Resilience Conference 2013 - British Red Cross

Resilience Conference 2013 Proceedings papers University of London 11th April 2013

British Red Cross Resilience Conference 2013

Putting resilience into practice – what works? University of London 11th April 2013

Copyright © 2013 British Red Cross Society UK Office 44 Moorfields London EC2Y 9AL British Red Cross Society, incorporated by Royal Charter 1908, is a Registered Charity in England and Wales (220949) and Scotland (SC037738). Any part of this publication may be cited, translated into other languages or adapted to meet local needs without prior permission of the British Red Cross, provided that the source is clearly stated. This publication does not necessarily represent the decisions of stated policy of the British Red Cross. ISBN 978-0-900228-15-5

Contents Welcome

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Alison McNulty, Head of Research, Evaluation and Impact (interim), British Red Cross 1 Community Currencies building financial resilience: cross-sectorial implementations and systemic implications

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Jenna Collins, NLGN | Ann Griffiths, Ealing Council 3 Resilience in humanitarian aid workers

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Dr Amanda Comoretto, London South Bank University | Professor Nicola Crichton, London South Bank University | Professor Ian Albery, London South Bank University 4 Working resiliently with young people in complex circumstances: what can a systematic consultative review tell us?

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10 What do we know about community resilience? Exploring the concept of community resilience through Capacity for Change Programme

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11 Resources for resilience – a response from Down Under

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12 British Red Cross emergency response 107 in Cumbria – How we’ve enhanced ERiC’s resilienc 37

David Taylor, Volunteer, British Red Cross 13 How communities are naturally resilient – mapping of community assets on the Wirral, Merseyside

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Geraldine Nosowska, Research in Practice for Adults | Charlotte McEvoy, Research in Practice for Adults 7 The Skill and the Will – A pilot study into the development of first aid training to encourage individuals’ propensity to act in an emergency situation

Sara Amalie O’Toole Thommessen, City University London | Dr Paula Corcoran, City University London | Dr Brenda K. Todd, City University London

Dr Helen Sheil, Director, Centre for Rural Communities, Inc., Australia

Terry McCormick 6 Working Together

Elisa Pepall, Centre for International Health, Curtin University

Dr Artur Steiner, Researcher, Scotland’s Rural College – SRUC

Angie Hart, Professor of Child, Family and Community Health, University of Brighton | Becky Heaver, Research Officer, University of Brighton 5 Be Prepared! 10 steps to complete your community emergency plan

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9 Enhancing resilience in asylum seeking, 77 first-generation and second-generation refugee youth: findings from a brief intervention

Leander Bindewald, Researcher and Project Manager, New Economics Foundation (nef) 2 Reducing Dependency – Provocation Paper: Interim Findings and Conclusions

8 Don’t forget the families! Equipping accompanying families of international humanitarian staff to thrive

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Gayle Whelan, Community Asset Researcher, Liverpool John Moores University

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Emily Oliver, Senior Education Adviser, British Red Cross | Jane Cooper, Project Manager, British Red Cross | David McKinney, National Development Officer, British Red Cross

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Welcome Over the past four years, the British Red Cross has furthered its understanding of resilience and, more importantly, started to learn how to practically implement this understanding. This led the Red Cross to host its inaugural Resilience Conference in April 2013. The conference had three main objectives: generating learning on how resilience can be built across a variety of settings; understanding how humanitarian agencies can effectively contribute to enhancing resilience in the communities they serve; and increasing partnership working and networking for those in attendance. For the Red Cross, the conference also provided a timely opportunity to take key messages forward into our next corporate strategy. In his concluding comments, our operations director Mike Adamson spoke about how the important messages around greater partnership working can truly enhance resilience. Many partnerships, networks and conversations were developed and furthered during the day, which perhaps isn’t surprising given the number of diverse organisations and services represented. From more than 200 delegates, over 100 represented local, national and international organisations – including emergency services, local authorities, think tanks and social enterprises. These delegates, in addition to those representing the British Red Cross and other Red Cross Red Crescent National Societies, created a buzz of interaction throughout the day, making the workshops exciting hubs for ideas and discussion.

With such a packed programme, there was much to learn and share. Establishing the tone for the day, the breakfast session, delivered by Professor Sandy Halliday, set in context the parallels between the approach to resilience taken by engineers and those working in the humanitarian context – underpinned by stressors and strengths and heavily influenced by environmental factors. The challenges associated with defining resilience and adopting a ‘shared language’ were also explored throughout the day but not dwelt on. The conference opened with a note from our chief executive, Sir Nicholas Young, who focused directly on the practical ways in which resilience can be achieved and enhanced. This proactive position very much reflects the thoughts of the Red Cross itself regarding resilience. During the day, a wealth of practical experience and evidence-based learning emerged. We had invited speakers on topics covering individual, household, community and organisational resilience – all were present. Their talks ranged from the individual resilience of international delegates through to a mass of learning around how communities are able to come together in times of crisis and beyond. Delegates also looked at the need for sustainability and resilience in our food systems, and the importance of acting early in recognising the long-term impact on resilience of growing up in a violent household. It would be impossible here to summarise the content of each session and the subsequent value of the discussions. However, we are distilling all the learning from the day and

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hope to arrive at a clear, shared answer to the question: ‘What works?’ This Conference Proceedings document presents full versions of the session presentations we received. For documents not included here, do refer back to the original Resilience Conference Delegate Handbook, available on our newly launched website: www.redcross.org.uk/resilienceconference. While there, also take a look at the photographs and videos from the day. We’ll regularly be renewing the content of this page, so do keep looking!

We don’t want to close the door on those fruitful discussions. So whether you were there or not, if you would like to contribute to the discussion – and read or contribute blogs – join our online wiki by dropping an email to: [email protected]. Finally, we would like to thank everybody who took part on the day: those who planned, those who attended, those who presented, and those contributing from afar. We hope you have gained, and continue to gain, a greater sense of what works.

Alison McNulty Head of Research, Evaluation and Impact (interim) British Red Cross

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Community Currencies building financial resilience: cross-sectorial implementations and systemic implications

Leander Bindewald Researcher and Project Manager, New Economics Foundation (nef)

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Theme: Volunteering, Aging, interdisciplinary, “Community Economies”

Abstract Community and complementary currencies are a long established instrument in crisis mitigation. Oft-quoted examples from the Great Depression in the 20th century range from scrip-currencies across the US to the ‘miracle of Woergl’ in Austria in 1932–3, and a later copy of the same idea in Lignières, France, in 1956. Recent examples include the widespread use of informal trade currencies in Argentina after their financial crash in 2001 and currently in many localities across Greece and Spain. Many of the historic examples were not long-lived, due to a variety of reasons that can be summarized as immature establishment of appropriate governance, security and regulatory procedures and an often hostile attitude from national monetary authorities to local currency initiatives. Today, the field of community currencies (CC) is positioned radically differently, with learning from hundreds of local experiences shared and documented, new technologies reducing the transaction costs both for issuers and users, legal and regulatory compliance carefully observed and policy makers engaging proactively. Literally hundreds of different currencies are in operation around the world and in very different contexts and environments, from grass-roots Local Exchange Trading System (LETS) schemes and time-banks, to professionally operated business-barter currencies, to social currencies employed to engage disenfranchised groups and invigorate communities. Only in the last few years has the public sector realized the potential of these innovative tools for the delivery of their public services in a time of severe budget constraints and, more fundamentally, for new ways to empower and engage their constituencies away from 4

being recipients towards being emancipated co-producers of public goods. Now, initiatives with direct government involvement are launching and operating currencies in Austria, Australia, Brazil, Belgium, France, Switzerland, the Netherlands and the UK. From developing local entrepreneurship to waste-reduction, consumer-awareness to poverty reduction, elder-care and social inclusion – community currencies are designed to meet the needs of their target populations. Such unorthodox approaches to local resilience are successful and game-changing at the micro-level but also hold the key to a systemic reorientation in the approach to economics and monetary policy. In accordance with complexity theory and quantitative findings in ecology, complementary currencies provide the diversity and enhanced interconnectivity that make any kind of tightknit system, from tropical forests to computer networks and post-industrial societies, resilient against the failure of one of their components. With the global and national financial systems revealing their long-term brittleness, any sector from business, to development and aid needs to find new sustainable ways of realising their goals. Complementary Currencies are one of the most promising new social technologies to realize such local and systemic resilience. Yet for most people the theoretical knowledge and practical know-how about this field is only accessible through dispersed sources and in mainly unconsolidated form. For many years efforts like the International Journal for Community Currency Research (www.IJCCR.net), the CC literature database (www.cc-literature.org), and individual scholars and research groups at the Universities of East Anglia, Lyon in France, Rotterdam in the Netherlands and

whole economy. Founded as a business cooperative after the Great Depression in 1934, it now serves over 60,000 businesses with an equivalent of over 1 billion pounds exchanged annually (www.wir.ch). In Brazil, the Bancos Palmas model that had started as a micro-credit institution in a slum near Fortaleza, has only a few extra years of experience in issuing a currency than the German Chiemgauer, but after successfully convincing the Central Bank of Brazil that such currency schemes do not pose a threat to economic or monetary stability when well run, but, on the contrary, are a effective and efficient tool for inequality mitigation, the model has now already been replicated over 100 times all across the country (www. inovacaoparainclusao.com). few others have seen a nascent academic discipline through its first decades. Notfor-profit initiatives and foundations have been promoting the implementation and experimentation with new currency models for longer. The Social Trade Organisation (www.socialtrade.org) from the Netherlands has the longest track-record of pioneering models and implementing successful systems at all scales and providing the most widely used and versatile open-source software worldwide (www.project.cyclos.org). Their most important and successful initiatives have been in the developing countries in South and Central America, in Brazil, Uruguay, Salvador and Ecuador. Only in recent years have they shifted focus again on Europe. Here, in several countries an unbroken chain of currency applications exists. In Germany, the most prominent local currency, that helped shape the term “Regiogeld” (regional currencies), the Chiemgauer in Bavaria (www.chiemgauer. info), celebrates its 10th anniversary this May, while the municipality of Nantes in France took the first firm lead by a public institution in setting up a currency for its SME-sector (www.unemonnaiepournantes.fr). In Switzerland, the WIR Bank, on which the currency in Nantes will be modelled, has long reached national spread and international recognition for its stabilizing effect on the

Similar models have been proposed for emergency relief currencies (backed by standard currency) to favour local spending and thus local value chains instead of having aid money quickly leave the affected areas through purchases of imported goods. This has been piloted in Bandar Aceh after the tsunami in 2004 and in Haiti in 2010 (see in Rethinking Money by B. Lieater and J. Dunne, 2013: 169). In Africa, again starting from the idea of microfinance, mobile payment technologies have revolutionized the banking sector, satisfying the needs of millions previously “unbanked” (www. en.wikipedia.org/wiki/MPesa). Being used in complementary currencies as the Brixton Pound and Bristol Pound (www. brixtonpound.org, www.bristolpound.org), such simple mobile technologies, effectively sending money through text-messages without the need for mobile internet or smartphones have predated comparable services of highstreet banks. Adaptions of these technologies with higher emphasis on the currency properties, differentially favouring local enterprises over imported goods, are now being implemented in local economic development projects like the Bangle-Pesa near Mombasa, Kenya (www.koru.or.ke/complementary_currencies). 5

The practice, implementation and diffusion use of these currencies has still to be established for acute emergency relieve efforts, but resilience by its nature is a preventive not an ad hoc provision. Defined in complexity theory as the product of diversity and interconnectivity (Ulanowicz, Goerner Lieater, Gomez, Journal of Ecological Economics, 2009: 76-81), resilience is always a programme that will require time and effort in planning, implementation and maintenance but bears systemic effects. The continuous struggle to convey the absolute value of our global biodiversity serves as an analogy of how this system property seems impossible to reconcile with our predominantly short-term oriented economic logic. Diversity in financial media of exchange and funding mechanisms confronts similar obstacles. Setting up new currency schemes requires time and investment and often remains difficult to achieve scale against the high efficiency and convenience of simply continuing to use national currency. This is true on the local as well on the national level, but the price of sticking exclusively with national currencies is reduction in the ability to self-determine development and economic strategies. The danger of neglecting resilience is the risk of whole system crashes, a concern that is only recently quantifiable and merits consideration from all sectors and actors (Goerner, Lietaer, Ulanowicz, Journal of Ecological Complexity 6, 2009: 27-36). In the financial arena, this means, amongst other measures, the diversification of exchange systems and the use of complementary currencies. In support of this work, several

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initiatives are already underway for a number of years, but gaining momentum and recognition today. In the United States, the UK and on the ­continent, national networks of time banks reach out to, and include, marginalized people back into their communities (www. timebanks.org, www.timebanking.org). The Dutch platform WeHelpen (www.wehelpen. nl) has a similar agenda but focussing on care services. This project is a good example of how mainstream actors are now engaging in this field prominently because WeHelpen is a collaborative project of the some of the biggest Pension Funds, a big insurance company and ­Rabobank, the biggest cooperative bank of the Netherlands. Partnering in the EU Interreg funded ­“Community Currencies in Action” project (www.ccia.eu), the New Economics Foundation (www.neweconomics.org), community currency agencies Spice, in Wales (www.justaddspice.org) and Qoin in Amsterdam (www.qoin.org) strive to make information and best practices on complementary currencies accessible and readily usable for the not-for-profit and public sector. Partnering with the UN-NGLS we will organize a special session on complementary currencies as a strategic development tool back to back with the UN-RISD conference on Social and Solidary Economy, May 6–8, (www.unrisd.org/sseconf) and with the university of Cumbria we hosted a workshop on the topic particularly aimed at developmental NGO’s in Lancaster, July 12th, (www.iflas.info).

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Reducing Dependency – Provocation Paper:

Interim Findings and Conclusions Jenna Collins NLGN Ann Griffiths Ealing Council

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Workshop: Public sector services, localisation and resilience British Red Cross Resilience Conference, April 2013

Introduction and description of the study The ‘reducing dependency’ pop tank (popup think tank) is one of the responses to a challenge defined and prioritised by the New Local Government Network (NLGN) and a group of its member councils and private sector partners as central to local government’s success in the coming years. The pop tank’s aim is to explore and develop ideas on and solutions to the following issues: • Avoidable dependent relationships between service providers and users • Areas where the notion of ‘dependency’ is more controversial, challenging to tackle, or where research is poorly developed • How public services recognise, measure and evidence dependency and its reduction. The focus and context of all of these questions is the current economic challenge that public services face and the unsustainable nature of long-term growing demand for services that do not meet their own costs. We deliberately chose to focus on ‘dependence reduction’ rather than encouraging independence, or reducing demand, as these have already been the focus of considerable research. We also wanted to investigate whether approaching the challenge from a different angle would produce new analysis and solutions. The pop tank has worked through a number of qualitative methods, drawing in analysis and practice from diverse sources. At this stage, this work remains in development and our conclusions are draft. The views expressed at this stage are those of the authors, writing in a personal capacity, and not a statement

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of policy. We are seeking new inputs, perspectives, challenges and ideas from the British Red Cross Resilience Conference to inform further development of the conclusions and findings, and potentially more formal recommendations. The information we’ve gathered has all been the result of time and contributions from local authorities, companies and central government representatives provided on a goodwill basis. For this we are extremely grateful.

