Covid recovery: learning from person-centred approaches

Annex 2: Case Study – Child Poverty Pathfinder Dundee (Best Start Bright Futures)

1. Why was this case study selected as an interesting example of a person-centred approach?

This case study offers insight into effective practice around engaging with people who have previously had little contact with services. The use of place-based working provides understanding around the person within their community and assets which can be drawn on to meet agreed aims.

This case study explores a strategy to reduce child poverty, a significant policy priority. Additionally, the interaction with other policies such as The Promise^[1] and GIRFEC ^[43] is interesting as Best Start, Bright Futures ^[7] moves beyond service provision for children and young people and into the wider context of family and community.

2. What elements of this policy are of particular interest in relation to learning about person-centred approaches?

The nuances around person-centred approaches provide insight into the importance of where and by whom services are provided. This case study explores ways of working ethically, "with dignity, respect and kindness" and without stigma or discrimination.

3. Does this case study relate to the period during which Covid restrictions were in place? If so, how?

Yes. The policy acknowledges the disproportionate impact of the pandemic and restrictions had on people already experiencing poverty. Although the evaluation does not directly discuss the pandemic, some themes from this case study are explored in other documents and as such it is possible to make links, particularly around the economic impact of Covid-19.

4. What were the enabling factors that supported a person-centred approach?

In recognising and seeking to address the issue of mistrust towards government agencies, this policy uses local, familiar people to engage with those who have no or limited prior involvement with services. Having a presence in the community, being known and being visible, is identified as enabling the relational aspect of person-centred approaches. Significantly, staff were known positively by reputation and word of mouth endorsement very much supported the making of connections in the local area.

The relational aspect of person-centred approaches is strongly evidenced in the evaluation, with participants describing staff as "lovely" and "easy to talk to". Staff coming from the local community was seen as a way to overcome barriers to accessing support as participants valued the sense of being in the same situation, and not "being looked down on".

In acknowledging the need to build trust, this case study recognises that the workforce is required to be dependable. A holistic approach where priorities are set by the person and some goals quickly achieved demonstrates not only understanding but dependability.

By working holistically, and recognising the interaction between complex variables and employability, goals can be realistic and move towards lifting a family out of poverty. Acknowledging the needs of the family as a whole appreciates the caring responsibilities of people, and identifies which professionals may be best placed to provide support, such as health visitors. This links to wider policy aims such as "no wrong door" and involves widening the knowledge base of professionals beyond their traditional remit.

5. How does this case study help us to understand the strengths of person-centred approaches?

Working holistically and ethically can enable co-production towards shared aims. Working to shared aims can prevent people becoming overwhelmed by the multiple and complex issues they face. Goals and methods can be changed to suit the needs of the family, providing choice and flexibility, important aspects of person-centred approaches.

While the focus of this policy is on families, it is also acknowledged the positive impact on the wider community by utilising and developing strengths within the local area.

6. What does this case study suggest might be some of the limitations of a person-centred approach?

Although the evaluation commends the holistic qualities of the project, it also highlights the lack of clarity which this can bring, reporting that there is often some vagueness around what its aims are. Connected to this lack of clarity are problems around measuring success. A related point was made by a respondent who advised that they believed that they were already providing a holistic service. The need for triage and the avoidance of duplication raised by respondents suggests potential unintended consequences to the "no wrong door approach".

Although qualitatively there is evidence that people value the relational aspect of the strategy, it is more difficult to determine a link between this and outcomes.

The lack of an exit strategy was also noted; this is particularly important where relationships are very important to the person. Managing expectations around a holistic and bespoke service, which is resource intense, was also noted by stakeholders.

The evaluation indicates the importance of understanding nuanced perspectives around the experiences of person-centredness. Although workers being known and trusted in the community was mostly regarded as positive, the lack of anonymity was an issue for some. Similarly, although the use of publicly available spaces for meetings may make services more accessible and less stigmatising, a respondent felt this diminished privacy and confidentiality.

7. What is the key learning from this case study relating to person-centred approaches?

The relational and holistic aspects of person-centred approaches can be effective in engaging people with limited experience of service provision. The importance of trust, dependability, and a sense of being understood is significant. In working with people with multiple and complex needs, co-production is effective for setting achievable goals.

Engaging with people in their communities can be instrumental in making public services more accessible. The use of people who are known within the local area can foster confidence and strengthen the wider community as a resource to be drawn on. At the same time, care should be taken to ensure privacy, confidentiality and dignity are not compromised.

Clarity is required around roles and remits of staff from different agencies where a "no wrong door" approach forms the basis of service provision. Similarly, where resources are under pressure, an exit strategy should be understood by those involved in offering and receiving support. Openness around mutual expectations is required to maintain trust.