The Health Inclusion theme focuses on the health and wellbeing of people in Staffordshire and Stoke-on-Trent who may experience complex and multiple needs and/or who may have difficulty accessing universal services. This could include, but is not limited to, people who experience substance misuse, homelessness, mental distress, migrants, and/or offenders.
This theme is important because people from marginalised groups often have poorer health outcomes. The Marmot review (2010) sets out six policy objectives that are required to reduce health inequalities. Included in those objectives is the need to enable all children, young people and adults to maximise their capabilities and have control over their lives, and to ensure a healthy standard of living for all. Thus, health inclusion and ensuring that there is equity in terms of opportunities for health and access to services are important in the reduction of health inequalities.
CHAD projects that sit within this theme are:
- City centre rough sleeping and street activity in Stoke-on-Trent
- Evaluation of a pilot project: Routine Enquiry about Adversity in Childhood
City centre rough sleeping and street activity in Stoke-on-Trent
This research is a qualitative study that focuses on city centre street activity and rough sleeping in Stoke-on-Trent. For this piece of work, we were successful in securing a tender opportunity advertised by VOICES. A multidisciplinary team from Staffordshire University worked alongside VOICES and Expert Citizens to understand what is happening currently and what can be done to help improve the situation.
Homelessness, including rough sleeping, has been rising nationally. Stoke-on-Trent is no exception. Stoke-on-Trent has a wide range of assets available aimed at helping people experiencing homelessness to recover. This includes statutory, voluntary, community, and faith-based organisations. This research aims to help inform the debate locally about perceived city centre homelessness and anti-social behaviour. This is with a view to further inform the development of positive city centre solutions which recognise the needs of people who are engaged in street activity alongside those who live, work and shop in the city centre.
We used participatory appraisal methodology – a cycle of research, data collection, reflection and learning – to build community knowledge and encourage collective action. A key part of this research was that Expert Citizens, individuals with relevant lived experiences, conducted data collection. Data collection consisted of:
- Interviews with eight individuals engaged in rough sleeping and/or street activity
- Surveys/interviews with ten wider stakeholders.
Following data analysis, CHAD held a wider stakeholder event to share the research and discuss the findings. The event was well attended by a wide range of individuals and included representatives from the local authority, police, housing and third sector organisations. Bringing stakeholders together in this way helped to generate a set of co-produced recommendations to improve experiences for all in the city centre.
This research is now complete and the report is available to download here. We are currently working on papers for publication and looking into ways to build upon this research.
Evaluation of a pilot project: Routine Enquiry about Adversity in Childhood
This study is an evaluation of the pilot project ‘Routine Enquiry about Adversity in Childhood (REACh) which is being trialled in three specific services in Stoke-on-Trent and North Staffordshire. The services involved are Arch, Lifeline and Community Rehabilitation Company (CRC). It is a 12-month pilot and is being co-ordinated by Stoke-on-Trent City Council and evaluated by CHAD. We were successful in securing funding for the evaluation from Staffordshire Police and Crime Commissioner.
Adverse Childhood Experiences (ACEs) are a complex set of childhood experiences before the age of 18 that can include: sexual abuse, emotional abuse by a parent/caregiver, physical abuse by a parent/caregiver, emotional neglect by a parent/caregiver, physical neglect by a parent/caregiver, drugs/alcohol abuse in the household, having witnessed abuse in the household, a loved one in prison, loss or abandonment of/by a parent/caregiver, and mental illness in the household (McGee et al, 2015). Existing evidence has found that increasing ACEs are strongly related to adverse behavioural, health and social outcomes including, for example, involvement in violence, early unplanned pregnancy, incarceration, unemployment and problems with drug use and drug addiction (e.g., Felitti et al, 1998; Bellis et al, 2013).
REACh is the process of systematically asking individuals about adverse childhood experiences during routine assessments (McGee et al, 2015). Ultimately, the goal of this pilot is to enable individuals to move forward, changing focus from ‘what’s wrong with me’ to ‘what happened to me’, supporting people to break the cycle of risky behaviours/coping mechanisms and reduce demand for repeat interventions.
CHAD is conducting a mixed methods evaluation of this REACh pilot. There are three main elements to this evaluation:
- Conduct secondary analyses of service data
- Collect qualitative data from clients to explore impact, experiences and delivery of the pilot
- Collect qualitative data from service providers to explore views about implementation, delivery and impact of the pilot.
We anticipate completing this piece of work by Summer 2018.
Bellis, M.A., Lowey, H., Leckenby, N., Hughes, K. & Harrison, D. (2013). Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health, 36(1): 81‐91. doi:10.1093/pubmed/fdt038.
Felitti, M.D, Anda, R.F., Nordenberg, M.D, Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P. & Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4): 245‐58.
McGee, C., Hughes, K., Quigg, Z., Bellis, M., Larkin, W. & Lowey, H. (2015) A Scoping Study of the Implementation of Routine Enquiry about Childhood Adversity (REACh): Blackburn with Darwen. Liverpool: Centre for Public Health, Liverpool John Moores University.