Research findings Our research included analysis of existing research on different types of dependence and independence, as well as a number of discussions, roundtables and case studies with local authorities and their partners. Our findings to date, and our analysis of the implications of these, are set out below. a. Definitions and assumptions Early discussions produced considerable debate around the definition of ‘dependency’ and the assumptions made about ‘appropriate’ levels to be expected. However, it was important to establish an initial overarching analysis around the key debates in defining ‘dependency’, and ultimately agree a single focus that everyone involved could agree would be of value to explore. i. Defining ‘need’ – on whose terms? Literature on the subject of dependency varies enormously in its definitions, assumptions, and scope with discussions revealing clearly that one person’s dependence is another’s ability to live their life free of anxiety and

hardship. The Young Foundation’s report ‘Sinking and Swimming’, illustrates the complexities of Britain’s unmet needs (Young Foundation, 2009) Examples raised in our discussion groups included that a personal budget for some social care users is ideal; for others it is a challenge adding complexity to their lives. This is not simply a matter of the status, health, strengths and support networks around individuals, though these factors are important; it is also a matter of personal preference, priorities and beliefs. Nor is one necessarily ‘better’ than any other – a drive and preference for ‘independence’ at all costs could ultimately lead to greater crisis further down the line through a failure to seek or accept early help. It is difficult to design ‘one size fits all solution’ in this arena, to assess ‘needs’ at a sufficiently nuanced and meaningful level through high-level data analysis, or to propose a single definition of how to calculate need and level of independence appropriate for people whose circumstances, abilities, and opportunities are all unique. For this reason, policies and services that seek to deliver sweeping approaches tend to meet challenges in implementation. Conclusions: One of the most fundamental issues with addressing ‘dependency’ will remain that a relationship between a public service and a person viewed by one person as imperfect or even harmful, may be simultaneously seen as beneficial, or even ideal, to another. As such, it is unlikely that there will ever be agreement around definitions and perspectives; however, we suggest that it is possible and worthwhile for organisations and services to actively discuss and consider their position on what would constitute ‘dependency’ on a service, if this is a beneficial thing or not, how they will identify that, and how they will act to minimise negative dependency if relevant.

b. Politics and narrative – is it possible to talk about independence and dependence without political assumptions and biases? Fundamentally, public services face increasing demand and reducing resources. In social care alone, it is predicted that there could be a funding gap of £1 billion by 2014 unless councils can achieve unprecedented efficiency savings (Humphries, 2011). Being able to define dependency in terms based on the need to maximise the efficiency of use of services offers an opportunity to look at the challenges and opportunities without immediately getting into debates about appropriate levels of responsibility, entitlement, and enablement. We do not suggest that minimising cost is the only important factor, nor the most important in the greater context of providing public services. Conclusion: We consider the economic argument and outcomes to be a useful way of considering the opportunities of reducing dependency, without making political judgements or assuming that this is the only factor in play in service delivery. Our working definition of dependency for the purposes of developing constructive ideas for local government has therefore been: avoidable ongoing support from public services that would be possible to reduce without a high likelihood of future escalation of need” c. Is dependency necessarily a bad thing? We began our research with the hypothesis that reducing dependency might have benefits in a number of areas: • Efficiency (savings) • Reducing a particularly challenging source of demand • Possible personal and community benefits • Indirect local/national economic benefits. There is less evidence on the impact of ongoing relationships that could be considered ‘dependent’, though the connection between factors such as unemployment and challenges with health and well-being could be considered to be evidence of a negative form 9

of ‘dependence’, as outlined by the Adler School of Professional Psychology Institute on Social Exclusion (The Adler School, 2013). There is enough of a case in established literature for both the economic and broader benefits of reducing dependency to suggest that at least considering whether dependent relationships between service users and providers may be having a negative impact is a helpful action to take when delivering any kind of support service, intervention, and public service. Conclusions: We suggest that these are discussions and considerations that services should be actively included in their service planning, commissioning, budgeting and performance management targets, referring to comparable services and outcomes elsewhere for similar cohorts of service users, and considering whether it is possible that an alternative approach to providing services, whether in terms of the model, delivery agency, or level of responsibility and control the service user has, could make a difference to the outcomes, ongoing use and cost of services.

Dependence on what services, and what type of service user? Initial reviews of published reports on dependence found that there is little focus on specific services but rather the ‘enabling state’, for example (Sir John Elvidge, 2012). However, it is challenging to look at single services in isolation, as both the services and their staff, and the service users experiencing and accessing them, exist in complex systems where interactions between different services are frequent and changes in one aspect of life or the services provided often have impacts on other areas. ‘Dependence’ isn’t confined to particular service use groups or users of a particular socio-economic status. Some level of ‘dependence’ can be necessary, helpful and operate on an ‘invest to save’ basis – though 10

it is always useful at intervals to consider whether the balance remains a positive one. Because of these considerations, and the economic arguments outlined previously, we agreed that there would be a particular value in exploring a focus on approaches to reducing ‘dependent’ use of services at a crisis and high cost level. This is a distinction important to consider in defining the difference between reducing dependency and reducing demand, more broadly. Dependent use of services is one element of demand, but perhaps the most challenging to address; partly because of likelihood of vulnerabilities among service users, but also because of the entrenched, intergenerational and complex life challenges those dependent on public services often experience. Conclusions: The pop tank developed of a model of potential types of dependency (Appendix A) and we felt that there is a particular value in taking a specific focus on higher need service users, where continued use could be reduced without likely negative long term impacts and future costs. However, managed reduction in dependency is likely to rely on understanding the whole picture of someone’s life and what strengths and support they have available to draw upon. It will also be important to consider the path to and from dependency and the kind of support that can be offered at different stages to maximise the likelihood of positive long term outcomes. This may include areas such as ‘early intervention’.

Key learning and solutions Ways of reducing dependency may fall into the categories of: • People meeting their own needs where possible; • Where this is not possible, people’s needs being met through support provided at no, or reduced, cost to the state, e.g. through community groups and charities;

• Where public services are provided to

tackle an issue, that they do so effectively and for the optimal time to reduce future costs; • Wherever possible, avoiding creation of need requiring state intervention in the first place. Our subsequent research explored the conclusions to our early discussions and produced a number of case studies and learning points that helped hone these ideas into more practical approaches to reducing dependency. a. Rising to the challenge: reducing dependency in practice Our case studies found examples of all the areas suggested, though solutions to reducing dependency often combine several elements of the hypothesised approaches all at once. Approaches that take account of multiple players, opportunities, strengths and resources are to be encouraged, though there may well also be a case for developing a more systematic overview of the different elements at play. Some of the key practical examples of approaches to reducing dependency included: • Service users being encouraged and supported to take on increasing responsibility and control of the services they receive, as a primary driver. Examples include the well-documented journey towards personalisation and use of direct payments. The reshaping of day care opportunities for adults with learning difficulties and mental health problems for example, shifting away from all-day sessions to more structured, personcentred and often work-focussed support, also aims at enabling adults to become more independent of support services and sometimes. Darlington Borough Council have designed and introduced such as a scheme. • Communities and individuals being supported to do more than public services may have previously been delivering in their area, and in doing so take on a

greater role in supporting the vulnerable, often in time-limited, exit-focused ways. Examples included community engagement and empowerment projects that support neighbourhood groups to establish projects and events in their area that reach out to disadvantaged groups, offer expert advice and support to work out issues. For example, Blackburn with Darwen Council’s ‘Your Call’ campaign which gives residents opportunities to make a difference in their community. • New approaches and use of providers that stop the creation of dependent relationships in the first place. Examples of services playing these roles are found across the spectrum of different levels of needs, and work both to stop cycles of dependency at a high level (e.g. Family Intervention Projects) and at the less acute, ‘early intervention’ end, supporting people for a limited time to address minor problems, or more significant issues at the stage where they first present, and in doing so, be able to avoid requiring further more intensive help in the future – for example, Rethink Mental Illness Early Intervention Programme to help people manage mental illnesses effectively early intervention with children and families. • Provision of early advice, support and action to avert the escalation of need and demand and future risk of dependency. The role of provision of information, awareness, access to support and help at an early stage seems vital in addressing escalating dependence. Some cases studies identified used communities and volunteers to take on these roles. Essex County Council and their community agents scheme supports communities in identifying need, signposting people to community groups and advice services. In almost all of these cases local government and its partner delivery agencies retain a role in provision of at least some support, commissioning, coordinating and oversight of performance and quality. It may be possible to consider whether this is developing a new kind of co-dependent relationship of compromise 11

between two models. It also means that the quality of those public services (or their commissioned providers) playing these roles remains paramount in achieving success, and that the roles of those playing related functions within authorities need to evolve to manage this relationship effectively. A robust strategic commissioning approach could achieve the suggestions set out through this paper so far, considering the optimal relationship providers would like to have with their service users, taking into account the reality of resource and likely outcomes, and establishing planning, delivery and outcomes measurement arrangements to support delivery of the desired approach. At the heart of solutions that enable and empower service users to move away from dependency is also genuine coproduction – ways of designing, planning and delivering services that make the most of the strengths

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and capabilities of service users themselves. A realistic and practical approach to involving service users in the design of services that help them achieve their goals, having debates as to the resources available and the contribution different players can bring, and ultimately delivering services that have been contributed to and shaped by all involved, may play a significant role in supporting users to overcome dependency in the short and long term. a. Remaining challenges and overcoming them A number of challenges that further work can be done to help overcome: • Defining, identifying and measuring dependence, as set out in our early findings, will remain a challenge. It may be worthwhile considering discussions and debates on outcomes measurement more broadly through the frame of dependency, to examine what these have to offer. • Understanding the causes – and what might

work to help. A lack of long term evidence and data on outcomes for different approaches implemented only over recent years and months will make understanding effectiveness a challenge. • There seem to be a number of approaches that are considered to be good because they intuitively help people to become or remain independent, yet considerable difficulties remain in understanding how well something works in the context of the other services and experiences existing around it. • The vital importance of signposting, awareness, access to information, and places to find advice and support, and the difficulty in doing this accurately in areas with vastly complex service offers and no current single view of what’s available where, who for, on what basis, and to what result. • The sharing of information between agencies is likely to be key in ensuring that needs can be met, issues can be identified, and successes and failures can be measured and analysed. The economic argument of some new modes remains unproven. Connected to the lack of long term evidence of success, the financial value of independence, and reduced dependence, remains articulated only in pockets, for specific context. Examples where new models include an element of income generation or becoming self-sustaining (e.g. through transition to a social enterprise) vary in their success rates to date and some remain heavily subsidised by public funds. • Work on cost avoidance remains in development; there may be an opportunity to do further detailed analysis and research into the detailed cost avoidance and savings case specifically around the issue of dependency, again taking a different perspective, and possibly resulting in different conclusions, from work being conducted in this area around ‘early intervention’ or intensive intervention at a high end of need. • The success of some approaches also remains unproven e.g. in some areas and for some groups of service users,

direct payments are not increasing and policies such as personal budgets have not necessarily empowered people to take responsibility. • Even where there is an evidence base for an approach, use of these has some way to go before it can be said to be well established or embedded in mainstream services. There remains a tendency to consider ‘needs’ and demand according to single issues and service areas, and for accountability structures, performance management demands and budgets to be shaped according to these single issues. • Again some of the opportunities for change in this area come with future commissioning considerations that define shared, strategic outcomes that are the responsibility of more than one service, or agency, and the active building of parts of a system that can help meet them. Further work needs to continue around addressing complex needs and challenges of lives that do not fit easily into a model provided based on one ‘need’ or requirement for support, how to deliver this and how to measure success and replicate it effectively. • The risk of co-dependency and the importance of behaviour of those both providing the services, and service users. It is possible to consider the relationship of different parts of the system of services as dependent on each other – interdepartmental and inter-agency dependency, reinforced assumptions, and contracts/ grants built and secured on dependent relationships.

Summary conclusions, proposals and recommendations The more we can do to support localised, tailored solutions delivered by those who understand the intricacies of individual lives, working alongside those who see the bigger picture, the better. The support of specialist charities, one-to-one support, and investing the time to properly understand needs, resilience, and opportunities for independence, 13

at a nuanced level for difference cohorts of service users, are important. Genuine co-design of services, taking the time to invest in working through with service users the reality of what’s offered, should be at the core of the improvement of services. Service development should go beyond user satisfaction surveys to enable service users to work through in a facilitated environment the areas of challenge and opportunity for development. Ultimately additional effort required in these early stages will be saved in efficiency of delivery and targeting later in the delivery cycle. It is difficult to draw conclusions from the work we’ve conducted to suggest a particular ‘model’ or specification of approach that will work to reduce dependency on services. Every sort of dependence is different and fundamentally underpinned by human behaviour and complex lives. Ultimately therefore, we suggest that attempting to understand and respond to ‘dependency’ is best done locally, based on definitions and understanding what is desirable for a specific area, or for specific cohorts of users, according to the perspectives and priorities of those taking decisions and impacted by them. We believe it is possible to suggest areas for consideration in service design to ensure that service user outcomes genuinely promote independence. These remain to be fully shaped and further details developed but are likely to include:

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3) Consider how to identify dependent service use. Ensure that the ability to monitor and measure key indicators of these things is available. 4) Consider the evidence as to need, and current success of services according to indicators of dependency. 5) Consider available opportunities and capacity to support different ways of delivering services, which may reduce dependency. 6) Evaluate different options in terms of opportunity for savings, ease of actions and leveraging resource required to implement, and likelihood of results that will not contribute to further costs at a later date – incorporating human impacts. Consider how different approaches fit into the wider system of services and support on offer. 7) Act on chosen option and measure success from day one of implementation. Putting the chosen option into practice is likely to include commissioning, defining success measures, communications and awareness raising, and considering personal development and behaviours of those involved in the service, whether transitioning new approaches in existing services, or developing new ways of delivering entirely.

1) Understand the picture of service offers and service users.

A focus on behaviour change and organisational and personal development is likely to be important, for example through resilience training, defining performance measures that reflect the outcomes sought, and ensuring ongoing recruitment and training is tailored around these.

2) Understand what ‘dependent’ means in the context of different specific service offers. Understand what is desirable and what is unacceptable in that context. For example, is it about frequency, duration, intensity or patterns of service use?

We recognise that this is a vastly simplified and ideal approach that addresses only the first stages of considering dependency, and does not make recommendations about the best practice to use. This is at least in part because the approaches to addressing

dependency vary as widely as the definitions, perspectives, and reasons for dependency do, and at this stage we do not feel we have decisive evidence to suggest specific approaches to delivery. A number of areas have been identified through this work that we feel could benefit from further work, research and targeted thinking around with a view to developing more practical recommendations: Defining the financial case specifically around dependence more robustly. Explore the role of behaviour and the opportunities of behaviour change approaches in addressing dependency. Conduct further work on behavioural analysis and application of deeper understanding of the relationships between parts of the system, to identify areas of solutions. None of these areas of work alone will address the issue of dependency across the board. But the more we can actively consider and work towards defining what is acceptable and desirable, how we know what’s working in achieving that, and how we can develop and evolve our approaches to do more of the good, proven approaches; the more we can use the strengths, capabilities and drive of everyone involved in supporting people and communities – including people and communities themselves; the more we can work as public services, community services, private sector and all others involved in local public services; the closer we will come to approaches that genuinely make the most of people and places’ potential, helping to address the demand and resource imbalances in ways that can evolve and improve over time.

Next steps We encourage feedback on the ideas expressed within this document and the opportunities for further developing, honing and acting on them. We intend to hold a summary closure workshop for the pop tank in summer 2013 to draw some final conclusions and agree what further steps can be taken on specific areas that would benefit from further research and action. It’s our intention to conduct this workshop using creative thinking techniques and exercises, intended to draw out of the current ideas some specific actions that can be taken to progress this work. We’d welcome case studies, workshop session ideas, and proposals for techniques and approaches we can use for this session. We’ll then be providing a final summary document and other outputs online to inform future work around this area, likely to continue to be of concern for some time to come. If you have feedback, ideas, or would like to participate in the pop tank closure workshop, please contact Jenna Collins or Ann Griffiths.

Appendix A: What does ‘Reducing Dependency’ mean? Dependency means different things for different people; early discussions of the working group identified the following areas for consideration in defining the role of this poptank:

15

Users of targeted, specialist (but not acute provision)

Who & Where

Within and between organisations

What dependency looks like

Habitual use of support that could be self-service – e.g. room booking, meetings arrangement, administration, survey design, web uploads

Unnecessary use of council services / resource – repeated calls and chasers, use of services that could be delivered in different ways (by people themselves, or other providers)

Repeat use of services Ongoing long term need for ‘revolving door’; escalation services into acute services; reliance on Council-run services and resource where other means of provision are available

How might it Self service technology be reduced and awareness raising; toolkits and training; removing support

Channel shift and more efficient customer service provision; ‘reducing avoidable contact’ activity; behaviour change and expectation shifting; Alternative providers who can deliver services more efficiently; encouraging community activity and support to provide what people can for themselves

More nuanced and efficient targeting – evidence based early intervention solutions that really work to stop escalation; smart commissioning – properly understanding need and what works to fulfil it, including providing support in different ways – e.g. market testing non-Council providers

Ensuring providers of services are most efficient and best at reducing any avoidable dependency; minimising numbers who reach acute need wherever preventable through early intervention; effective measurement of genuine dependency and need

Reasonable expectations about community activity and ‘big society’; squaring off the fact that some taxpayers use very few services and expect to be able to get non-statutory universal services in return for their tax; how to build community strength

Scales and measures of dependency; staff training and awareness of alternative provision and what’s appropriate where; practical steps to alternative provision models

How we report and understand ‘need’ / scales of dependence, nuanced enough to take decisions on commissioning and provision; how do we tell when people could be independent, and ID hidden need? Professional awareness and standards

Better access to information, e.g. online databases and ‘single point of info’ stores

Areas for further thought

Expectations and culture change requirements, implications for performance management, access issues, use of technology

Users of Universal Services

There is a strong business case for considering this issue in detail. Increasing demand for public services, decreasing resources, opportunities of new technology, increasing diversity in the range of providers of services, crossparty political focus on enablement and independence, and changing expectations from society in regard to public services, consumption, democracy and community, all provide reasons to consider this subject as a priority.

