Advocacy case study: Think Family

Title: Think Family

Organisation Involved: Blackburn with Darwen Borough Council, United Kingdom

Website: https://www.blackburn.gov.uk/Pages/Public-health.aspx

Contact Name: Ruth Youth, Public Health Research and Development Manager

Context: Blackburn with Darwen in North West England has a population of 140,000. Substantial health problems are associated with high levels of social deprivation, in particular a high mortality rate from circulatory diseases and lifestyle-related health problems such as alcohol and diabetes. The life expectancy for both men and women is the third worst in England. The combined impact of multiple SDH, such as poor housing, low incomes, neighbourhood deprivation and poverty also means poor health and social outcomes for children. Moreover, the area has high levels of inequalities between the most and least deprived areas in the borough.

The question of how to advocate for health equity is therefore of particular local relevance. Our case study aims to explore this question by examining a local partnership approach to supporting families with complex problems called “Think Family”.

Think Family commenced in 2010 and was a major initiative to provide a new model of support and intervention for families with complex problems living in some of the most deprived local neighbourhoods. Requiring significant investment of health, social care and criminal justice resources, the multi-agency initiative approach involved family advocates acting as a single point of contact to co-ordinate cross-agency responses to the issues experienced by families. The approach also included a six-week therapeutic programme in which families confronted their own issues.

Think Family was hosted by the borough council on behalf of local partners and was piloted in three areas (Bastwell, Sudell and Shadsworth wards). During the course of Think Family there were six cohorts, involving 45 families and a total of 105 children. Findings and learning from Think Family have fed into the implementation of subsequent related policies.

An internal evaluation tracked the Think Family pilots between June 2011 and July 2012. The aims were: to capture short, medium and long-term outcomes for the families, communities and integrated partnership working; to evidence any difference that may have been made through changing systems, processes and services for (i) the families (ii) communities (social capital) and (iii) integrated working with partners (the process); and to inform on-going and future decision making processes to ensure that the local, regional and national evidence is considered alongside the implementation of the initiative.

According to the families involved, the main outcomes of Think Families were: emotional health, physical health and safety, sustaining changes made, having strong social networks of support, being in education, training or employment, and living in and contributing to strong and safe communities. The main objectives of the organisations involved were to: improve outcomes; and reduce cost in the longer term. The overall ethos was that the approach was family led, holistic and involved early help underpinned by social capital, with families nominated by the people who knew them best rather than waiting for a crisis to occur.

Aims:

1. To learn from the experience of implementing Think Family in relevant dimensions of advocacy for health equity;
2. To gain more detailed insights into links between health and well-being, and their links to advocacy and policy making processes;
3. Testing any identified new elements, through interviews with policy makers.

Research Method:

1. Secondary analysis of the documentary evidence available from the evaluation (final report, interview notes, etc.);
2. Analysis of other available documentary materials relevant to Think Family (e.g. minutes of meetings, press releases, newspaper reports, etc.);
3. Follow-up semi-structured interviews with key informants (e.g. children’s services managers, early years practitioners, public health, and members of Think Family steering group, etc.) to explore the specific learning in relation to advocacy for health equity.
   1. Notes will be taken and the interviews will be recorded with participants’ permission in order that notes can be supplemented by re-listening to what was discussed.
   2. Both the interview and documentary information collected will be analysed using thematic coding techniques (see below under “Expected Outcomes” for analytical themes to be used).

Expected Outcomes:

• Identify whether there are key ‘policy entrepreneurs’ or ‘champions’ who drive developments;
• Identify the methods of presenting evidence that have worked well/ are less convincing in successfully making the advocacy case to policy makers/relevant partners;
• Identify how far evidence needs to be tailored for different stakeholders and if it does, how;
• Identify the types of evidence/arguments required to convince different stakeholders;
• Identify the key actors (organisational, departmental, individual) who need to make the case;
• Identify the kinds of stakeholders that need to be convinced at different political ‘levels’ (i.e. in the local administration and in external agencies);
• Identify the legislation, opportunities and other potential facilitating factors involved;
• Identify potential barriers and hindering factors to advocating for health equity;
• Identify the extent to which the success or failure of advocacy efforts can be evaluated. What is realistic in local context? What are the links to the national policy context?