Tony Bullock, Dr Samantha Weston and Dr Aliko Ahmed explain how the new focus on public health is an opportunity to involve the whole community in addressing alcohol and drugs challenges through an asset-based approach.
There is no shortage of negativity in the drug and alcohol field. Crime, social exclusion, lack of education and employment opportunities, depression and anxiety, services under enormous pressure and increasing hospital admissions – are all familiar features of the lives of service users, providers and commissioners. However, the recent transfer of public health to councils and the establishment of health and wellbeing boards offer a fantastic opportunity to address alcohol and drugs challenges synergistically with communities and public services. This article describes how a growing understanding of asset-based perspectives has influenced the transformation of a local drug and alcohol strategy and shone a different – and much more positive – light on a number of key issues.
Asset-based approaches have some obvious attractions; it is much more satisfying to take an optimistic view of situations and to focus on opportunities rather than problems. This perspective certainly influenced the early stages of the most recent developments of the drug and alcohol strategy in Staffordshire. However, as this process progressed, asset-based ideas became increasingly relevant to many of the key challenges, and a common thread emerged between what were originally conceived as a number of separate ideas that may actually be mutually supportive – possibly suggesting something of a ‘virtuous circle’ in this inherently risky and problematic field.
The new approach to drugs and alcohol in Staffordshire is placing an increasing emphasis on prevention and early intervention, but perhaps the most significant development is the current redesign of the treatment system, which has incorporated a number of asset-based themes.
The first of the ideas being developed is the key role that community assets are likely to play in the redesign of the treatment system, which is currently out to tender. The multiple and complex needs of clients – often including polydrug/alcohol use combined with inadequate housing, unemployment, mental health problems and a range of other issues – presents a major challenge in the county. Given the demands on interventions (not least from the high prevalence of dependent drinkers that dwarfs problematic drug use), it is unrealistic to expect service providers to have the capacity or expertise to comprehensively address this array of issues. Consequently, a core feature of the model outlined in the tender specification is the requirement for the new care pathway to be thoroughly embedded within the existing abundance of people, voluntary associations and mainstream health and social care services that have the potential to help those with drug and alcohol problems, in terms of housing, relationships, education and employment.
The recognition of clients’ complex needs and the benefits of multi-agency working are nothing new or unique to asset-based approaches. There are excellent examples of innovative partnerships between services locally and elsewhere. However, while multi-agency working with mainstream services features in best practice guidance and in many aspects of service delivery, it appears to be often somewhat peripheral to the perhaps more central concerns relating to the technical requirements of delivering evidence-based interventions.
These concerns were highlighted in a study of community treatment services in the north of England that found excellent examples of keyworkers working closely with other health and social care agencies for the benefit of their clients (Sick, deviant, or something else entirely: The implications of a label on drug treatment progression, recovery and service delivery, University of Manchester). However, this interaction was highly variable with, in some cases, staff in the same agencies working in the same room having a very different understanding and experience of working with mainstream services. This isolation was starkly contrasted with the close relationships observed within criminal justice agencies, where joint working protocols were clear, expectations on both sides were well documented and co-location of service delivery normalised. There were some examples where mutually beneficial relationships had been fostered in other areas, but this was far less systematic. These points are by no means meant as criticism of people with high caseloads of complex people in difficult working environments, but help to illustrate the peripheral nature of multi-agency working within some sectors.
Acknowledging the potential benefits of community assets, we are working with Baseline Research and Development to ‘map’ resources (local people and organisations), build connections between them and explore how they could potentially enhance existing provision. This process will help us to understand how community-led initiatives are initially formed and developed, and this learning will be used to help establish similar activities where they do not currently exist. Ultimately, we hope to encourage strong relationships between specialist interventions, mainstream services, voluntary associations and local individuals that will enable the co-production of a vibrant pathway that both draws from and gives back to local communities.