References Watts et al. (2012) Sinking and Swimming, The Young Foundation. Prime Minister’s Strategy Office, (2010) Building on Progress: The Role of the State [Online], Available: http://webarchive. nationalarchives.gov.uk/+/archive.cabinetoffice. gov.uk/policy_review/. OECD, (2005) The “Enabling State?” from public to private responsibility for social protection: Pathways and pitfalls 16

Users of acute and intensive statutory services

[Online] Available: http://www.oecd.org/ dataoecd/7/34/35304720.pdf. Goncalves, C. (2008) ‘The Enabling State and the Market’ [Online], Available: http://www. pedrocostagoncalves.eu/PDF/the_enabling_ state.pdf Elvidge, J. (2012) ‘The Enabling State’, Carnegie Trust [Online], Available: http:// www.carnegieuktrust.org.uk/CMSPages/ GetFile.aspx?guid=b90e80a4-a243-4f6b-bfb134b15c3cb7b3 The Alder School (2013) ‘First-of-its-Kind Mental Health Impact Assessment Released Today: Why It Matters’ [Online], Available: http://theadlerschool.wordpress/com/2013/04 /03/first-of-its-kind-mental-health-impactassessment-released-today-why-it-matters/ Humphries, R. (2011) ‘Social care funding and the NHS: an impending crisis?’, The Kings Fund [Online], Available: http://www. kingsfund.org.uk/sites/files/kf/social-carefunding-nhs-crisis-kings-fund-march-2011.pdf

3

Resilience in humanitarian aid workers Dr Amanda Comoretto London South Bank University Professor Nicola Crichton London South Bank University Professor Ian Albery London South Bank University

17

Introduction Resilience is a word that describes a group of factors promoting well-being and psychological strength in individuals experiencing extremely stressful life conditions. Several research studies on stress-coping mechanisms have focused on policemen, soldiers and health care personnel (Taylor and Frazer, 1982), whereas only in the past decade has workplace adversity in the humanitarian field become the focus of attention (Bjerneld et al., 2004). Aid workers have to cope with different work-related challenges and continuous exposure to human suffering in addition to the stress of working in disaster and war situations, such as occupational health and safety issues (Bjerneld et al., 2004), concerns around re-entry stress (Hewison, 2003) and pre-existing problems (Ehrenreich and Elliott, 2004). While some aid workers leave their organisations because of issues associated with workplace adversity, many are likely to remain. Of those who do so, some may experience psychological burnout and Post-traumatic Stress Disorder (PTSD) (Eriksson et al., 2001; Jones et al., 2006). Nonetheless, the majority of aid workers are able to cope within challenging organisational and occupational situations (Cardozo and Salama, 2002). This raises the general issue of why some people are able to thrive and find satisfaction despite challenging career choices while others do not. Three protective categories have been identified as responsible for the development of resilience in populations at risk for stress. First, individual and dispositional characteristics (e.g. gender and age) can modify responses to adversity (Garmezy, 1993). Second, social support is likely to play an essential role in determining 18

coping (Cutrona and Russell, 1987). Finally, cognitive features (e.g. motivation and coping) are usually related to resilience (Hjemdal et al., 2006). The investigators of this study developed a model theorising that positive or negative change in resilience would be governed by the interactive relations among protective factors within the individual and the wider environment. Over the past ten years research has undergone a shift in focus from the study of protective features in isolation to the investigation of developmental processes associated with healthy outcomes because, as highlighted by Gore and Eckenrode, “there may be more explanatory power in considering the effects of protective factors in conjunction with each other, rather than in isolation” (1994: 31). The hypothetical model developed in this study and highlighted in Figure 1 proposes that cognitive and environmental factors are likely to impact on individuals’ psychological responses during stressful life experiences. At the same time these factors are mediated by fixed dispositional markers (e.g. in this study gender, age, number of previous field missions, general health, marital status, age at which participants had left education). Environmental protective markers include relationship networks: family members, work associates and friends. Cognitive protective factors are motivation, locus of control, and coping mechanisms. The interrelationship of these three domains was predicted to impact on change in resilience, either positively by an increase in this construct or negatively by a decrease in the same. Moreover, the relationship between dispositional resources and outcome was hypothesised to mediate environmental stressors. To summarise, the current study tested the model depicted in Figure 1 in a humanitarian field context to

predict resilience and whether change in this construct would be affected by the identified protective factors.

Description of the study A mixed-method investigation was carried out in two phases: a longitudinal self-completion questionnaire survey (phase I) and a series of semi-structured qualitative interviews (phase II). In phase I questionnaires were completed by expatriate staff members of 36 humanitarian agencies before (time 1) and after (time 2) a field mission. Fifty-six people took part in the study: 23 males (41%) and 33 females (59%). Ages ranged from 20 to 62 years. Fifty-one returned the

questionnaire at follow-up (91% of the cohort). The questionnaire incorporated previously validated scales (see Table 1). Post-Traumatic Stress Disorder and burnout were assessed using the Los Angeles Symptom Checklist (LASC) (King et al., 1995) and the Maslach Burnout Inventory (MBI) (Malasch and Jackson, 1993) respectively. Coping styles (in the model associated with participants’ cognitive protective factors) were assessed using the Coping Orientation to Problems Experienced (COPE) scale (Carver et al., 1989). Self-efficacy, which permits the development of adaptation skills, was measured using the Generalised Self-Efficacy Scale (GSE) (Schwarzer and Jerusalem, 1995), together with an adapted version of Rotter’s (1966) Internal-External Locus of Control

FIGURE 1 A MODEL OF DISPOSITIONAL, COGNITIVE AND ENVIRONMENTAL FACTORS TO EXAMINE CHANGES IN RESILIENCE

MEDIATORS COGNITIVE PROTECTIVE FACTORS:

• Motivation - Internal Locus Control - Optimistic self-beliefs DISPOSITIONAL PROTECTIVE FACTORS:

• Gender • Age • Number of previous • missions • Physical health • Marital status • Age at leaving education • Intelligence

OUTCOME: CHANGES IN RESILIENCE

- Self-efficacy

• Coping skills

MEDIATORS ENVIRONMENTAL PROTECTIVE FACTORS:

STRESS RELATED INDICES

INPUT

POSITIVE Increase in resilience

NEGATIVE Decrease in resilience

• Social support from family and friends at home • Social support from colleagues • Organisational support

19

TABLE 1. SCALES INCLUDED IN THE FINAL QUESTIONNAIRE AND THEIR CHARACTERISTICS Measured construct

Part of the theoretical model tested

Los Angeles Symptom Checklist (LASC)

PTSD

Maslach Burnout Inventory (MBI)

N Items

Score range

Stress

43

0–4

More PTSD symptoms (172)

Less PTSD symptoms (0)

Burnout

Stress

22

0–6

Higher degrees of burnout (30)

Lower degrees of burnout (0)

Coping skills

Cognitive protective factors

60

1–4

More ability to put in place coping strategies (16)

Less ability to put in place coping strategies (4)

Generalised SelfEfficacy Scale (GSE)

Self-efficacy

Cognitive protective factors

10

1–4

High selfefficacy (40)

Low selfefficacy (10)

Adapted version of the Rotter’s InternalExternal Locus of Control (LOC) scale

Cognitive Locus of control protective factors

10

0–1

External LOC (10)

Internal LOC (0)

Life Orientation Test (LOT)

Optimism

Cognitive protective factors

12

1–5

Less optimistic attitude (60)

More optimistic attitude (12)

Adapted version of the Social Provisions Scale (SPS)

Social support

Environmental protective factors

14

1–4

High availability of social support (56)

Low availability of social support (14)

Self-Report Questionnaire-20 items (SRQ-20)

General health

Dispositional protective factors

20

1–0

High number of symptoms present (20)

Low number of symptoms present (1)

Ego Resiliency Scale (ER-89)

Resilience

Resilience

14

1–4

High resilience (56)

Low resilience (14)

Connor-Davidson Resilience Scale (CD-RISC)

Resilience

Resilience

25

0–4

High resilience (100)

Low resilience (0)

Resilience Scale for Adults (RSA)

Resilience

Resilience

33

1–7

High resilience (231)

Low resilience (33)

Tool

COPE

Scale. Optimistic self-belief was assessed by the Life Orientation Test (LOT) (Scheier and Carver, 1985). The Social Provisions Scale (SPS) was used as a measure of the availability of social support (Cutrona and Russell, 1987). As one of the dispositional protective factors linked to change in resilience, health status was assessed via the Self-Report Questionnaire-20 (SRQ-20) (Harding et al., 1980). Finally, three scales to assess resilience were adopted, as no agreement was reached 20

High score Low score (highest value) (lowest value)

on the best measure to assess this construct: the Connor-Davidson Resilience Scale (CDRISC) (Connor and Davidson, 2003), the Ego Resiliency Scale (ER-89) (Block and Block, 1980), and the Resilience Scale for Adults (RSA) (Hjemdal et al., 2001). Phase II involved the development of semi-structured interviews to investigate humanitarian workers’ own accounts of field experiences. A schedule of questions

was developed allowing for themes surrounding resilience to emerge and to explore participants’ reflections about field experiences. Participants’ existing and changing social networks, as well as their importance in understanding the role of support in the experience of adversity, were explored too.

Findings Participants’ characteristics Sixty-eight percent (n=37) of humanitarian workers had left education between the ages of 17 and 25 years; 32% (n=17) had continued education after their 25th birthday. Most participants (N= 32, 57%) held a postgraduate degree. Seventy-one percent (N= 40) were regularly employed by some kind of humanitarian agency. The majority of aid workers (N= 33, 59%) had previously been assigned to a maximum of 2 missions; 41% of them (N= 23) had experienced 3 or more missions. Four people (8%) presented with PTSD symptoms before overseas deployment. Predicting change in resilience: quantitative results Path analysis was the statistical technique used to explore and test the model presented in Figure 1. People scoring high on the LASC were more likely to report negative changes in resilience. Similarly, those participants employing mental disengagement as a coping technique were characterised by negative changes in resilience at follow-up. Finally, those participants who actively looked for friends, family and colleagues in difficult times showed increased resilience compared to those who did not seek out available social support networks. Predicting change in resilience: qualitative accounts Motivations for starting up aid work (e.g. having strong humanitarian drives), deploying positive coping strategies (e.g. tolerance and cooperation), using mental preparation before a mission, and finally mentally distancing from occupational stressors were cognitive

protective factors helping participants minimise the effects of work-related stress and maximise positive changes in resilience. Participants also detailed types of social support and the long-term consequences of humanitarian work experiences on preexisting social relationships. When asked to identify occupational stressors, participants mainly identified the external environment (e.g. security threats, working and living in close proximity to others all the time), foreign status, excessive workloads, inconclusive pre-mission training and almost non-existent post-deployment briefing. Nonetheless, despite many participants reporting feeling psychologically vulnerable because of the stressful job, many seemed to be determined to go back to the field.

Key learning According to previous researchers (Masten, 2001) resilience is a form of “ordinary magic” originating from the operation of basic human adaptive systems when confronted with environmental stressors. According to the results of the present investigation, LASC scores (a measure of stressful experiences), the use of mental disengagement (a coping technique), the age at which participants had left education, as well as the presence of social support networks all significantly predicted changes in resilience at baseline and follow-up. People reporting higher LASC scores were more likely to develop negative changes in resilience than those reporting lower LASC scores. Moreover, they were more likely to resort to the use of mental disengagement to respond to stressors. In a consistent way, the qualitative results showed that positive coping strategies (and NOT mental disengagement), for instance being tolerant and being able to mentally prepare for the worst, may be more effective in dealing with environmental stressors in that they may lower perceived stress and enhance positive changes in resilience. Findings also showed mental disengagement to be associated to negative changes in resilience. Previous work 21

(Pearlin, 1991) has shown that avoiding active confrontation with a stressor to reduce any emotional tension associated with it is more likely to result in increased stress and less resilience. Mentally disengaging from a problem often prevents active coping (Billings and Moos, 1984), and is non-adaptive over the long term (Carver et al., 1989). During interviews, participants also reported mentally distancing from occupational problems as a common form of coping. Consistent with previous investigators (Cardozo and Salama, 2002; Masten et al., 1990), those people who reported the availability of social networks were more likely to demonstrate positive changes in resilience. In addition, interviewed aid workers who reported being able to rely on families and friends as sources of support were less likely to respond negatively to the various stressors encountered during a mission. Finally, participants leaving school at a later age were able to rely on a wider social support network that allowed for positive changes in resilience. Moreover, people who had spent more time in education were less likely to mentally disengage from a mission’s environmental stressors. Finally, those who had left school at a later age were also less likely to report higher LASC scores (indicative of mental distress), and more likely to experience positive changes in resilience.

Conclusions and recommendations The practice significance of the aforementioned findings for those organising relief work and preparing workers for overseas deployment should be stressed. Because results showed a direct relationship between work environment and individuals’ emotional and psychological well-being, i) pre-mission preparatory training, ii) careful employee selection for deployment, and iii) accurate post-mission debriefing all have the potential to diminish the effects of occupational stressors, minimize the use 22

of maladaptive coping responses (mental disengagement) and reinforce the availability of social support mechanisms. “If workers know that symptoms are common and predictable, their emergence is not traumatic, hence not as likely to be exacerbated by anxiety or refusal to seek resolution” (Dunning, 1990: 97). To conclude, the model developed in this study is aimed at contributing to the understanding of how resilience develops in field-based humanitarian aid workers allowing them to survive and thrive within extremely challenging work environments.

References Billings, A.G. and Moos, R.H. (1984) ‘Coping, stress, and social resources among adults with unipolar depression’, Journal of Personality and Social Psychology, 46, 877-891. Bjerneld, M., Lindmark, G., Diskett, P. and Garett, M.J. (2004) ‘Perceptions of work in humanitarian assistance: interviews with returning Swedish health professionals’, Disaster Management & Response, 2, 101-108. Block, J. and Block, J.H. (1980) ‘The Role of Ego-Control and Ego-Resiliency in the Organisation of Behaviour’, in W.A. Collins (ed.) The Minnesota Symposia on Child Psychology, Minneapolis: University of Minnesota Press. Cardozo, B.L. and Salama, P. (2002) ‘Mental health of humanitarian aid workers in complex emergencies’, in Y. Danieli (ed.) Sharing the front line and the back hills: peacekeepers, humanitarian aid workers and the media in the midst of crisis, Amityville, NY: Baywood. Carver, C.S., Scheier, M.F. and Weintraub, J.K. (1989) ‘Assessing coping strategies: a theoretically based approach’, Journal of Personality and Social Psychology, 56, 267-283.

