Lessons from the Alaskan Family Wellness Warriors Initiative - Conference Report

Conference - Day 2 - Workshops

The aims of the workshops on day two of the conference were:

• To consider how preventative approaches like the Family Wellness Warriors Initiative would be suitable for Scotland
• To identify interested parties who might wish to develop the thinking further
• To identify interest in piloting a model developed for Scotland

A number of themes emerged which cut across all the workshops and, as such, this report addresses those themes rather than the individual workshop topics of Awareness Raising and Community Engagement, Development of a Potential Model for Scotland and Care and Support. This still allowed us to address the aims for the day as well as the overall aim of considering whether a model of support for survivors of childhood and domestic abuse, similar to FWWI, might be appropriate for Scotland. It has also enabled us to identify some key points for Community Engagement and considering a model for Scotland.

Community Engagement

Political Leadership

It was clear from the presentations on the FWWI and CEDAR project that the involvement of communities as well as political and civil leadership is important in taking such programmes forward. The groups considered where this support and leadership would be needed for a programme of support in Scotland. If a model was developed on a local basis then support could be sought from the community, with local authority councillors and relevant MSPs and MPs. However, a national model for Scotland would require commitment from the Scottish Government, with political leadership being sought on a cross party basis to ensure future support.

Ownership

A starting point for a model for Scotland should be for the community to recognise and accept that there are problems. Some of the groups felt that the scale of domestic abuse, childhood abuse and neglect was still denied or not considered a high priority. A lack of statistical data also meant that it was not reflected in local police plans or community plans. The key was to consider how we make this a community ownership issue in Scotland.

Asking communities for their views would be the first step. The community could then work together to identify issues surrounding abuse and consider what action and funding was required to meet these needs. The next step would be to let government, local and national, know what was required and for government to actively engage with the community. Some people felt that public funds should be ring fenced, while others felt that funding might have to be addressed as part of the overall resourcing available. Any issues and decision making around funding should involve the community in question.

One of the challenges identified was the ability to turn the vision of a Scottish model into reality. That vision had to be positive, a model of wellness rather than a model dealing with abuse, ensuring it would be clear and accessible. The concept of customer owners was interesting as it emphasised that the relationship between service providers and service users should be based on equality i.e. a service delivered with people not a service done to people. This would help to build up trust and resilience in communities.

Some people highlighted the need to mitigate resistance to change within a community. For other recent changes and interventions, community champions had been identified to lead, mediate and mobilise the community. This would be important in taking forward any new model.

Engagement

Engagement would be required at both a national and local level, to join up the communities within Scotland and the community of Scotland as a whole. This would require engagement beyond current survivor organisations and networks.

In addition to the question of where engagement needs to take place, the question of how to engage was raised. Smaller events might help to get more people from the community involved. Attendance at larger organised events can often be poor because some people find it difficult to express their views in such environments. This could, in part, be overcome through engaging with people in existing groups in which they felt comfortable to express their views. Further methods of engagement could also be carried out through media campaigns and social media.

Further work would be required on how to engage with people who were not in a group or who no longer felt part of a community. Many people who had been harmed felt isolated without any interaction with family, friends or neighbours. This feeling of isolation could often be more acute in rural and remote areas and as such, different approaches would be required for villages, towns and cities. Methods of engagement would need to take account of diversity and equality. Separate engagement might be required with men's and women's groups as well as faith groups for example.

Engagement with public sector organisations could be done at a national level with the NHS and local authorities and at a local level with GPs as well as health and community centres. To address child protection, it would be important to link into and engage with the National Public Awareness Advisory Group which sits under the Scottish Child Protection Committee Chairs Forum, and at a local level all Child Protection Committees have a reference/public group as a sub group. It was also felt that religious and faith organisations should be consulted in addition to the third sector at a national and local level. Many of these organisations work directly with survivors on a local basis.

Community Engagement - Key Points

• The importance of political influence and leadership.
• A cultural change on ownership is required. Individuals and wider communities need to take more responsibility for their own wellbeing.
• The importance of engaging with the community in its entirety, using feedback from such engagement to inform service delivery and to contribute towards the development of an evidence base.

