Asset-based approaches in service settings: striking a balance An illustration of asset-based approaches in services, and an exploration of their potential for the future March 2017 Jennifer McLean Valerie McNeice Charlotte Mitchell Acknowledgements We are grateful for the warm welcome we received at each service and for the co-operation and interest of all the organisations and individuals who participated in this research study, who opened their services and day jobs to us, and who shared their learning, insights, opinions and experiences. Thanks also to the staff of the GCPH for their continued support and encouragement, and to Sara Dodds, Lisa Garnham, Lorna Kelly, Lisa Pattoni and Carol Tannahill for helpful comments and feedback on drafts of this report. We continue to be inspired by people working with sensitivity, compassion and the importance of building relationships at the centre of all they do. Photographs featured in the Family Nurse Partnership case study are taken from the NHS Scotland Photo Library. Contacts Dr Jennifer McLean Public Health Programme Manager Email: [email protected] Twitter: @theGCPH Web: www.gcph.co.uk Contents Part One: Research report Key points 5 1. Asset-based approaches in Scotland: where are we now? 6 2. Research aims and objectives 11 3. Research approach 12 4. Findings: Illustrating asset-based approaches in services: findings from the case studies 18 The potential of asset-based approaches: findings from the stakeholder interviews 29 5. Learning from the research 42 6. Looking forward: forward thinking, discussion and action 49 7. Final reflections 54 References 55 Part Two: Case studies Primary Care Learning Disability Local Area Co-ordinators 61 The Bridging Service 77 Healthy Mind 90 Family Nurse Partnership 101 musicALL 116 North West Recovery Communities 130 The ‘nurturing’ approach 144 Cassiltoun Housing Association and Cassiltoun Trust 157 Violence Reduction Unit in Hawkhill 169 Appendices Appendix 1: Research protocol 183 Appendix 2: Notes on terminology, including asset-based principles 186 Appendix 3: Interview topic guides – case studies 188 Appendix 4: Case study analysis framework 190 Appendix 5: Interview topic guides – stakeholder interviews 191 Appendix 6: Themes emerging from ‘Assets in Action’ 192 Part One Key points Discussions about asset-based approaches now permeate several areas of public policy in Scotland, and are informing and influencing the planning and delivery of services across Scotland. Across Scotland, a number of national and local statutory, third sector and community-led organisations are already working in an asset-based way while others are developing asset- based approaches as a means to improve health and wellbeing and tackle deep-rooted social problems. However, a number of key questions around this way of working within the public sector remain, despite the receptive policy landscape and the increasing number of examples of practice and people and organisations engaging with the debate. Adopting a two-phase qualitative methodological approach, this research profiles the work of a number of mainstream statutory services embedding asset-based principles in their approach to service delivery, and uncovers opinion and thinking on the potential of this way of working within public services in a Scottish context. The individual case studies presented in this report reflect the experiences, delivery, management, activities and learning arising from each service. Although each case is unique, a number of interconnected themes emerged across aspects of structure, culture and learning. The importance of relationships, partnerships, citizen involvement and collaborative endeavour as central tenets of asset-based working within a services context was evident. Going beyond describing asset-based approaches in practice, the research also placed a focus on exploring the potential of asset-based approaches. A number of interrelated themes relating to features of language and terminology, balancing power and possibility, the interplay of policy and practice, and the attitude or intervention debate, were identified. A step towards asset-based approaches was broadly supported by stakeholders. Across the research, the importance of evidence in supporting, legitimising and justifying the approach, despite the current limitations of the research base, was evident. Important questions were also raised as to what constitutes ‘evidence’. The language of asset-based approaches remains a contentious issue, and although defined and described differently, a mutual and shared understanding of the underpinning values and principles was clear. A number of enablers and constraints to working in an asset-based way, including issues related to power and control, leadership and management style and organisational cultures, were identified and are discussed. The asset-based workforce was seen to be striving to work collaboratively and developmentally with a clear vision for change while retaining good governance and a focus on delivery. Resulting from the research, key points requiring further discussion, thinking and action are presented. 5 1. Asset-based approaches in Scotland: where are we now? The Scottish Government has expressed a commitment to reform public services to build on the assets and potential of individuals, families and communities1-7. With a decisive shift towards prevention, partnership, participation and citizen involvement at the core5, the public services reform programme aims to maintain an “emphasis on achieving the outcomes that matter the most to the people of Scotland and to lead public services into new ways of working and thinking, new understanding of people’s needs and innovative ways to meet those needs”5. Furthermore, at national level the reform programme recognises and emphasises the importance of partnership working and collaboration to ensure that “public services are built around people and communities”4, that individuals are able to exercise more choice and control over the types of support they need for better health and wellbeing outcomes, and that individuals and local communities are empowered by involving them in designing and delivering the services they use. In recent years, discussions about asset-based approaches have permeated several areas of public policy in Scotland, including the work and function of the Scottish Government8,9. These discussions are informing and influencing the planning and delivery of services at a local area level in Scotland6,10,11, including those which impact on health and wellbeing. The integration of health and social care, through the passage of the Public Bodies (Joint Working) (Scotland) Act 20142, is a further dimension of public service reform. The Act supports the provision of personalised and flexible services, planned and delivered from the perspective of the service user or carer, and a clear shift in focus from providing care in acute service settings to providing care and support at home or in an individual’s community. A strong moral and ethical case is emerging for a health and care system which starts with what matters to individuals and recognises the contribution that strong, resilient communities can make to support health and wellbeing12. What difference could asset-based approaches make to health and wellbeing? Despite extensive efforts and improvements across public services in Scotland, inequality continues to grow13-15. It is now recognised that to achieve a fair and equitable Scotland with positive outcomes for all, there is a need to re-examine both the structural causes of inequality and poverty and the role that public services play in alleviating and reducing their impacts16. Examining current issues in terms of asset-based approaches may allow us to think differently about the dynamics between the state and the citizen, and the relationship between service providers and people using services16. This shift in Scottish policy direction embraces a move towards asset-based approaches with a focus on ‘what keeps us healthy, rather than makes us ill’17, in an attempt to bring together both the causes of and the treatment for inequality and poor health. It has been argued that the approach and methods used to improve health must be transformed in light of the changing nature of disease, in the context of unprecedented funding pressures on health and care services, and the recognition that current models of delivery of public services are no longer effective in addressing causes of ill health and poor quality of life. In many instances these current models may no longer be desirable or sustainable in the longer-term. 6 | Asset-based approaches in service settings: striking a balance It is now widely accepted that health is more than simply the absence of disease, and health improvement does not happen solely through clinical means18. Viewing ‘health beyond the lens of healthcare’ and embracing a broader definition to encompass aspects of safety, physical functioning, control over one’s life, nourishing relationships, financial and emotional security and a sense of meaning19 may make it possible to further create and sustain health and reduce the demand for health services. The aims of the public services reform programme in Scotland clearly reflect the principles of an asset-based approach20. In theory, asset-based working means valuing the skills, strengths and successes of individuals and communities, recognising the importance of achieving a balance between service