Connor, K. and Davidson, J. (2003) ‘Development of a new resilience scale: the Connor-Davidson Resilience Scale (CDRISC)’, Depression and Anxiety, 18, 76-82. Cutrona, C.E. and Russell, D.W. (1987) ‘The provisions of social relationships and adaptation to stress’, Advances in Personal Relationships, 1, 37-67. Dunning, C. (1990) ‘Mental health sequelae in disaster workers: prevention and intervention’, International Journal of Mental Health, 19, 91-103. Ehrenreich, J.H. and Elliott, T.L. (2004) Managing stress in humanitarian aid workers: a survey of humanitarian aid agencies’ psychosocial training and support of staff. Peace and conflict: journal of peace psychology, 10 (1), 53-66. Eriksson, C.B., Bjorck, J. and Abernethy, A. (2003) ‘Occupational stress, trauma and adjustment in expatriate humanitarian aid workers’, in G. Fawcett (ed.) Stress and trauma handbook, Monrovia, CA: World Vision International. Eriksson, C.B., Vande Kemp, H., Gorsuch, R., Hoke, S. and Foy, D.W. (2001) ‘Trauma exposure and PTSD symptoms in international relief and development personnel’, Journal of Traumatic Stress, 14, 205-212. Garmezy, N. (1993) ‘Children in poverty: resilience despite risk’, Psychiatry, 56, 27-136. Gore, S. and Eckenrode, J. (1994) ‘Context and process in research on risk and resilience’, in R.J. Haggerty, L.R. Sherrod, N. Garmezy, and M. Rutter (eds.) Stress, risk, and resilience in children and adolescents, New York: Cambridge University Press. Harding, T.W., de Aarango, M.V., Baltazar, J., Climent, C.E., Ibrahim, H.H., LadridoIgnacio, L., Murthy, R.S. and Wig, N.N. (1980) ‘Mental disorders in primary health care: a study of the frequency and diagnosis

in four developing countries’, Psychological Medicine, 10, 231-241. Hewison, C. (2003) ‘Working in a war zone: the impact on humanitarian health workers’, Australian Family Physician, 32 (9), 679-681. Hjemdal, O., Friborg, O. and Martinussen, M. (2001) ‘Preliminary results from the development and validation of a Norwegian scale for measuring adult resilience’, Journal of the Norwegian Psychological Association, 38, 310-317. Hjemdal, O., Friborg, O., Stiles, T.C., Rosenvinge, J.H. and Martinussen, M. (2006) ‘Resilience predicting psychiatric symptoms: a prospective study of protective factors and their role in adjustment to stressful life events’, Clinical Psychology and Psychotherapy, 13, 194-201. Holtz, H., Salama, P., Cardozo B.L. and Gotway, C.A. (2002) ‘Mental Health status of human rights workers, Kosovo, June 2000’, Journal of Traumatic Stress, 15, 389-395. Jones, B., Muller, J. and Maercker, A. (2006) ‘Trauma and posttraumatic reactions in German development aid workers: prevalences and relationship to social acknowledgement’, International Journal of Social Psychiatry, 52 (2), 91-100. King, L.A., King, D.W., Leskin, G. and Foy, D.W. (1995) ‘The Los Angeles Symptom Checklist: a self-report measure of PostTraumatic Stress Disorder’, Assessment, 2, 1-17. Maslach, C. and Jackson, S.E. (1993) Maslach Burnout Inventory: Third Edition, Palo Alto, CA: Consulting Psychologists Press. Masten, A. (2001) ‘Ordinary magic: resilience processes in development’, American Psychologist, 56, 227-238. Masten, A., Best, K. and Garmezy, N. (1990) ‘Resilience and development: 23

contributions from the study of children who overcome adversity’, Development and Psychopathology, 2, 425-444. Paton, D. and Purvis, C. (1995) ‘Nursing in the aftermath of disaster: orphanage relief work in Romania’, Disaster Prevention and Management, 4, 45-54. Pearlin, L.I. (1991) ‘The study of coping: an overview of problems and directions,’ in J. Eckenrode (ed.) The social context of coping, New York: Plenum Press. Rotter, J. (1966) ‘Generalised expectancies for internal versus external control of reinforcement’, Psychological Monographs, 80, 3-28.

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Scheier, M.F. and Carver, C.S. (1985) ‘Optimism, coping, and health: assessment and implications of generalised outcome expectancies’, Health Psychology, 4, 219-247. Schwarzer, R. and Jerusalem, M. (1995) ‘Generalised Self-Efficacy scale’, in J. Weinman, S. Wright and M. Johnston (eds.) Measures in health psychology: A user’s portfolio. Causal and control beliefs, Windsor, UK: NFER-NELSON. Taylor, A.J. and Frazer, A.G. (1982) ‘The stress of post-disaster body handling and victim identification work’, Journal of Human Stress, 8, 4-12.

4

Working resiliently with young people in complex circumstances: what can a systematic consultative review tell us?

Angie Hart Professor Professor of Child, Family and Community Health, University of Brighton Becky Heaver Research Officer, University of Brighton

25

Introduction The past decade has seen an increase in the number of resilience-based interventions reported in the academic literature, with clear signs of their potential in evidence-based practice (Powers, 2010). However, we share the frustrations of practitioners and parents about inaccessible reviews that do not answer the most relevant questions about what to do in the immediate future. Therefore, a more organic review process emerged for this paper. We aimed to summarise the current state of the evidence in relation to the population and outcomes of interest, in a way that was useful to people on the ground. Major challenges exist in relation to extracting meaningful ways forward for practice from academic reports of resilience interventions. Firstly, there is enormous variation in the literature regarding precisely what is meant by a ‘resilience intervention’. Secondly, resilience interventions are generally too complex for direct comparison to be meaningful in a meta-analytic review, due to, for example, vast differences in the ways in which resilience is defined and measured (if at all). Therefore, we were drawn to the emerging ‘realist’ approach to systematic review and evaluation of complex social interventions (Pawson, Greenhalgh, Harvey and Walshe, 2005). Realist review combines theoretical understanding and empirical evidence to identify what works for whom, in what circumstances, in what respects and how. In the context of our work on resilience, our realist focus is on explaining the relationship between context, capacities and outcomes. Parents and practitioners frequently communicate their urgency and desperation to find practical, evidence-based strategies to make changes in the lives of their young 26

people in the ‘here and now’. They often find the resilience literature difficult to navigate, and lacking answers to their contextually driven questions. What was still missing was a way to integrate these questions into a review, so we consulted a focus group to find out what they wanted to know. This was combined with a systematic realist approach to form a ‘systematic consultative review’. In an iterative process, the findings were fed back to parents and practitioners to refine the questions and affirm the results. By consulting ‘end users’, it also incorporated elements of a participatory review process, informed by the needs and knowledge of ‘stakeholders’ (see Rees and Oliver, 2012). Our goal in relation to this systematic consultative review was to work towards giving practitioners and parents a robust and systematic view of what the propositional knowledge base in relation to resilience can tell them about useful ways to approach their specific dilemmas in practice. We wanted to produce a review that was helpful and accessible, whilst still having a rigorous and accountable methodology (Gough, Thomas and Oliver, 2012).

Description of the study Practitioners and parents were consulted twice, once prior to the literature search to establish the questions of interest, and once after the literature search to check that the results were congruent with the aims. We asked a convenience sample of fifteen practitioners and five parents, with whom we work on applying resilience concepts and methods to practice, what questions they wanted the resilience research base to answer. We also drew on the perspectives of other parents and practitioners as recorded in evaluations of training events we have conducted over the past five years. Finally, we considered key issues raised by

parents and practitioners, documented in the reflective diary of one of the authors, who has been conducting workshops and other training events for seven years. An initial search of the literature was made through social science journal databases for articles between 2000–2011, which included resilience keywords in the title, and keywords related to age group, intervention and improvement in the abstract. Additional publications were identified in an iterative process via Google Scholar, manual searches of reference lists, and discussion with colleagues. Of the 1488 retrieved references, 84 documents were identified as relevant on the basis of their title and abstract, and full text was reviewed by one or both researchers. Inclusion criteria for the review were: at least some of the participants were aged 12–18; at least part of the intervention took place at, during or after school; the intervention was resilience-based and evaluated. We chose this age range because the practitioners and parents involved in our review were working with young people in this age group. In line with realist approaches we were keen to document the ecological context of the interventions; therefore programs were not required to target predefined developmental or resilience aspects. However, it was essential that discussion of models or theories of resilience (e.g. Hart, Blincow and Thomas, 2007; Masten, 2001) provided a conceptual basis for why the intervention would be effective in enhancing resilience (e.g., increased self-esteem). Additionally, outcomes had to include either a resilience scale or measures of the individual resilience capacities defined in the authors’ rationale (e.g., self-esteem). We wanted to capture any information that included an inequalities angle as the parents and practitioners with whom we are working support young people in contexts they would define as complex inequality or disadvantage, those who are ‘denied access to the tools needed for self-sufficiency’ (Mayer, 2003: 2). Resilience scholars and researchers are not always aware of the inequalities focus that

needs to be applied for work to be effective – a key issue in framing resilience work (see Hart et al. , 2007; Hart, Hall and Henwood, 2003). Addressing basic inequalities and lack of access to developmentally-appropriate resources has been authoritatively described as the single most important step in improving outcomes for mental health (Friedli, 2009; Layard, 2005). Yet these factors are, even within interventions targeting disadvantaged populations, rarely explicitly considered and worked with beyond citing contextual issues relating to the child’s social ecology. Twelve of the 84 papers identified were selected for inclusion in this article, which, through their variation in program content, setting, delivery, and young people, both authors felt were best-placed to answer the questions raised in consultation with parents and practitioners. These papers met the inclusion criteria in full, including a robust resilience concept and basis to the intervention. Although none of our consultation questions addressed the conceptual basis, evaluation or measures, these criteria were used to show that interventions were of sufficient quality and relevance.

Findings The twelve papers conceptualised resilience variously as a: tool, outcome, process, dynamic interaction, capacity, ability, characteristic, act, skill, trait, protective factor, positive influence, potential, asset, resource, recovery, disposition, competency, attitude, value, strength, knowledge, response, performance, functioning, adaptation, tendency, transactional relationship. As they did not meet the inclusion criteria, some otherwise interesting and innovative interventions unfortunately could not be included in the review. The most common reasons for exclusion were that they did not conceptually relate their study to resilience (e.g. not including a definition), despite using the term in the abstract or key words, or they did not report on an evaluated intervention. However, some were impressive enough that 27

we thought them worth mentioning, because colleagues might well find them useful. In one such paper, by making intervention delivery part of a service-based learning course for undergraduate psychology students, Kranzler, Parks and Gillham (2011) were able to form sustainable community-university links, potentially increasing the social capital of the target community, and its novel approach gave practical advice and at least basic inequalities angle (the intervention took place in a deprived area and part of the intervention was providing a basic nutritional intervention in the context of food poverty).

Demographics The types of young people involved seemed quite broad at first glance, however, when we looked at the numbers we found that this range was much narrower (see Table 1). Very few of the young people had complex needs such as learning difficulties (only six). This is particularly concerning given that resiliencebased interventions might be thought of as TABLE 1. DISTRIBUTION OF CHARACTERISTICS OF YOUNG PEOPLE IN THE REVIEW INTERVENTIONS. Characteristic Lowest quintile of disadvantage (Hodder et al., 2011)

28

Number of young people 1449

Average (Grunstein and Nutbeam, 2006)

781

At risk of HIV (Ebersöhn and Ferreira, 2011; PeacockVillada et al., 2007)

670

Black and ethnic minority (Davis and Paster, 2000; Griffin et al., 2009; Kruger and Prinsloo, 2008)

229

Exposed to trauma (Baum, 2005; Vetter et al., 2010)

136

Specific learning difficulties (Theron, 2006)

6

Severe emotional and behavioural difficulties (Leve et al., 2009; Woodier, 2011)

2

being most useful in complex circumstances – we see resilience in Masten’s (2001: 228) terms as a ‘positive outcome despite serious threats to adaptation or development’. Young people with learning difficulties or mental health issues were under-represented in resilience interventions, with studies such as the Penn Resiliency Program (e.g. Kranzler et al., 2011) specifically recruiting subclinical samples. Studies are often conducted in mainstream schools (e.g. Grunstein and Nutbeam, 2006), with few marginalised young people taking part (e.g. absent from school when intervention took place/measures recorded, non-respondents, measures not accessible). Resilience-focused interventions often exclude those complex young people who need them the most.

What really works? The lead author has been asked this question for 8 years by parents and practitioners attending training, supervision and consultation sessions. The targeted empirical consultation we conducted with them corroborated this as the question they most wanted answering. Our analysis of the papers in this review unsurprisingly and, for many parents and practitioners, disappointingly, gives us little in the way of definitive answers to that question. Most evaluations focussed on the positive findings, but without reporting effect sizes to facilitate comparisons, some findings appearing rather modest, and all were specific to the contexts in which they occurred. This confirms our realist review position that any discussion of what works has to be contextually focussed.

‘Where do I start?’ and ‘What can I do right now that will make a difference?’ There was little in the school-based resilience intervention literature about starting positions, except that the earlier the better, and that there are major differences in approach.

None of the interventions addressed the issue of whether a hierarchy of importance could be attached to specifics within the portfolio of techniques and approaches described in Table 2 and Table 3. This is an interesting gap in the intervention literature, particularly if we take Roisman and Padron’s definition of resilience seriously. They see it as, ‘an emergent property of a hierarchically organized set of protective systems that cumulatively buffer the effects of adversity...’ (Roisman, Padrón, Sroufe and Egeland, 2002: 1216). For them, understanding where to start, and what to do at any given moment in time, is crucial. Our own take on this is that these questions must be addressed through an analysis of the specific context. In relation to Resilient Therapy, the resilience-based practice intervention approach developed by the lead author of this paper alongside colleagues (Hart et al., 2007), we have devised a list for practitioners and parents, since these questions came up over and over again, eliciting considerable anxiety (see Hart, Aumann and Heaver, 2010). Still a work in progress, in the absence of definitive guidance from research, the approach helps people decide how to answer these two questions, and to move forward with making ‘resilient moves’ within a specific context. It may prove useful for others trying to decide exactly ‘what to do and when’, in the course of attempting to instigate a resilience-based intervention of any nature. An important point to consider is what can we take anywhere? If we cannot say for sure precisely ‘what to do and when’, is it worth considering what techniques are effective across contexts, situations and individuals that may form a portable and flexible approach, without reliance on resources and infrastructure? Suitable strategies highlighted in our review, which also occur in the broader resilience evidence base we have summarised elsewhere (Hart et al., 2007), include developing problem-solving skills, autobiographical narrative (‘consciousnessraising’), prioritising the development of a relationship with one caring adult, instigating a system of reward points, intensity of intervention and consistency.

Is it better to work with young people or parents or teachers or the whole school? The variation between interventions was so great that it is not possible to conclude that any particular approach worked better than the others. Six worked directly with young people (Griffin et al., 2009; Grunstein and Nutbeam, 2006; Hodder et al., 2011; Theron, 2006; Vetter et al., 2010; Woodier, 2011), one with young people and (foster) parents (Leve et al., 2009), two with young people and teachers or instructors (Kruger and Prinsloo, 2008; Peacock-Villada et al., 2007), one with young people, parents and teachers (Davis and Paster, 2000), and two with only teachers (Baum, 2005; Ebersöhn and Ferreira, 2011). Approaches also varied in whether they targeted individuals, classrooms, the whole school, or asked for volunteers to sign up. Four interventions targeted students on the basis of individual characteristics such as gifted intelligence (Davis and Paster, 2000), learning disability (Theron, 2006), or involvement with child welfare services (Leve et al., 2009; Woodier, 2011), via voluntary work (Woodier, 2011), group work (Davis and Paster, 2000), art and music therapy (Theron, 2006), or multiple strategies (Leve et al., 2009; Theron, 2006). Four interventions targeted entire year groups on the basis of age (Griffin et al., 2009; Kruger and Prinsloo, 2008), exposure to trauma (Vetter et al., 2010), or opportunity sample (Grunstein and Nutbeam, 2006), via in-class activities (Kruger and Prinsloo, 2008), performing arts (Grunstein and Nutbeam, 2006), role play (Griffin et al., 2009), and adventure recreation (Vetter et al., 2010). One intervention recruited participants from several schools (Peacock-Villada et al., 2007) to engage in afterschool football (Peacock-Villada et al., 2007). Two interventions were systemic ‘whole-school’ approaches with schools selected for exposure to trauma (Baum, 2005), or low socioeconomic disadvantage (Hodder et al., 2011), acting via teacher training (Baum, 2005), modifying school policies, and developing school-community links (Hodder et al., 2011). One program targeted a proportion of teachers within schools to act as resource 29

negotiators for their whole school (Ebersöhn and Ferreira, 2011).

How do you make a really entrenched and marginalised young person change? This topic received little focus due to the relative lack of attention to young people with complex needs in these studies. However, some key capacities that kept reoccurring are included in Table 2.

What do you do exactly, for how long and with what intensity? This review confirmed our conclusions from many years of research and practice, that to be effective one has to be contextually focussed. All programs were interventions, enhancing resilience for the present and the future, and 8 had a specific focus (see Table 3). For further information about the strategies used in the interventions, see Hart and Heaver (2013).

TABLE 2. RESILIENCE CAPACITIES TARGETED BY SCHOOL-BASED INTERVENTIONS.