Scottish Model

Existing Services

There would be a number of challenges to directly applying the Alaskan model for use in Scotland without adaptation, for example, differences in population sizes and cultural identities. Before a Scottish model could be seriously considered it was suggested that historic attitudes and ways of working between agencies, organisations and institutions related to survivors, needed to be addressed. Some people felt that many current services are risk averse. Any new approach would need to address this, to accept that things might not work first time as well as to be more ready and willing in dealing with situations where things go wrong. At the moment, the top-down approach of national and local government to service provision and funding has significant influence on service design and delivery. The result of this can be that services are inhibited in their scope and levels of innovation. This risk is something that would need to be addressed.

The Nuka healthcare system and the FWWI represent a highly integrated model of health and social care that a number of group members felt would be difficult to replicate in Scotland. However, many felt that a more integrated model of care would be desirable and something worth pursuing.

An integrated system of care would include an awareness of services available, something that a number of people felt that they already possessed. However, many others felt that they were working in isolation, particularly in rural areas. They did not always know what other services were available in their area, to enable a wider choice of services supporting clients. A greater awareness of services could help identify any overlap in service provision. A fully integrated approach would need to include the public sector, noting the potential of training for GPs and other frontline workers and the value of education and training to understand and connect both the physical and mental health effects of abuse.

It would be important to recognise the makeup and diversity within communities in identifying what would be required. There is a difference in access to services in rural areas where it is more difficult to co-locate these services than in urban areas. It would also be important to factor in the needs, for example, of ethnic minorities where a culturally informed approach to bringing services and representatives of the communities together would need to be considered.

As a first step it was felt that there should be a mapping of existing services; health, social care and the third sector. Doing this could enable organisations to work together better, share skills and knowledge and identify the best person and/or organisation to address the needs of the survivor. It would also build towards an evidence base for the development of any future Scottish model.

Alternative models

Given the landscape and diversity of Scotland some people thought that a single existing model would not work and that a number of different approaches would be required.

The groups felt that there was a need to look at a range of models from Scotland and abroad, beyond the FWWI. Some suggestions were:

• The Caledonian System - an integrated approach to address men's domestic abuse and to improve the lives of women, children and men
• Systemic Family Therapy
• CEDAR
• Existing models in the voluntary sector

While many felt the FWWI was an excellent business model others felt that, although they had heard a lot about its aims and outcomes, it would be helpful to know more about how these aims and outcomes were achieved. The FWWI's emphasis on breaking the silence on abuse and on preventing future abuse was welcomed. Yet, it was felt that it was unlikely that an existing, unmodified model could be fit for purpose in Scotland and that work to adapt any potential model would be required. In addition to learning from best practice of alternative models, it was suggested that much could be learned and shared from other policy areas as part of a wider strategy to tackling domestic violence, childhood abuse and childhood neglect.

Person Centred Approach

The groups felt that there should not be a ready-made agenda or model but instead, survivors should be asked what they need. It was felt that a bottom-up approach is needed, addressing the needs of the individual and having the individual inform the design and delivery of the support, not the other way around.

A number of group members felt that statutory services in health and social care did not take care of the whole 'you', that there was often a lack of communication and little consistency in delivery of care. For example, some indicated that they felt lost in bureaucracy when they had reported abuse to their GP. As a result, they felt that a range of professionals became involved in their lives, when it would have been preferable to work intensively with one organisation or professional who could provide long-term support as required. There were also concerns about the number of times information would be shared amongst organisations and professionals. To address these concerns it would be helpful if a range of services e.g. health, housing, advocacy and rights support and police could be located in one place. This could further encourage partnership working, opportunities to share information and easier access to services.

Funding

Third sector organisations highlighted the barrier of funding for existing services. That is, it was often difficult to identify the funding streams available, funds were allocated for a, often short, set period of time and the priorities often changed. The restrictions and boundaries of funding streams, often target driven, could also inhibit the scope and collaborative potential of organisations. It was felt that project managers and skilled staff were dedicating too much of their time developing plans, applications and reports instead of supporting survivors.

