Lessons from the Alaskan Family Wellness Warriors Initiative - Conference Report

Conference - Day 1

The aims of the first day were:

• To share and learn lessons from community-based programmes such as the Family Wellness Warriors Initiative
• To consider how we provide services for adult survivors of childhood abuse in the future

The conference heard from a number of speakers who were invited to provide a picture of the services in Scotland at present, the wider context that these services operate in, and provide examples of current work being undertaken to improve these services in the future.

Michael Matheson MSP, Minister for Public Health opened the conference, highlighting the Scottish Government's commitment to support survivors of childhood abuse through the SurvivorScotland Strategy. The Scottish Government's aims are to put people at the centre of their care, as seen in the FWWI and Nuka healthcare system. He underlined the significance of the integration of Health and Social Care in Scotland as a key part of achieving a person-centred approach. He recognised that there were a variety of innovative services for survivors in Scotland but that there was always more that could be done and that Scotland is willing to learn from and share good practice the world over.

Following Mr Matheson's overview of the Scottish Government's work, Dr Andrew Fraser, Director of Public Health Science, NHS Scotland, provided a wider context of some of the challenges that face Scotland's public health, including a range of issues for survivors of abuse. Dr Fraser stressed the need to look at the whole picture of abuse, including domestic and childhood abuse; neglect; associated health inequalities as well as contributory cultural factors like consumption of and attitudes towards drugs and alcohol. Within this context consideration was then given to how services for adult survivors of childhood abuse could look in the future. Examples of this included the FWWI, the CEDAR Project and the Violence Reduction Unit's work with gangs, mentoring programmes, and work in prisons. A key component of all these programmes was their engagement with communities, families and individuals.

Our main aims for the day were to share and learn lessons from community-based programmes and to consider how services are provided in the future. Leading up to the conference, we had a short consultation on FWWI with some of our stakeholders who highlighted the desire for community-based programmes and their engagement with communities. The CEDAR project is one such model originating from Canada, which had been successfully implemented and further adapted in Scotland.

Heather Coady, the National Co-ordinator described factors which were important in introducing the CEDAR model in Scotland and which would be equally important in developing a model of support for survivors of childhood abuse. These included an action research approach; multi-agency learning and integration; the need for multiagency buy-in, for example, statutory services, NHS, Police, head teachers, Women's Aid and voluntary organisations. A key component of this work was maintaining a person-centred approach throughout service design and delivery. Heather's experiences of adapting a model from outwith the UK, with its own distinct social, civic, political and geographical environments, and overcoming these differences to make CEDAR viable in Scotland, helped to provide an example of how a model similar to FWWI could be adapted for Scotland.

The conference went on to hear what lessons could be learned from community-based programmes outside Scotland. Katherine Gottlieb the President and CEO of Southcentral Foundation and Steve Tierney, Michelle Tierney and Kevin Gottlieb spoke about FWWI and the Nuka model of health and social care. FWWI harnesses the power of story to break the silence associated with abuse and aims to initiate a safe, healing journey through drawing upon cultural strengths that can be used to address the spiritual, emotional, mental, and physical effects of abuse. Underpinning FWWI is the Nuka model, a healthcare system that has been transformed in its entirety, with shared responsibility, commitment to quality and family wellness at its core. Shared responsibility comes through people taking responsibility for their own wellness as customer owners. Employees and volunteers also commit to the idea of customer owners and undergo core concepts training which is designed around the concept of wellness:

• Work together in relationship to learn and grow
• Encourage understanding
• Listen with an open mind
• Laugh and enjoy humour throughout the day
• Notice the dignity and value of ourselves and others
• Engage others with compassion
• Share our stories and our hearts
• Strive to honor and respect ourselves and others

The experiences and work of Southcentral Foundation provided attendees with an insight into an alternative view of healthcare provision and how the principles and approach of such a system can inform wider services, including services for adult survivors of childhood abuse. Paul Gray, Director General Health and Social Care, Scottish Government and Chief Executive NHS Scotland echoed some of these sentiments. He praised the courage of survivors who came forward to talk about andshare their experiences. He highlighted the importance of talking to each other and recognised the need to learn from other successful models, recognising that services must be for and about people.

Plenary

A number of points emerged during the presentations and were put to the panel, made up of the speakers of the day:

• People need to accept responsibility for their own health and wellbeing
• Survivors need to be involved in making key decisions rather than decisions being made for them
• The concept of customer owners was something that people liked but felt that there was a long way to go before there was customer ownership in Scotland
• There is a need to recognise that men and boys also suffer from abuse including domestic abuse and should have a model of support like CEDAR or FWWI. Any model of support needs to be about the whole family, recognising men and same sex relationships
• It is possible to address difficulties in rural areas. We have already started this in Scotland through telecare which the Nuka model also recognises as a key element of its health and social care delivery
• Professionals need to be prepared to let go, to embrace change. While they are experts in their own fields, it is the people who are the experts in their own lives. Change is needed to enable them to break the silence
• Child protection is important in helping to identify and prevent abuse
• There needs to be support for transition from children's services to adult services. There also needs to be additional support for adults in transition from one service to another