The growth of the tree was an allegory for those things in life thatindividuals can‟t control but which can be achieved against the odds by a combination of pulling together,positive thinking, and the strength drawn from shared faith, values and beliefs.After surviving many storms the final wind had blown, the axe had fallen and the tree was a thing of the past.But its message survives and will linger in the memory of many. It is an enduring message of hope againstadversity and the inspiration that can be drawn from the world around us. This is a recurring cornerstone ofJewish teaching and appreciative thinking, illustrated just a few hundred yards from where the story of the treehad been told. The message had been delivered – the tree had served its purpose.
  49. 49. “The asset approach is a set of values and principles and a way of thinking about the world.” It takes everyone to build a healthy, strong and safe community. www.assetbasedconsulting.net