Some people felt that we should look at what could be done with existing funding rather than rely on additional funding. Addressing things now that would also be important in the future, making sure that the right services were in place, services that survivors helped to identify rather than those chosen for them. For example, investing in prevention and person-centred support could reduce the necessity to access Primary Care services.

Faith

The FWWI model is a faith-based model, although its origins were not faith-based. For some, such a model was an issue as many survivors had been abused by church representatives and had felt let down by the church.

Others took a different view where they felt that engaging with religious leaders could be a means of gaining access to otherwise insular communities. It was acknowledged that faith did not necessarily mean religion. It is still possible to have a personal faith or cultural belief without that being associated with a particular religion, and that this should be taken in to account when considering any model for Scotland.

Language

Language was considered to be important in both understanding existing models and developing any future model, as it frames and informs wider discussion. A number of people felt that the language used in the FWWI did not speak to them and their values. For example, it appeared that there was an imbalance of power and control being handed to men (warriors) as the message about Princess Warriors did not come out clearly in the presentation. The language of the model did not make it clear that this was about the whole family and not just about men.

The groups highlighted the importance of addressing the stigma attached to abuse and neglect. People often felt they were labelled by professionals and related services, and that they were treated as a community problem. A number of people liked the language of the FWWI which spoke of those who have been harmed rather than victims or survivors, and those who have harmed or caused harm rather than offenders or perpetrators. This helped to reduce some of the perceived barriers, stigmas and labels associated with these terms. Such a change in the language used would be important for the families of those who had caused harm, as they can be associated with the same stigma.

People were clear that the development of any new model should have a positive message, with the positive role models featured in the FWWI and CEDAR project providing key examples of this. The model should seek to reframe the discourse and focus on wellness rather than abuse. It should be about achieving goals rather than problems and aim to remove not reinforce negative stereotypes and stigmas. All language used in the development of a Scottish model should be clear, meaningful and free from jargon.

Legislation

The groups felt that new legislation was not required to take this work forward. Instead, it was felt that better use can and should be made of existing legislation. For example, Self-directed Support legislation (SDS) provides people with increased choice and control over their assessed social care needs. SDS focuses on the outcomes of the individual, placing them at the table when any support plans for their care are being made. In part, the aim of this is to address the imbalance of power between the professional and the individual, giving the individual a bigger role and say over their care.

Moreover, health and social care integration in Scotland aims to ensure people are supported to live well at home or in their community for as much time as they can. This approach stems from the Christie Commission Report (2011) on the future delivery of public services which said: ". . . effective services must be designed with and for people and communities - not delivered 'top down' for administrative convenience". It was strongly felt that this approach should apply equally to the services that survivors are seeking.

Scottish Model - Key Points

• A mapping of existing services is required, particularly identifying areas where there was already a good model of partnership working.
• Important to consider other models as well as FWWI.
• An inclusive approach is important to the development of any Scottish model. Ensuring that wider communities are involved throughout the model's development rather than statutory services exclusively leading the way.
• The importance of collaborative working at the level of individuals. There was a view that there is a tendency to focus on professionals working with professionals, organisations working with organisations and little discussion about working with individuals and service users.
• It was felt by some that a consistency in service provision and advice for service users can be problematic when there are various organisations offering duplication of services for survivors with their own approaches. This lack of consistency was said to be exacerbated due to organisations competing for the same funding, leading to the possibility of a non-collaborative approach between organisations.

Plenary

Some of the questions identified had already been addressed during the workshops. The key points from the discussions have been outlined below:

Plenary - Key points

• Identifying the needs of any model should involve the whole community. This means finding ways of engaging people who do not normally identify themselves as part of a community and those who are socially isolated.
• Service providers and service users have to be prepared to take shared responsibility for and ownership of change.
• Any new model should be complementary to or part of existing services. This could mean a re-alignment of existing services but not a replacement of them.
• Support would be required for service users and providers before and during their engagement with any new approach and continuing care should be in place following this experience.
• Education is important in raising awareness and tackling stigma.
• Outcomes need to be measured to demonstrate success and highlight where things have not worked or where further work is required.