Individual

Interpersonal

Friends & Family

Community

30

Capacities

Studies

Self-esteem

Baum, 2005; Griffin et al., 2009; Grunstein and Nutbeam, 2006; Hodder et al., 2011; Kruger and Prinsloo, 2008; Peacock-Villada et al., 2007; Woodier, 2011

Autonomy

Griffin et al., 2009; Grunstein and Nutbeam, 2006; Hodder et al., 2011; Kruger and Prinsloo, 2008; Peacock-Villada et al., 2007; Theron, 2006

Problem-solving

Grunstein and Nutbeam, 2006; Kruger and Prinsloo, 2008; Theron, 2006; Vetter et al., 2010

Goals & aspirations

Griffin et al., 2009; Grunstein and Nutbeam, 2006; Hodder et al., 2011; Kruger and Prinsloo, 2008; Peacock-Villada et al., 2007; Theron, 2006

Sense of purpose

Baum, 2005; Griffin et al., 2009; Grunstein and Nutbeam, 2006; Kruger and Prinsloo, 2008; Vetter et al., 2010

Skills, interests, competencies

Davis and Paster, 2000; Griffin et al., 2009; Grunstein and Nutbeam, 2006; Kruger and Prinsloo, 2008; Leve et al., 2009; Peacock-Villada et al., 2007; Vetter et al., 2010; Woodier, 2011

Empathy

Baum, 2005; Davis and Paster, 2000; Grunstein and Nutbeam, 2006; Hodder et al., 2011; Kruger and Prinsloo, 2008; Theron, 2006; Vetter et al., 2010; Woodier, 2011

Being caring

Davis and Paster, 2000; Griffin et al., 2009; Grunstein and Nutbeam, 2006; Vetter et al., 2010; Woodier, 2011

Social competence

Griffin et al., 2009; Grunstein and Nutbeam, 2006; Hodder et al., 2011; Kruger and Prinsloo, 2008; Leve et al., 2009; Theron, 2006; Vetter et al., 2010; Woodier, 2011

Family connectedness

Baum, 2005; Davis and Paster, 2000; Ebersöhn and Ferreira, 2011; Griffin et al., 2009; Grunstein and Nutbeam, 2006; Hodder et al., 2011; Kruger and Prinsloo, 2008; Leve et al., 2009

Bond with one caring adult

Davis and Paster, 2000; Ebersöhn and Ferreira, 2011; Leve et al., 2009; Peacock-Villada et al., 2007; Theron, 2006; Vetter et al., 2010; Woodier, 2011

Positive peer relationships

Ebersöhn and Ferreira, 2011; Griffin et al., 2009; Hodder et al., 2011; Kruger and Prinsloo, 2008; Peacock-Villada et al., 2007; Theron, 2006; Vetter et al., 2010

(In)formal social support

Baum, 2005; Ebersöhn and Ferreira, 2011; Griffin et al., 2009; Kruger and Prinsloo, 2008; Leve et al., 2009; Peacock-Villada et al., 2007; Woodier, 2011

School connectedness

Ebersöhn and Ferreira, 2011; Grunstein and Nutbeam, 2006; Hodder et al., 2011; Kruger and Prinsloo, 2008

Community connectedness

Davis and Paster, 2000; Ebersöhn and Ferreira, 2011; Griffin et al., 2009; Hodder et al., 2011; Kruger and Prinsloo, 2008; Peacock-Villada et al., 2007; Vetter et al., 2010

TABLE 3. EXAMPLES OF CONTEXTS, INTERVENTIONS AND INTENSITY OF INTERVENTIONS. Context

Intervention

Intensity

Study

Alcohol, tobacco and/or other drug use

problem-solving and communication skills

90 mins, 2–3 x week, for 9 weeks

Griffin et al., 2009

curriculum modifications

implemented for 3 years

Hodder et al., 2011

teacher training

3 x 3 hr sessions

Baum, 2005

mountaineering and survival skills

one-week residential course

Vetter et al., 2010

Disability

individualised program

12 x 1 hr sessions over 5.5 months

Theron, 2006

Career/vocation

training and role-play

90 mins, 2–3 x week, for 9 weeks

Griffin et al., 2009

Preventing HIV

teacher training and vegetable garden

6 x 8 hr sessions over 1 year

Ebersöhn and Ferreira, 2011

outdoor recreation

6 weeks

Peacock-Villada et al., 2007

Emotional and behavioural

one-to-one curriculum; work experience

3 hrs a week for 1 year; twice a week for 3 years

Woodier, 2011

Foster care

individualised program

6–9 months

Leve et al., 2009

General

psychosocial skills groups

1hr weekly for a year

Davis and Paster, 2000

dance/drama competition

not specified

Grunstein and Nutbeam, 2006

curriculum modifications

12 x 1 hr sessions

Kruger and Prinsloo, 2008

Trauma

31

How much does it cost? Few interventions provided any details on cost, or gave consideration to sustainability, social capital and capacity building through, for example, having parents, teachers or young people developing and/or delivering training (e.g. Experience in Mind, Taylor and Hart, 2011; Hart, Virgo and Aumann, 2006; Winter et al., 2012; see also Hart and Heaver, 2013). Most interventions were researcher-led, and whilst interventions delivered by teachers/ parents can be adopted and continued after the study has been completed, researchers are likely to leave at the end of the study.

What do we think could have made the interventions better/ more successful? The studies we reviewed lacked school-parent interaction, complex or marginalised (or absent) young people, and the value of addressing the basics (e.g. giving the young people a decent breakfast). There was very little participatory research (particularly at the point of program evaluation) from the point of view of the teachers, parents or young people. Only one study involved an advisory panel for school staff, parents and community members (Hodder et al., 2011), and another incorporated youth feedback during the pilot, and was evaluated by a local peer educator who acted as an insider researcher and remained working in the region after the program finished (Peacock-Villada et al., 2007). Ebersöhn and Ferreira’s (2011: 5) PRA meant they ‘viewed participants as partners and experts throughout the research process and encouraged them to not only share their knowledge but also co-create and co-determine the progress and processes of the research’. This study deserves particular mention because, as well as being participatory, it also addressed the basics (food, clothing, health care), made connections between the school, families and the community, focussed on schools with high levels of complex adversity, and built capacity in parents and teachers (Ebersöhn and Ferreira, 2011). 32

When trying to develop psychosocial resilience interventions, researchers may understandably not see tackling structural inequality as the primary goal of their project. However, despite the massive potential benefits, few interventions had any inequalities angle at all, such as: providing food or travel costs, including strategies to raise awareness of inequalities, engaging in equality training, using ‘inequalities imagination’ (e.g. Hart et al., 2003), or consciousness raising (e.g. autobiographical narrative). Only two studies focussed on young people from a deprived neighbourhood (Ebersöhn and Ferreira, 2011; Griffin et al., 2009), and one briefly considered racism and prejudice (Davis and Paster, 2000). One study describes selecting schools where pupils lived in the ‘lowest quintile of socioeconomic disadvantage’ (Hodder et al., 2011: 2). Whilst this might at first sound like pupils come from deprived backgrounds, the Australian Bureau of Statistics designate Quintile 1 as those having the least disadvantage. Attempts to contact the authors for clarification have been unsuccessful, and this ambiguous phrase suggests instead that pupils are from more privileged backgrounds. Hobbies have a good evidence-base in relation to resilience-building and also other evidencebased resilience capabilities like problemsolving skills (Hart et al, 2007), but in general these interventions did not encourage hobbies. The few that are mentioned are sports and recreation (Peacock-Villada et al., 2007; Vetter et al., 2010), dance and drama (Grunstein and Nutbeam, 2006), art (Theron, 2006; Vetter et al., 2010), music (Theron, 2006; Vetter et al., 2010) and religion (Baum, 2005; Kruger and Prinsloo, 2008; Woodier, 2011). Most often these activities form a very minor component of a complex intervention, or are described in terms of facilitated ‘play therapy’ rather than encouraged as an independently pursued and rewarding hobby. Elsewhere in the literature such leisure activities have been reported to increase resilience in young people with disabilities through providing supportive relationships, power, control, ‘desirable’ identity, and social justice (Jessup, Cornell and Bundy, 2010).

Key learning The findings of the review identified repeating themes of effective resilient practices across the studies and contexts, such as teaching problem-solving skills, building relationships, and working at multiple levels (individual, family, community). A bond with one caring adult was found to be particularly important in communicating caring, support, and high expectations, whether this was one-to-one mentoring, skills guidance from a non-family adult, or positive support from a teacher or foster parent. Entrenched and marginalised young people with highly complex needs were of specific interest to the parents and practitioners we consulted, and we can infer from the papers in our review that, perhaps unsurprisingly, these young people responded to high intensity, individually customised interventions, and continuity between contexts, such as the home and school environments.

Conclusions and recommendations There are limitations to what we have undertaken in that many interventions that do not define themselves as narrowly ‘resiliencebased’ have been excluded for practical reasons. A better resourced, broader and more sophisticated systematic consultative review would find a way to include such papers. Our approach was successful in answering some of our consultation group’s questions, but not all; in particular, we did not manage to identify which programs were most effective (if indeed comparisons across contextualised interventions are appropriate).

In the messy, complexity of situated practice there is often a huge gap between what research reports, and what people want to know and learn about. Most studies did not include enough of the very young people most people with whom we are involved are trying to support, and many of the interventions did not seem very practical to replicate in the

real world outside a well-funded research project. No basic information about costs was included, and from our knowledge of the area, such large-scale interventions are usually expensive. This is particularly an issue for high-intensity interventions, and consideration needs to be given to how information is packaged for front-line workers, supporting young people with complex needs, who may only be able to offer time-limited intervention, with limited resources and under far from ideal conditions. Most interventions were researcher-led, and seven of the twelve interventions did not include the teachers who would be involved with the young people beyond the end of the research study. Capacity building in teachers and parents was woefully absent, with the exception of Ebersöhn and Ferreira (2011). The inequalities dimension was also barely considered. We recommend that all of these issues should be addressed in future developments of school-based interventions. As discussed in the methods section, many of the papers originally selected were using the term ‘resilience’ in such a vague and conceptually weak manner that it was hard for us to pin down if the intervention really could be described as ‘resilience-based’. Future papers reporting on resilience-based approaches could usefully pay more attention to defining the specific ways in which they understand it to be resilience-based. It is disappointing that only partial answers to our questions can be gleaned from the current literature. However, we hope that this review provides a starting point to generate some ideas for ways of working at the interface between academic research and practice development.

References Baum, N.L. (2005) ‘Building resilience: A school-based intervention for children exposed to ongoing trauma and stress’, Journal of Aggression, Maltreatment & Trauma, vol. 10, no. 1/2, pp. 487-498. 33

Davis, T. III and Paster, V.S. (2000) ‘Nurturing resilience in early adolescence: A tool for future success’, Journal of College Student Psychotherapy, vol. 15, no. 2, 17-33.

oriented substance abuse and violence preventive intervention’, Journal of Health Care for the Poor & Underserved, vol. 20, no. 3, pp. 798-816.

Ebersöhn, L. and Ferreira, R. (2011) ‘Coping in an HIV/AIDS-dominated context: Teachers promoting resilience in schools’, Health Education Research, vol. 26, no. 4, pp. 596-613.

Gough, D., Thomas, J. and Oliver, S. (2012) ‘Clarifying differences between review designs and methods’, Systematic Reviews, vol. 1, no. 28. doi:10.1186/2046-4053-1-28.

The ‘Experience in Mind’ project and Taylor, S. and Hart, A. (2011) Mental health and the Resilient Therapy toolkit: A guide for parents about mental health written by young people, Bath: MBE, [Online], Available: http:// www.boingboing.org.uk [18.03.2013].

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Grunstein, R. and Nutbeam, D. (2007) ‘The impact of participation in the Rock Eisteddfod challenge on adolescent resiliency and health behaviours’, Health Education, vol. 107, no. 3, pp. 261-275.

Friedli, L. (2009) Mental health, resilience and inequalities, Copenhagen: WHO Europe.

Hart, A., Aumann, K. and Heaver, B. (2010). Boingboing resilience research and practice, [Online], Available: http://www.boingboing. org.uk [18.03.2013].

Griffin, J.P., Jr., Holliday, R.C., Frazier, E. and Braithwaite, R.L. (2009) ‘The BRAVE Program: Evaluation findings for a career-

Hart, A., Blincow, D. and Thomas, H. (2007) Resilient Therapy: Working with children and families, London: Routledge.

Hart, A., Hall, V. and Henwood, F. (2003) ‘Helping health and social care professionals develop an ‘inequalities imagination’: A model for use in education and practice’, Journal of Advanced Nursing, vol. 41, no. 5, pp. 1-9. Hart, A. and Heaver, B. (2013) ‘Evaluating resilience-based programs for schools using a systematic consultative review’, Journal of Child and Youth Development, vol. 1, no. 1.

Masten, A.S. (2001) ‘Ordinary magic: Resilience processes in development’, American Psychologist, vol. 56, no. 3, pp. 227-238. Mayer, S.E. (2003) What is a “disadvantaged group”? Minneapolis: Effective Communities Project.

Hart, A., Virgo, S. and Aumann, K. (2006) Insiders’ guide to bringing up children with special needs: Evaluation of the Amaze parent support course. Brighton, UK: Amaze.

Pawson, R., Greenhalgh, T., Harvey, G. and Walshe, K. (2005) ‘Realist review: A new method of systematic review designed for complex policy interventions’, Journal of Health Services Research & Policy, vol. 10, no. S1, pp. 21-34.

Hodder, R.K., Daly, J., Freund, M., Bowman, J., Hazell, T. and Wiggers, J. (2011) ‘A school-based resilience intervention to decrease tobacco, alcohol and marijuana use in high school students’, BMC Public Health, vol. 11, no. 722.

Peacock-Villada, P., DeCelles, J. and Banda, P.S. (2007) ‘Grassroot Soccer resiliency pilot program: Building resiliency through sport-based education in Zambia and South Africa’, New Directions for Youth Development, vol. 2007, no. 116, pp. 141-154.

Jessup, G.M., Cornell, E. and Bundy, A.C. (2010) ‘The treasure in leisure activities: fostering resilience in young people who are blind’, Journal of Visual Impairment & Blindness, vol. 104, no. 7, pp. 419-430.

Powers, J.D. (2010) ‘Ecological risk and resilience perspective: A theoretical framework supporting evidence-based practice in schools’, Journal of Evidence-Based Social Work, vol. 7, pp. 443-451.

Kranzler, A., Parks, A. and Gillham, J. (2011) ‘Illustrating positive psychology concepts through service learning: Penn teaches resilience’, The Journal of Positive Psychology, vol. 6, no. 6, pp. 482-486.

Rees, R. and Oliver, S. (2012) ‘Stakeholder perspectives and participation in reviews’, in Gough, D., Oliver, S., and Thomas, J. (eds.) Introduction to systematic reviews, London: Sage.

Kruger, L. and Prinsloo, H. (2008) ‘The appraisal and enhancement of resilience modalities in middle adolescents within the school context’, South African Journal of Education, vol. 28, pp. 241-259.

Roisman, G.I., Padrón, E., Sroufe, L.A. and Egeland, B. (2002) ‘Earned-secure attachment status in retrospect and prospect’, Child Development, vol. 73, no. 4, pp. 1204-1219.

Layard, R. (2005) Happiness: Lessons from a new science, London: Allen Lane. Leve, L.D., Fisher, P.A. and Chamberlain, P. (2009) ‘Multidimensional treatment foster care as a preventive intervention to promote resiliency among youth in the child welfare system’, Journal of Personality, vol. 77, no. 6, pp. 1869-1902.

Theron, L. (2006) ‘Critique of an intervention programme to promote resilience among learners ,with specific learning difficulties’, South African Journal of Education, vol. 26, no. 2, pp. 199–214. Vetter, S., Dulaev, I., Mueller, M., Henley, R.R., Gallo, W.T. and Kanukova, Z. (2010) ‘Impact of resilience enhancing programs on youth surviving the Beslan school 35

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siege’, Child and Adolescent Psychiatry and Mental Health, vol. 4, no. 11.

[Online], Available: http://www.boingboing. org.uk.

Winter, S., Buttery, L., Gahan, L., Taylor, S., Gagnon, E., Hart, A. and Macpherson, H. (2012) Visual arts practice for resilience: a guide for working with young people with complex needs, Brighton: BoingBoing,

Woodier, D. (2011) ‘Building resilience in Looked After young people: a moral values approach’, British Journal of Guidance & Counselling, vol. 39, no. 3, pp. 259-282.

5

Be Prepared!

10 steps to complete your community emergency plan Terry McCormick

37

“How would my community survive the first 48 hours of a serious emergency?”