A second way in which asset-based approaches are being explored in Staffordshire is through the recognition of the role that the development of personal assets (strengths and interests) can play in people’s recovery – ideas that were firmly established through the emphasis on ‘recovery capital’ in the 2010 drug strategy. In the same way that health is much more than the absence of sickness, recovery is perhaps much more than the absence of addiction, and the development of protective factors have a role to play alongside the alleviation of problems or deficits.
There are a number of ways in which strengths and interests are being encouraged in Staffordshire, including the recent launch of RIOT radio (www.riotradio.co.uk) – an internet-based radio station run by people in recovery. The station provides the opportunity for people to express their talents, as well as develop new skills and interests. Following a small amount of investment and training, the station broadcasts for up to ten hours a day, five days a week and is hoping to apply soon for an FM licence to broadcast locally as a traditional community radio station with a recovery twist. Not only does the radio station provide the opportunity for people in recovery to build and display their skills, and thereby strengthen their recovery, it also provides the opportunity to give something back to the community – one of the founding principles of the station is that it broadcasts a positive message, a highly visible (or audible!) form of recovery.
People as assets
Through the radio station and other similar projects it is apparent how the people in recovery and recovery communities become assets to the wider community, helping other people struggling with drug and alcohol problems, breaking down stigma, and contributing to society through fund raising and huge amounts of voluntary work.
Observing such positive activities sparked the idea of this article: people in recovery (not least through recovery communities) can be enormous assets to their local neighbourhoods and community-led organisations. These initiatives have huge potential to enhance specialist treatment provision – while services can encourage the development of personal strengths and interests, they can also enable people to become assets themselves, presenting what might be considered a ‘virtuous circle’.
A real ‘light-bulb’ moment occurred at one of the asset-mapping workshops that wonderfully illustrated the potential of asset-based approaches. What became clear from the session was that there are numerous local people and organisations that are putting huge amounts of time and effort into developing their community, not for financial reward but because of a deep-held desire to make their areas better places for people to live. However, this begged the question of how much these community assets could achieve with just a small amount of external support and resources, given the inherent motivation and time contributed without cost.
While the activities of some of the local organisations may not have a direct impact on people’s recovery, they did raise the possibility that asset-based community development (ABCD) could potentially operate as a form of prevention. While drug and alcohol problems clearly impact across all communities, they are disproportionately concentrated in the most deprived areas, where risk factors are high and protective factors low. However, the evidence base for effective prevention appears to primarily relate to initiatives focused on changing the behaviour of individual people (such as education in schools) and to some extent families (such as the Strengthening Families programme).
Given the social elements of drug/alcohol problems and their concentration in often closely defined localities, the ‘community’ could perhaps become the focus of prevention. An ABCD approach offers opportunities to make communities more cohesive, build connections and enhance protective factors, all of which could act to prevent drug/alcohol problems developing in the first instance. While this, at the time of writing, is very much only a germ of an idea, exploring community-focused initiatives with an asset-based approach is perhaps something worthy of further examination.
The asset-based perspective has contributed much more to the development of the local strategy than was originally anticipated. This is probably because the insights outlined above touch on what are fundamental but sometimes under-estimated issues: people with complex needs can benefit from the community and not just specialist resources; building strengths/protective factors can complement addressing needs/deficits; and people in recovery are often enormous assets to recovery and wider communities. While asset-based perspectives may not offer wholly new ways of working (all of the examples cited above draw from existing approaches), they nevertheless suggests a common thread between what otherwise appear as somewhat disparate ideas and could usefully galvanise them in the same way that the term ‘binge drinking’ did not create the issue but helped to add sense and communicate a concept.
The approach also helps in creating a positive atmosphere of wellbeing that promotes better partnerships across disparate public services and the people and communities they serve. It will remain at the core of delivering the Staffordshire Health and Wellbeing Strategy.
Further reading: McKnight, J. Block, P. (2010) The Abundant Community. Berrett-Koehler Publishers, San Francisco, California.
Anthony Bullock is commissioning lead for alcohol, drugs, smoking and mental wellbeing, Public Health Staffordshire; Samantha Weston is lecturer in Criminology, University of Keele; and Dr Aliko Ahmed is director of public health, Public Health Staffordshire.