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: ‘Asking about ACEs’ (Adverse Childhood Experiences)
Fair Society, Healthy Lives: The Marmot Review (2010).
City centre rough sleeping and street activity in Stoke-on-Trent
Qualitative study of city centre street activity and rough sleeping in Stoke-on-Trent: 2016-2017, VOICES of Stoke-on-Trent.
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 project aimed to 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 through interviews with individuals engaged in rough sleeping and/or street activity and surveys/interviews with 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 available to download here.
Massie, R., Machin, R., McCormack, F. & Kurth, J. (2018) Having a voice: a collaborative research project exploring the challenges and assets of people experiencing homelessness. Journal of Integrated Care. doi: 10.1108/JICA-02-2018-0017
Evaluation of a pilot project: ‘Asking about ACEs’ (Adverse Childhood Experiences)
This study is an evaluation of the pilot project ‘Asking about ACEs’ which is being trialled in two organisations in Stoke-on-Trent. The services involved are Arch and Youth Offending. It is a 6 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).
Routine Enquiry about Adversity in Childhood (REACh) is the process of systematically asking individuals about adverse childhood experiences during routine assessments (McGee et al, 2015). The ‘Asking about ACEs’ pilot follows the same principle. 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 the 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 the end of 2019.
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.
COVID-19 and Homelessness: National policy at the local level
The Centre for Health and Development (CHAD)set out to explore the ‘Everyone In’ initiative during the first emergency COVID response to rough sleeping (March-June 2020), and how the national policy was playing out at the local level. We interviewed a range of stakeholders at the local level (in Stoke-on-Trent), regional level (West Midlands) and nationally.
As the COVID-19 situation and government response has evolved, much changed in the months following data were collection, but some of the learning and take home messages remain relevant.
This was a collaborative project CHAD, Expert Citizens, VOICES of Stoke-on-Trent and Public Health England. The research was made possible by the National Lottery Community Fund through VOICES.
This research is available to download here.
Doctoral research projects
Louise Summerfield – Exploring measurement of social isolation and loneliness in the development of a screening tool for primary care (louise.summerfield@research.staffs.ac.uk).
Should require any further information about, details of, or access to any of our research, projects, publications or associated publications, please contact us.