1. Getting together

Who should you involve? • Friends, neighbours, parish councilors,

Preparing a Community Emergency Plan will require voluntary input from across the community, and the harnessing of local knowledge and resources. Remember you are the local experts.

potential volunteers • Emergency services (Police, Fire & Rescue, etc), County and District emergency team

What should you discuss? • How your community would cope in an

An open meeting One way to start this process is to call an open meeting, working with neighbours and the parish council, to encourage wider consideration of the key question that we opened with “How could we better survive the first 48 hours of an emergency?” An open meeting can take a variety of formats from an informal “drop in” where small numbers of people can view and discuss information about emergency planning, such as this toolkit, to a full scale public meeting in the village hall. In either case you need to think about how you might publicise the event, where it will take place, what information and materials you may need and who you should invite. The emergency services and the County Emergency Planning Team may be able to help with information while support organisations such as ACT can advise on organising your event and may be able to help you run it on the day. Whatever the format you decide upon you can use the event to talk about your shared concerns, review this toolkit and decide whether there is support for the preparation of an emergency plan. This is also a great opportunity to identify potential members of a Community Emergency Group, a set of volunteers prepared to work together to develop a local plan. “After the devastating floods in 2009, we knew we had to be better prepared. Talking to ACT and holding an open meeting was an essential first step” – Penny Poole, Coordinator, Melbreak Communities (Lorton, Loweswater, Blindbothel, Buttermere) 38

emergency, and the benefits of planning ahead • How this toolkit can help, who is willing to

help prepare a plan

For more ideas see back page for links to the following: • ACRE: Preparing for your future event

(available only from ACT) • Cabinet Office: Community Emergency

Planning Toolkit, Page 3 • Cumbria County Council: A Guide to

developing a Community Emergency Plan, Page 6

2. Organising the work Essential to seeing through the preparation of a Community Emergency Plan is the effective coordination of the work involved and the championing of the use of the Plan once it is completed. The Community Emergency Group Coordination is the role of a Community Emergency Group. It should comprise a number of volunteers with a good range of local knowledge. The group should be led by, or appoint, a Community Emergency Coordinator and deputies with the time and ability to guide the work of the Group, and the development of the Emergency Plan. You should think about how you will involve the Parish Council and local representatives of the Emergency Services, including any local search and rescue team there may be.

Media liaison A further function of the Group, the importance of which has been highlighted by past experience, should be liaising with the media. Identify someone to lead in this role who communicates well, can manage questions and stay focussed under pressure. Work together to agree what key messages the community wishes to communicate and work with media representatives to help the flow of information. Group meetings The Community Emergency Group will be the lead organisation in the community for working through the 10 step process and for leading the community’s response should an emergency arise. It will probably need to meet on a number of occasions in order to work through the steps in a comprehensive and structured way. You may therefore need to think about where the Group should meet, and prepare an agenda or programme for its meetings so that all the necessary ground is covered. Also essential is that the meetings of the Group are properly recorded and that good written records are kept of its work and the information that it produces as it works through the 10 Steps – who will do this? You will see that Step 10 in our planning process involves regularly reviewing and testing the Community Emergency Plan, this and its responsibility for directing local action in an emergency means that the Group has important responsibilities that extend beyond the drafting of the Emergency Plan itself.

Making sure it happens

• Cumbria County Council: A Guide to

Developing a Community Emergency Plan, Pages 6–7

3. Knowing the unknowns Each community will face emergency risks from a range of differing sources. What creates an emergency is the unpredictability of these. A key task is to think about the types of event that are most likely to occur in your area. Assessing the risks A key task for the Community Emergency Group is not to try and second guess every possibility but to think about the types of event that are most likely to occur, giving some context for the Group’s work in emergency planning. A good starting point for this is the Community Risk Register that has been prepared by the Cumbria Resilience Group (see web link below). This handy document reviews a wide range of possible causes of an emergency and will give you ideas about what the greatest risks for your community may be. Consider various types of risks You should also consult local representatives of the Emergency Services and begin to use the local knowledge of your group members and other volunteers. For example you should think about and record: Social Risks – Particular groups of local people who may be vulnerable in the face of an emergency (elderly people, holidaymakers, travellers)

• Set up a Community Emergency Group

and appoint Community Emergency Coordinators • Involve your Parish Council and representatives of the emergency services • Plan to work with the media • Keep good records of your meetings and the information that you gather

For more ideas see back page for links to the following: • Cabinet Office: Community Emergency

Planning Toolkit, Page 4

Environmental Risks – Areas that flood regularly, vulnerable sites of heritage or environmental interest Infrastructure Risks – Major traffic routes, bridges, industrial sites that are possible sources of emergency problems It is important that you do not try to plan in detail for each specific risk as this will limit your flexibility to respond to very different situations. Instead focus on identifying the people resources and facilities that you have and which you 39

“We are pre-responders working with and helping the emergency services and aware of our limitations. We do not want to end up being rescued ourselves” – Graham Thompson, Keswick Volunteer Lead (Keswick Flood Action Group)

can utilise flexibly as a situation arises and changes.

What things might trigger an emergency? • Consult the Community Risk Register • www.cumbria.gov.uk/eLibrary/Content/

Internet/535/4077812276.pdf

Talk to key informants • Representatives of the Emergency Services • Local people involved in previous

emergency situations.

For more ideas see back page for links to the following: • Cabinet Office: Community Emergency

Planning Toolkit Pages 4–6 • Cabinet Office: Community Emergency

Planning Template, Page 4 • Cumbria County Council: A Guide to

developing a Community Emergency Plan, Page 7.

4. Identifying skills and resources At the heart of your plan will be a comprehensive register of the local resources that can be called upon by the Community Emergency Group in the event that an emergency does arise. Your community’s assets Every community has access to a range of local skills, knowledge, physical resources and support organisations that can be mobilised in the event of an emergency. The key to acting promptly and effectively in an emergency is having identified these in advance. There are three main topics to research: Who is good at what? Each community has people who have been known to help in the past or who have skills that would

40

be particularly useful. These will include local farmers, health professionals, First Responders, builders, electricians, search and rescue team members and others with specialist skills and training. What resources do we have? There are likely to be a variety of vehicles, tools, machinery, equipment, and sources of food, water and construction materials. How will we communicate? Where in the community are there good telephone communications and a strong mobile phone signal. How might these be affected in an emergency and may you need alternatives? Having identified the skills and resources that you may be able to call upon make sure that you record the relevant information in an easily accessible form. You will need contact details for all concerned and an understanding of the terms on which you might be able to utilise equipment and materials. Think about how you will use your volunteers, perhaps identifying teams to: • Staff your local control centre • Assist with a rest centre • Become local wardens to ‘door knock’ particular parts of your community should an emergency arise Consider whether you need to put in place agreements with the individuals and organisations concerned, relating to their availability in an emergency. If you identify the need to acquire special equipment (e.g. 2-way radios, first aid materials, blankets, battery radios, torches, grit), you will need to think about where these can be stored securely but be accessible when needed. You will also need to think about who is to be responsible for their security and maintenance.

Who is good at what? • People with useful or specialist skills e.g.

farmers, contractors, health professionals, First responders, search and rescue team members

What equipment do we have? • Tools, machinery, communications

any training or ways of working that will minimise the risks that you identify.

equipment, vehicles • Sources of food, water, construction

materials

For more ideas see back page for links to the following: • Cabinet Office: Community Emergency

Planning Toolkit, Pages 7–8 • Cabinet Office: Community Emergency Planning Template, Page 5

5. Legal issues The use of resources in an emergency may raise a range of legal and financial issues. Thinking about these in advance and putting in place any necessary agreements can minimise any difficulties.

Insurance for Volunteers Consider whether you need insurance for local volunteers, it is possible that an existing local organisation (e.g. your Parish Council), or an organisation of which the volunteer is a member (e.g. Red Cross, Lions), already has appropriate cover. Costs Consider how the costs of any emergency action that you take, e.g. room hire, materials, etc may be paid. In the first instance make contact with the emergency officer nominated by your Borough or District Council and seek their advice.

Buildings and equipment • Agreements with owners and insurance to

Resolving legal issues in advance The use of resources, especially buildings and vehicles, in an emergency may not be covered by their present insurance. Similarly, there may be health and safety concerns about the use by volunteers of unfamiliar equipment. You may incur costs for premises hire, materials, etc that will need to be paid. These issues cannot be left until the emergency takes place because they may result in real constraints on what you and other community members can actually do. Issues to consider Planning ahead will help to minimise any problems of this type. There are a number of practical things that you should be able to do: Buildings and Equipment Insurance Liaise with the owners of buildings and vehicles about any constraints that may arise from their insurance and see if it is possible to remove these, perhaps by notifying the insurer. Equipment Use Think about the types of equipment that might be used by volunteers, and the circumstances in which they will do this. Prepare a risk assessment of the activity to help you identify

cover usage • Arrangements for paying any costs incurred

Working with volunteers • Personal liability insurance • Safe working arrangements

For more ideas see back page for links to the following: • Cabinet Office: Community Emergency

Planning Toolkit, Page 8 • Cumbria County Council: A Guide to

developing a Community Emergency Plan, Page 9 • Website of the Association of British Insurers: www.abi.org.uk

6. Organising key facilities Think in advance about the facilities that you may need in order to effectively manage an emergency situation and to support local people who are affected. Facilities needed Effectively managing an emergency is likely to require some facilities. You will need to think about these in advance and have plans in place 41

for suitable buildings or locations to meet the needs you identify. Facilities that are most often found necessary include:

Other things to think about?

Local Control Centre – Somewhere where the Community Emergency Group and representatives of the Emergency Services can meet to review the situation and plan and coordinate their actions. This may simply be a good sized room where a dozen people can get round a table to talk. Remember that good communications are at the heart of responding to an emergency situation so reliable telephone communications is a must.

For more ideas see back page for links to the following:

Rest Centre – A place to which people can be moved, spend the night and be fed if they have to leave their own homes. A village or school hall may provide what you need: space for people to sit, secure storage for their belongings, toilets, a kitchen and sufficient space for people to sleep. Again, good communications are essential.

7. Keeping in touch

Issues to consider In both cases check the county emergency plan to see whether this has already identified suitable premises in your community. If not, try to pick locations that are unlikely to be directly affected by an emergency (e.g. unlikely to flood) but which are readily accessible to as much of the community as possible. Think also about the possible need for “reserve” facilities in the event that those you first identify are not available when needed and how you would manage in your selected premises if mains services are not available. You might, for example, need a generator. Talk to those responsible for the buildings you identify, secure their agreement in principal to their use and have plans in place for just how you will use them should an emergency arise.

What facilities might we need? • Local Control Centre – accessible, good

• Facilities identified by Emergency Services • Managing without mains services

• Cabinet Office: Community Emergency

Planning Toolkit, Page 9 • Cabinet Office: Community Emergency

Planning Template, Page 6 • Cumbria County Council: A Guide to developing a Community Emergency Plan, Page 10

In developing your Community Emergency Plan you will have identified key people and groups that you may need to contact and mobilise should an emergency arise. Effective communications with these people is essential. Identify key people In developing your plans you will have identified a significant number of people who will be important in your response; people with significant resources, skills or knowledge, local volunteers and professional advisers. It is essential that you record the contact details of all these people. Be comprehensive and make sure that the information is readily accessible by key people such as the members of the Community Emergency Group and the Emergency Services. Telephone tree/cascade Importantly, you should also plan how you will mobilise these people when an emergency occurs. This is usually achieved using a telephone ‘tree’ or cascade in which each person telephones two or three others. In designing your cascade you may want to divide it into several teams (e.g. Control Team, Rest Centre Team, Local Action Teams) so that you can mobilise only those people who are needed at the time.

communications, room for meetings • Rest Centre - warm, accessible, cooking

facilities, room for beds, etc

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You will need to back your communications plan with a plan “B” that can operate should any of the key people in the tree not be available.

FIGURE 1. EXAMPLE OF A TREE CASCADE.

Data protection In preparing your records you will need to consider whether you are subject to the provisions of Data Protection legislation and, if so, how you may best comply with these. You may perhaps register with the Data Protection Commissioner and have procedures in place to restrict the access to your information to specific individuals and for specific purposes.

Whose comprehensive contact information will we need? • Emergency Services, County/District

Emergency Planning Teams • Your volunteers, owners of buildings,

equipment and vehicles

8. Activating your emergency plan With all of the main components of your plan in place, people, skills and resources, you next need to think about how your plan will be put into action when a real emergency arises. Know the triggers Following the preceding steps you have established an emergency group, identified likely causes of an emergency, listed the key people, resources and facilities that you have available, and agreed how you will communicate and mobilise these. Your next task is to think about how you will know when to put these plans into practice, that is, how will you know when an emergency has occurred?

How will we mobilise our contacts? • Use a pre-prepared telephone contact ‘tree’

or cascade • Consider alternative communications in the

case of telephones not working

For more ideas see back page for links to the following: • Cabinet Office: Community Emergency

Planning Toolkit, Page 9 • Cabinet Office: Community Emergency Planning Template, Pages 6–7 • Cumbria County Council: A Guide to developing a Community Emergency Plan, Pages 10–11

It is valuable for the Community Emergency Group to have thought about this in advance and to have agreed, in so far as is possible, the types of event that will trigger local action. Members of the Group should consider who is to be responsible for monitoring these as a possible emergency approaches. Give some thought to the point at which the Community Emergency Group may need to apply its arrangements for mobilising local resources, the communications cascade and first meeting. Examples of the types of “trigger” you might identify could well include: 43

• Warnings / requests from the Emergency • • • • • •

Services Environment Agency warnings Substantial changes in local river levels Locally recognised hot spots and early indicators for flooding Media messages Severe wet weather warnings from the Met Office Cumbria Community Messaging www.cumbriacommunitymessaging.co.uk

Agree key sources of information and advice e.g.

“The emergency plan should help us to feel more in control in an emergency, to manage the situation as best we can and help us to recover from it more quickly.” – Caroline Langdon, Coniston Parish Council advance preparation you can do is to have pre-prepared plans for this meeting. To ensure that this important meeting covers all of the necessary issues and drives an appropriate local response, prepare an agenda for such a meeting in advance. Make it sufficiently flexible to work effectively whatever the emergency that has arisen.

• Emergency Services, Environment Agency,

Met Office • Cumbria Community Messaging service,

local radio

Agree local signs that will alert you to a possible emergency e.g. • Substantial changes in local river levels,

You also need to consider: • Where the meeting will take place – perhaps your Local Control Centre • Who should attend – The Community Emergency Group, Parish Councillors, local volunteers, representatives of Emergency Services (if available).

other early indicator ‘hot spots’ • Environment Agency website, media

messages

For more ideas see back page for links to the following: • Cabinet Office: Community Emergency

Planning Toolkit, Page 10 • Cumbria County Council: A Guide to developing a Community Emergency Plan, Pages 11–12

9. Taking control When an emergency actually happens and you begin to activate your plans you will need to coordinate what happens next. There are some key things that you can do to help this process run smoothly. Prepare to take control Firstly, have a prepared checklist for actions that the Community Emergency Planning Group and/or Coordinators will need to take. One of these, in fact a critical first step in the process, will be to hold a meeting of the key people involved. So the second piece of

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Over the page is an example agenda for a first emergency meeting that you might use as a basis for your own. Your first meeting, of course, is just the first step in developing a local response to an emergency and it may take some time for the full extent of the challenge to become apparent and for you to implement the plans that you have prepared. You may therefore need to arrange to meet regularly over a period of time. Arrangements for follow-up meetings should be put in place and communicated clearly to everyone who needs to be involved. Meeting frequently, at fixed times, can help individuals organise their activities and ensure their attendance.

How can we coordinate our actions? • Put plans in place for a first Community

Emergency meeting • Agree where this should be, who should attend and what you will need to discuss

Remember: • You will need to maintain regular contact

with the official Emergency Services so that what you do supports and complements their actions.

For more ideas see back page for links to the following: • Cabinet Office: Community Emergency

Planning Toolkit, Page 11

• Cabinet Office: Community Emergency

Planning Template, Page 10 • Cumbria County Council: A Guide to developing a Community Emergency Plan, Pages 11–12

SAMPLE

First Emergency Meeting Agenda Date: Time: Location: Attendees:

1. What is the current situation? – Type of emergency – Is there a threat to life – Is the emergency near a school; a vulnerable area; a main access route – Has electricity, gas, or water been affected? 2. Are there any vulnerable people involved? – Elderly – Families with children – Non-English speaking people 3. What resources do we need? – Food – Vehicles – Blankets – Shelter 4. What is the effect on our community? 5. Establishing contact with the emergency services 6. How can we support the Emergency Services? 7. What actions can be safely taken? 8. Who is going to take the lead for the agreed actions? 9. Arrangements for future meetings? 10. Any other issues?

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10. Testing your plans Having thought through and prepared an Emergency Plan for your community it is important to test the arrangements that you have put in place to make sure that they work. Identifying possible problems and resolving these will ensure things go smoothly when you do it for real.

Live Play – A great tool for testing and building confidence in your arrangements, such as the setting up of your control centre and rest centre, however the process needs careful preparation and can be costly.

How will we know our plans work? • Organise an annual “practice” to test your

arrangements and train your volunteers • Be prepared to make changes if things

Checks and trials If you have followed all of the steps described you will have: harnessed local voluntary support; set up a group to coordinate actions; identified key people; resources and places that you may need; thought about communications and prepared arrangements to be implemented should a real emergency take place. Well done! However, it is very important that you test your arrangements. Regular testing will help to ensure that your plans remain up to date and effective. There will inevitably be changes as people come and go, resources change etc. The main reasons for doing this are to: • Involve outside agencies • Train participants • Test your procedures

don’t work

Advice available on how to test arrangements effectively: • Advice, and materials to help you plan

your exercise, is available from the County Emergency Planning Team

For more ideas see back page for links to the following: • Cabinet Office: Community Emergency

Planning Toolkit, Page 12 • Cumbria County Council: A Guide to developing a Community Emergency Plan, Pages 12–13 • Support from Cumbria County Council Emergency Planning Team

Contacts and links

Routine checks might include: • Contact lists: ring every 3 months • Communications equipment: regular

checks • Activation Process: trial annually • Facilities set-up: Trial annually Trial exercise options There are several types of exercise that you can use to test your arrangements and train participants, these include: Discussion based – Cheap and easy to prepare, useful as a talk through of your plan and a handy tool for training. Table Top – A scenario-based simulation of an emergency which can help validate your plans but requires a significant amount of prior preparation.

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The Cabinet Office guidance referred to in this document can be accessed at: www. cabinetoffice.gov.uk/resource-library/ community-resilience-resourcesand-tools. The Cumbria County Council publication referred to in the toolkit can be accessed at:www.cumbria.gov.uk/emergency/voluntary/ default.asp Advice and Support in Cumbria ACTion with Communities in Cumbria Tel: 01768 840827 www.cumbriaaction.org.uk Cumbria Council for Voluntary Service Tel: 01768 800350 www.cumbriacvs.org.uk

Cumbria County Council Emergency Planning Team www.cumbria.gov.uk/planning-environment/ emergencyplanning.asp Cumbria Community Risk Register www.cumbria.gov.uk/eLibrary/view.asp? ID=43685 Cumbria Police Contact your local policing team www.cumbria.police.uk Cumbria Fire and Rescue www.cumbriafire.gov.uk Cumbria Association of Local Councils www.calc.org.uk Environment Agency Tel: 0843 2615248 www.environment-agency.gov.uk Other Relevant resources Preparing for Emergencies www.direct.gov.uk/preparingforemergencies National Risk Register www.cabinetoffice.gov.uk/resource-library/ national-risk-register British Red Cross www.redcross.org.uk WRVS www.wrvs.org.uk St. John’s Ambulance www.sja.org.uk RSPCA www.rspca.org.uk/in-action/international/ emergencyresponse Informed.Prepared.Together www.informedprepared.eu Radio Amateurs’ Emergency Network (RAYNET) www.raynet-uk.net

Community Emergency Plan Toolkit Have you ever asked yourself: “Would I, and my community, survive the first 48 hours of a serious emergency such as the floods in Cumbria in November 2009?” If so this toolkit may be for you. It is not a rigid template for a local emergency plan, instead it describes a method that you can follow to help you prepare for an emergency in a way that fits the particular needs of your community. It will help you identify the key tools that you will need; local people, local knowledge and local resources. Working with the Emergency Services The professional emergency services including the police, fire and rescue, local authorities, health service and similar organisations, have tried and tested plans that are activated when an emergency occurs. However, Cumbria is a huge and sparsely populated county and it is impossible for these services to reach every community in the first hours of a widespread emergency. Early action on the ground, especially in more remote areas, depends upon local capacity, skills and resources. Prior planning, using this toolkit, can make sure that your local response is as effective as possible and that your community can recover speedily from an emergency. In an emergency the professional services have a well organised command structure: • Gold Command = Strategic • Silver Command = Tactical • Bronze Command = Operational The plan you prepare will make an important contribution to the resources that Silver Command can call upon and to the operational response that takes place within you community. As you prepare your plan make sure that you inform and involve representatives of the professional services so that they are aware of your capacity, skills and resources and how to call upon these when needed. Preparing a community emergency plan will also: • Raise local awareness of the risks that may affect residents 47

• Encourage local people to adapt and

use their existing skills, knowledge and resources to deal with an emergency • Build local commitment to working in partnership with the Emergency Services Remember: • If producing a complete community

emergency plan appears to be a daunting task, any preparation that you and your neighbours can do will be worthwhile, perhaps focusing your efforts on Step 4 – Identifying Skills and Resources. • Do not try to make detailed plans for specific emergencies, instead identify the people, resources and facilities that you might need and be prepared to use these flexibly as a situation changes. • Any activity should complement, and not replace, the County and District emergency teams and Emergency Services. Keep in close touch with them as you work, agree how you will work together and provide them with copies of your completed plan.

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For more information please contact ACTion with Communities in Cumbria on Tel: 01768 840827 or visit our website: www.cumbriaaction.org.uk

ACT champions community and rural issues ACTion with Communities in Cumbria The Old Stables, Redhills, Penrith Cumbria CA11 0DT T: 01768 840827 F: 01768 242134 www.cumbriaaction.org.uk [email protected] Registered in England as Voluntary Action Cumbria Charity Registration Number 1080875 Company Number 3957858

6

Working Together Geraldine Nosowska Research in Practice for Adults Charlotte McEvoy Research in Practice for Adults

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Introduction The government has said that it is essential that local authorities work in partnership with everyone who needs to be involved in making social care work well. This is an essential part of making adult social care more personal and responsive to the people who access and use it. “Carers are one of the key partners in this agenda to create a new, high quality care system which is fair, accessible and responsive to the individual needs of those who use services.” (Department of Health, 2007). Carers play an essential role in our society. According to Carers UK, there are 6 million unpaid carers providing £119 billion of support. Carers’ experience shows that they often do not receive the support and services they require. This can lead to distress, illhealth, financial difficulties and ultimately to carers being unable to continue their role. Research provides useful insight into what carers want from services. A Glasgow university project identified that how people were treated by practitioners and services could be as important as what was achieved. Carers identified that they wanted to be valued and have their expertise recognised (Miller et al., 2008). This was echoed by the Commission for Social Care Inspection which identified from inspections that people wanted respect and to be heard and by other research which shows that people who use services and carers want to be recognised as individuals (Richards and Coulter, 2007) and for the situation to be seen as part of their whole life (Fisher et al., 2006). A systematic review of what makes a good experience for carers found that the approach and qualities of the staff delivering interventions contributed to the outcome. This included recognition of a carer’s role, 50

knowledge and expertise (Victor, 2009). The research recognises the need to engage carers in partnership (Fox, 2010), value their work, recognise their expertise and actively involve them (Seddon, 2008). One study suggests that recognition of carers is supported by having a specialist carers service (Fox, 2009). A large survey of older people, carers and voluntary groups found that they appreciated social workers who worked collaboratively and demonstrated concern (Manthorpe et al., 2008). In a study of responses to assessment, the main things carers appreciated were quick and reliable responses, keeping the carer informed and maintaining contact, being expert and well-informed, a good listener and comfortable to talk to. Asian carers identified that it was important that a worker is supportive and available, some found friendship important (Hepworthy, 2005). Feeling informed and equipped is one of the most important outcomes for carers (Miller et al., 2008). Information underpinned all the other elements that people wanted from services and was seen as essential for making choices (Morris et al., 2007; Fisher et al., 2006; Hanson, 2003). Evidence about what helps carers to feel informed includes not worrying about carer expectations but instead telling them what is possible, being clear about what you mean for example by carer support (Seddon, 2008) and listening attentively. A large-scale English study found that carers’ experience of assessment can be as an administrative exercise, with a lack of clarity about terms: very few assessments lead to care management, and carers have limited confidence in services provided, and their flexibility and responsiveness (Seddon, 2008). Carers value organisations that are there to support them and to help them to find a way in to the system (Fox, 2009).

Research also identifies the barriers that carers face in accessing the support they require. The King’s Fund study of care in London found that the search for information and advice is often a struggle, especially for people from black and minority ethnic backgrounds, and there was a lack of services, again particularly for minorities and for older people with mental health problems (Kings Fund, 2005). In mental health services interviews with group of carers found that they were often poorly informed about care plans, medication and complaints procedures (Wooff et al., 2003). There is a general lack of public awareness about social care and what is available to people who need support (IPPR, 2009). The people who are least known to services are least known about so information is not directed towards them. Particular minority groups struggle to gain access to services due to language issues, lack of information, and information not being relevant (Manthorpe et al., 2009; Hepworth, 2005; Hubert, 2006). A large proportion of people who require support are not eligible for local authority funding and therefore selffund. A large scale study of their experiences found that sixty two per cent of those not meeting eligibility thresholds were not given alternative information (CSCI, 2008). Older people and their carers express confusion about social workers’ roles and responsibilities, together with a lack of understanding from services and services being denied (Manthorpe et al., 2008). A review of the literature on the support needs of people with a physical impairment and a mental health problem found that both services were difficult to access because staff in one service lacked knowledge about the other, and there was poor or no communication between organisations (Morris, 2004). Research of the experiences of self-funders found there was lack of clarity and transparency, insularity and fragmentation of services, and inadequate diversion and signposting (CSCI, 2008). The Triangle of Care project identified six elements that are needed to work well with

carers of people admitted to hospital. This included identifying carers as soon as possible, making staff aware of carers, having good protocols for confidentiality and sharing information, knowing who to refer carers to for specific responsibilities, having information for carers and having a range of support for carers (Worthington and Rooney, 2010).

Description of the study The aim of the Working Together project was to increase understanding of carers’ and practitioners’ experience of working together, and to learn from them about what works, as well as what can be done to improve working together. The focus of this project was on individuals rather than organisational structures and systems. It was also on what an individual is able to do to improve working together, rather than the complex and costly changes organisations and systems need to make. The key questions for the project were: • What will improve the experience and outcomes of carers? • What can carers and practitioners do to work together more effectively? To find answers to these questions, we used an action research methodology called a Change Project. The starting point of the Change Project was an Expert Knowledge Exchange. People from research, practice and policy discussed the context for working together and established what a useful focus for the project would be. Research in Practice for Adults then carried out a preliminary overview of the literature to find the main messages about how agencies work together, what makes a good experience for carers and for service users, and what can be done to improve the way services work together and with those who access and use services. During the development stage we held four workshops in Bristol, Leicester, Cambridge and Stockport. Each workshop involved carers, 51

practitioners and voluntary sector colleagues who came together to share experiences, learning and knowledge around adult social care, from their different perspectives. Forty carers, 32 social care practitioners and nine voluntary sector workers attended. We then synthesised the learning and identified the main messages. We shared these at an event in Birmingham with carers, voluntary sector workers and social care practitioners, and asked them to identify what the striking messages were, what carers and practitioners in adult social care needed to hear, and how best to share these. Based on feedback, the messages were then incorporated into two resources: a Carers’ Guide and a Practitioners’ Tool. The resources were piloted with carers and practitioners in four local forums and refined based on feedback. The final resources were then produced. As a by-product of the project, we identified that there was a lack of clear, accessible, information for the public about adult social care. We designed and developed a line of Customer Guides which set out the information about a particular aspect of adult social care, what to expect as a member of the public, and advice from other users and carers to support you through the process. The guides are peer reviewed by the public and by practitioners.

Findings The project revealed a high level of agreement about the concerns and experiences of both practitioners and carers. Carers’ concerns fell broadly into four themes: recognition, relationships, communication and information, and systems. A key message to emerge from the workshops was the importance carers attribute to being listened to: “The most important thing that affects me as a carer is not being listened to.” This was a common concern and one which carers see as a major obstacle to developing good working relationships. Carers feel 52

practitioners do not always recognise or accept the experiential knowledge of the carer as a contribution. They would like to see more efforts made to treat the carer as a valuable contributor and/or equal partner in the social care team working around the service user. “I would like professionals to realise that I am an individual with a life of my own as well as my caring role. Although I have a big commitment to helping my son, I also think it is better for him and me to have as much independence as possible. It is good if professionals work with carers as partners and consult then about arrangements etc. I also need to feel that there is someone I can contact in a crisis (this can happen very suddenly with mental health problems) this greatly relieves the anxiety. I need to feel recognised as part of the team.” Carers also reported the importance of understanding the carer as a whole person, who has other roles and relationships and a history of knowledge and experience. They value practitioners who ask them how they are doing, how they are coping and when they are given time to share any anxieties or fears affecting them. It was particularly evident the extent to which carers find changes in social care very unsettling and distressing, they recommend practitioners show sensitivity to the concerns and fears this causes for the carer. They also highlighted the lack of reassurance and feedback they receive from practitioners on how well they are doing their job. They want practitioners to be more active in offering feedback and mindful of the many demands and isolation carers feel. “I feel tired, stressed and exhausted most days and am very sensitive and raw to critical comments. Sleep is poor, often up at night. The responsibility of organising care, keeping my own maintained and having a very demanding and responsible job gives me no life of my own because I am constantly on call. Lost my marriage – no-one asks me how I am. Not seen as a ‘carer’ but someone that can do.” Carers talked about how services are not designed to take into account their needs in the same way they are for service users. This means services are comparably weaker in

supporting and responding to carers’ needs. To improve this they suggest relevant training be offered to carers and suggest services should take better account of the carer as an important and valuable member of the team. To fill the gap carers can look to local support groups and networks to share and spread support, information and experience. Another important message that emerged within this category was the low status carers receive within the social care sector and in society at large. They feel job recognition for carers is poor and therefore entitlements and support is not balanced.

all carers shared the same positive experience with GPs, but it was considered that the role of the GPs is vital in developing and promoting support for carers. They also felt GPs tended generally to not view their own role as central within a wider team of social care practitioners working around the service user. The implication of this is that if GPs understood better their significance within the wider social care team, working around the patient or carer, this would improve experiences because the GP would have a more comprehensive understanding of the background, present and future story of the service-user and carer.

Developing better relationships with social care professionals featured very highly in all four workshops. The most important of these were the relationships between the GP and carer and between care worker(s) and carer. A key message from carers was the value they place on the support GPs can provide. Not

Carers identified the need for more interagency collaboration in social care. Carers think effective multi-partnership working has to include the carer. Carers regard their role as central to the success of delivering good social care and essential for improving better working together in social care. Carers

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recommended GPs make more effective use of carer registers as a way of offering and promoting support for carers in the local area. “It is important for everyone to work together for the service user. Doctors, nurses. Trust and respect breaks down, team work dies and things get tougher for everyone.” Carers also emphasised developing and sustaining trusting relationships with care workers as critical to improving their lives. They value the role of care workers but commented that care workers often do not communicate important information about the service user to the carer. This lack of communication is seen as a consequence of the restraints care workers are working under, which leaves very little time for building interpersonal relationships between care worker, service user and carer. “Periodically he stops taking his medication and his care worker would know weeks before I do, and I only find out accidentally.” What they don’t want is for the care worker to view the role of the carer as interfering or reactionary; carers want to be included as part of the team and be kept up to date with all relevant information. “It works well if a care worker will listen to the carer, it doesn’t work well if the care worker thinks the carer is overreacting.” Another strong message that came across was the concern carers have over the high turnover of care staff in residential and home care services. This was also viewed as a major obstacle to developing good working relationships between carer, service users and care worker. It was understood this was a sector- wide problem and a significant barrier to effective working together. Many had the view that the quality of care suffers because of the lack of time care workers have to attend to the human and more inter-personal side of care provision. Carers value being able to express their views freely and honestly especially over negative experiences they have. Similarly they would prefer if practitioners demonstrate honesty 54

over questions about eligibility and resources. This gives them a realistic understanding and expectation of what services and resources can be provided, thereby enabling them to plan ahead well. “Honesty on all sides is essential – it is important to me as a carer that I highlight things done badly – it is essential that the professionals take it seriously....It is important for a carer (for me) to know that the professionals are caring, competent, open and supportive – without that things get hard.” Another strong message was the importance of getting up to date information regarding changes to services and how it will impact on the carer’s care package. Getting this information early helps alleviate potential anxiety and distress. “GPs don’t guide carers to social services or advice or give information.” Local authorities and GPs publicising information about local support networks for carers so they know where to go to access further support was seen as a valuable way of getting information to carers. “GPs getting more information and more guidance to local carers support groups.” It was also felt there needs to be better interpretation services available to support service users and carers where language barriers are evident. Information needs to be understandable, concise and jargon free and it needs to cover all the different services available in their area. Carers would like to see assessments for carers included as routine practice to ensure carer support is built into care packages. They also felt there is too much time spent completing assessments in adult social care, as it is time consuming, repetitive and often limiting in terms of what an assessment asks and the kinds of information captured. There was also a clear message from carers that waiting times for assessments was too long. Again the importance of carer involvement in assessments and review processes came up as an important message. “It is important that I am involved in all assessment and review processes. I would like to be respected for the support that I give and not made to feel

that I am an interfering inconvenience in the process.” Making sure there are effective administrative systems and good coordination systems in place to inform service users and carers about any changes to care worker schedules and/or timetables was also another important message about improving service provision. Strengthening administrative and communication systems improves the experience for carers and reduces frustration and disappointment. “We find the care situation on the administration side is very poor, i.e. not knowing who is coming to your door and what time. I have repeatedly asked for schedules but am completely ignored on this point. It can be quite unnerving when someone you may not have even seen before will walk in because obviously they have the access and you need the care.” Better coordination systems between agencies prevents there being a lapse in social care provision. “It took six months from stoppage of support worker and the starting of CPN visits. Coordination between different departments is sadly lacking.”

Key learning The main messages from the workshops reveal some important practice implications. Below are suggestions of things that individuals and organisations can do that would improve working together. These focus on what can be done in the context of the pressures that carers and practitioners face. Practitioners • Ask carers how they are feeling and how they are coping. • Ask carers about what other support they have (other family member, friends, volunteers) and if they don’t signpost them to local support groups. • Understand the carer’s isolation and the demands of the job. • Ask carers about their other roles and relationships.

• Give the carer reassurance and feedback. • Talk to carers about the benefits of keeping

•

• • • • •

a carer diary (for assessments and review processes). Involve carers in all stages of planning around care assessment and review processes. Check that carers really understand the information that they get. Be honest and open about the eligibility criteria and resource allocation process. Keep the carer informed of changes or challenges to services as early as possible. Make sure there is a contingency plan in case the carer needs it. Share information across agencies.

Care workers • Take some time to communicate with the carer, make time to meet the carer for a brief recap. • View and treat the carer as someone who is part of the care team. • Inform the carer of any change with the service user (e.g. user not taking medication). • Involve the carer by keeping him/her involved in any routine changes. Carers • Keep a diary of your day-to-day routine as a carer (useful for assessment and for review processes). • Ask to speak to someone who has been through the process. • Ask for meetings at a time and place that fit with what you are able to manage. • Make sure you know the name and job title of the people you meet. • Get a copy of anything that is agreed in writing and keep it in one place. • Ask about back-up in case things get difficult. • Keep a note of what is working and what is not working with the care. • Ask for an assessment and a review if you don’t hear from the service for a year. • Don’t be afraid to say if you are not happy or if you are. • Always ask if you are not sure about something. 55

• Make a list of contacts for other agencies • •

• •

•

• • •

that help you and share with other carers. Keep a notebook by the phone to write down who contacts you and what they say. Ask if there are any support groups in case you need to talk to someone about what is happening. Find your local carer support groups from your local authority or ask your GP. Go to local support groups with questions (they will have experience in the challenges carers face). To understand benefit and other entitlements go to your local Citizens Advice Bureau. Influence change by getting involved in carer support groups or forums. Get involved in consultation groups within your local authority. Find out if there’s a carer’s lead in your surgery.

GPs • Get to know who is involved in the social

care team around the patient. • Utilise carer registers by setting or

advertising for a carer lead in the surgery. • Make available information about social

care services and eligibility and other relevant signposting. • Make supporting carers part of someone’s role so it doesn’t get overlooked.

Conclusions and recommendations This learning echoed research and clearly shows what carers value. The project focused on low-cost, straightforward things that can be achieved by willing individuals in services, rather than on changes in the whole system. We found that what carers want and need is first of all to be treated as individual human beings, to be listened to and to have their expertise recognised. This doesn’t cost money but it does require awareness on the part of people working in social care, health and other services.

56

Secondly carers need knowledge – good clear information about what being a carer can mean, how to manage their role, and where to get help. This information ideally will include experience from other carers. Thirdly, carers often benefit from peer support. Opportunities to meet with and hear from other carers can bring reassurance and encouragement. Some carers will also need practical support and help. When this is required, it needs to be based on their individual situation. Ensuring that carers know what to expect and are prepared for the encounter with the service helps to make it successful. By recognising and respecting carers, providing good information, linking carers to others and helping them to access services appropriately, we can support them to manage their role, to access the support, and to build the skills and knowledge to continue to care for as long as they choose. The resources that we have produced – the Carers’ Guide, Practitioners’ Tool and the Customer Guides – all aim to share the messages about what carers want, to provide the information they need, and to prepare carers and services to work well with each other. What’s so promising about the learning is that there are things that individuals can do that have very little cost implications, which will make a difference to people’s experience, will support successful working together, and will support carers’ to build their resilience and capacity to care.

References and further reading Commission for Social Care Inspection (2008) Cutting the Cake Fairly – Review of Eligibility Criteria for Social Care, London: CSCI. Department of Health (2007) Putting People First, London: Department of Health.

Fisher, P.A., Gunnar, M.R., Dozier, M., Bruce, J. and Pears, K.C. (2006) ‘Effects of therapeutic interventions for foster children on behavioural problems, caregiver attachment and stress regulatory neural systems’, Annals New York Academy of Sciences, 1094, pp. 215- 225. Fox, A. (2010) ‘From independence to interdependence: integration means “think” family’, Journal of Integrated Care, vol. 18 (2), pp. 41-48. Fox, A. (2009) Putting people first without putting carers second, Essex: The Princess Royal Trust for Carers. Hanson, M. (2003) ‘Evaluating user experience of an NHS mental health service’, International Journal of Health Care Quality Assurance, vol. 16 (7), pp. 341-346. Hepworthy, D. (2005) ‘Asian Carers’ Perceptions of Care Assessment and Support in the Community’, British Journal of Social Work, vol. 35, pp. 337-353. Kings Fund (2011) Transforming social care: sustaining person-centred support, York: Joseph Rowntree Foundation. Manthorpe, J., Moriarty, J., Rapaport, J., Clough, R., Cornes, M., Bright, L., Iliffe, S. and OPRSI (Older People Researching Social Issues) (2008) ‘There are wonderful social workers but it’s a lottery’: older people’s views about social workers’, British Journal of Social Work, vol. 38 (6), pp. 1132-1150. Manthorpe, J., Iliffe, S., Moriarty, J., Cornes, M., Clough, R., Bright, L., Rapaport, J. and OPRSI (2009) ‘“We are not blaming anyone, but if we don’t know about amenities, we cannot seek them out”: black and minority older people’s views on the quality of local health and personal social services in England’, Ageing and Society, vol. 29 (1), pp. 93-113.

Miller, E., Whorisky, M. and Cooke, A. (2008) ‘Outcomes for Users and Carers in the Context of Health and Social Care Partnership Working: From Research to Practice’, Journal of Integrated Care, vol. 16 (2). Morris, J. (2004) One town for my body, another for my mind: services for people with physical impairments and mental health support needs, York: Joseph Rowntree Foundation. Richards, N. and Coulter, A. (2007) Is the NHS becoming more patient-centred? Trends from the National Surveys of NHS Patients in England 2002–07, Oxford: Picker Institute. Seddon, D., Robinson, C.A., Russell, I., Woods, B., Phillips, J., Cheung, I. and Williams, J. (2008) ‘The modernisation of social care services: A study of the effectiveness of the National Strategy for Carers in meeting carer need’, Modernising Adult Social Care Research Programme, Department of Health, London. Victor, E. (2009) A Systematic Review of Interventions for Carers in the UK: Outcomes and Explanatory Evidence, Essex: The Princess Royal Trust for Carers. Wooff, D., Schneider, J., Carpenter, J. and Brandon, T. (2003) ‘Correlates of stress in carers’, Journal of Mental Health, vol. 12 (1), pp. 29-40. Worthington, A. and Rooney, P. (2010) ‘The Triangle of Care: Carers Included – A Best Practice Guide in Acute Mental Health Care’, London: National Acute Care Programme. Research in Practice for Adults (2011–13) Customer Guides: What is Adult Social Care? What is Self-directed Support? What is Safeguarding? What is a Carer? What is Reablement? What is the Mental Capacity Act 2005? What is a User-Led Organisation?

57

Dartington. Research in Practice for Adults (2012) Carers’ guide: Working together with adult social care, Dartington.

58

Research in Practice for Adults (2012) Practitioners’ Tool: Working Together with Carers, Dartington.

7

The Skill and the Will

A pilot study into the development of first aid training to encourage individuals’ propensity to act in an emergency situation Emily Oliver Senior Education Adviser, British Red Cross Jane Cooper Project Manager, British Red Cross David McKinney National Development Officer, British Red Cross

59

Introduction First aid training is widely advocated to help save lives, but to achieve that learners need to use their skills. Unfortunately training does not always translate into helping behaviour.1 In the UK, just 7% of the population is both skilled and willing to help a stranger.2 It is the mission of the British Red Cross that everyone should receive the help they need in crisis, and as such, it works to spread the knowledge of first aid widely. This study looks at the possibility of increasing the propensity to act through first aid education. Much research has been conducted on how people act in an emergency situation. For example, it has been shown that people are more likely to help people they know or those that they recognise as being from their own ‘in’ group, those with whom they share a common identity.3 People have also been found to be more likely to help those they have empathy for and feel compassion for (empathic concern),4, 5 as well as those with whom they share a common identity.6 However, research has also shown that the more people around when an emergency happens, on the whole, the less likely an individual is to act.7, 8 This is known as the Bystander Effect. Documented cases conclude that the diffusion of responsibility and the need to behave in a socially acceptable way (i.e. if others are not reacting there is either no need to react or it is not appropriate) are main reasons for the occurrence of the Bystander Effect. It has been proven that those made aware of the Bystander Effect are more likely to act.9 But there is also evidence that awareness of such issues may not be sufficient: sometimes people need to deliberate and discuss an issue to be able to determine how and if they should 60

alter their own behaviour.10 However, Van de Velde supplemented first aid training with a lesson to reduce barriers to helping.11 He then tested the speed of response of participants against those who had not received the supplementary lesson. His results showed no difference in response time between those who received a supplementary lesson in helping and those who did not. This research looks at ways in which to increase the propensity to act of people who learn first aid skills, thus supporting them to develop not only the skill but also the will to help effectively. It aims to determine what activities would increase an individual’s propensity to act, no matter what the circumstances are. It measures willingness and self-efficacy of learners, building on Bandura’s theory12 that increase in self-efficacy can lead to behaviour change. It has focussed on encouraging propensity to act where the situation involves a stranger.

Description of the study The objective of the research is: • What activities can be included in future first aid training that will increase individuals’ propensity to act in an emergency situation? A secondary objective is: • What effect do different activities included

in first aid training have on claimed willingness to act to help a stranger in an emergency situation?

Methods Based on discussion within a focus group, activities targeted at increasing willingness

to act were added to two hour British Red Cross first aid courses, leaving one as a control course. Sample 554 participants (members of the public over 10 years old) received training across three locations recruited using local advertising. Each was allocated to a course using non- random methods to provide mixed demographic for each course type. Measures Propensity to act was measured as willingness, and self-efficacy (as validated by Bandura).12 All participants completed a pre- and postcourse questionnaire in which they: • rated their willingness to help; • rated their self-efficacy to use first aid skills effectively and, following the course… • any change to pre-identified fears about stepping in to help. The questions asked, using what scale and at what point each was asked are set out in Table 2 below.

TABLE 1. SESSION CONTENT OF THE TESTED TRAINING INTERVENTIONS. Course Name

Content

A

Control course

First aid only

B

Information course

• First aid • Video to trigger discussion of bystander effect • 999 activity

C

Helper course

• First aid • Video to initiate a discussion on qualities of a helper • helper qualities’ activity

D

Red Cross course

• First aid • Video and activity to aid discussion on qualities of someone who shares the values of the Red Cross

BC

Information and • As for B and C helper course

BD

Information and Red Cross course

• As for B and D

TABLE 2. QUESTIONS ASKED OF PARTICIPANTS OF ALL COURSES. When asked

Measure used

Pre-course

Post-course

Two months post-course

How willing are you to help a member of your family in an emergency first aid situation?

0-10

X

X

X

How willing are you to help a friend in an emergency first aid situation?

0-10

X

X

X

How willing are you to help a colleague in an emergency first aid situation?

0-10

X

X

X

How willing are you to help a stranger in an emergency first aid situation?

0-10

X

X

X

How confident are you that you can use first aid skills effectively in a real emergency?

0-10

X

X

X

I am aware of the reasons why people help or don’t help in an emergency

Likert

X

I’m aware of my own behaviour in an emergency situation

Likert

X

I’m worried about doing the wrong thing in an emergency situation

Likert

X

I’m worried about getting sued in an emergency situation

Likert

X

I’m worried about getting involved when confronted with an emergency situation

Likert

X

Question

61

Ethics Ethics approval was not sought, however all participants were informed that they were part of a research project but not the subject of the research. The courses were provided free of charge, but it was a condition of attending the course that the pre-and post-course questionnaire was completed. Participants were free to withdraw.

Key findings The demographic split of the results is shown in Table 3. Willingness to help Following the removal of records which were incomplete (n=89), all interventions including the control (useable records n=465) showed an increase in willingness to help both following the training intervention and two months later. Table 4 compares the change of participants’ willingness scores pre-course to post course, and pre-course to two months later.

Self-efficacy The majority of participants across all courses increased their self-efficacy score following the course, and many scored themselves even higher two months later. No one intervention course stood out as significantly increasing self-efficacy levels, as shown in Table 5. Pre-identified fears about stepping in to help When comparing the Control course (A) with those taught the Information and Helper course (BC), many participants said they were: Much less worried about getting sued in an emergency situation (46% vs. 23% = significant at 99.9% probability using T test). Much less worried about getting involved when confronted with an emergency situation (46% vs. 22% = significant at 99.9% probability using T test). Table 6 below shows how participants on the Information and Helper course respond with

TABLE 3. DEMOGRAPHIC SPLIT OF EACH COURSE. All records

Course A

Course B

Course C

Course D

Male

159

29%

22

25%

27

32%

30

31%

18

26%

32

29%

30

29%

Female

379

68%

65

74%

53

62%

61

64%

50

71%

78

70%

72

70%

10-18

70

13%

13

15%

16

18%

9

9%

14

20%

5

5%

13

13%

19-45

292

53%

47

53%

34

40%

60

62%

41

59%

66

59%

44

43%

46+

187

35%

28

32%

35

41%

27

27%

15

20%

41

36%

46

44%

59

11%

10

2%

6

1%

16

3%

6

1%

12

2%

9

2%

Age

Disability (selfassessed)

Course BC

Course BD

TABLE 4. BREAKDOWN OF PERCENTAGE CHANGE IN SCORE FOR WILLINGNESS TO HELP DIFFERENT GROUPS. Change pre to post course

Change pre course to two months later

Negative change

No change

Positive change

Negative change

No change

Positive change

Family

2.3

70.3

27.4

12.3

60.7

27.0

Friend

2.9

62.7

34.2

15.9

51.5

32.6

Colleague

2.9

47.4

49.6

14.0

40.5

45.5

Stranger

4.8

30.7

64.4

18.3

30.1

51.6

62

TABLE 5. PERCENTAGE OF PARTICIPANTS WITH POSITIVE CHANGE IN SELF-EFFICACY SCORE. 95%

Pre to post course

90%

Pre course to two months later

85% 80% 75% 70% 65%

Control

Information

Control

Helper

Red Cross

Informationhelper

InformationRed Cross

Information Helper Red Cross Information-helper

Information-Red Cross

Pre to post course

86.6

90.5

78

86.4

83.9

84.1

Pre course to two months later

88.9

90

88

76.9

91.2

79.4

TABLE 6. PERCENTAGE RESPONSE TO PRE-IDENTIFIED FEARS ABOUT STEPPING IN TO HELP. 50 45

Control

40

Information Helper

35

Red Cross

30

Information-helper

25

Information-Red Cross

20 15 10 5 0 Much more Much more aware of aware of own reasons why behaviour in people help or an emergency don’t help situation

Much less worried about doing wrong things

clear self-awareness and understanding of their role in a medical emergency in their answers to the statements on pre-identified fears about stepping in to help. Enrolment onto courses The aim was to get 600 people onto the research courses: 100 on each of the six

Much less Much less worried about worried about getting sued getting involved

types of course. This proved to be difficult despite a variety of methods of advertising and promotion. Most successful efforts were those made in community centres which had newsletters and leaders who recommended the course by word of mouth or email to the members of its community. 63

for the Information and Helper course (BC), where confidence levels were high due to the information section, and remained high or increased when learners had time to reflect on the helper activities. The evidence from this study indicates that there is a benefit in additional elements included in first aid education. Specifically, a combination of informing and discussing the Bystander Effect, dispelling participants’ concerns about the implications of their intervention, and reinforcing helper qualities moved learners towards a more positive attitude with regard to stepping in to help in an emergency situation as a result of their learning.

Key learning The Control course (A) confirmed that doing a first aid course does itself increase confidence and willingness to act. However, the participants on the Information and Helper course (BC), indicated that the additional elements increased their self-awareness and understanding of their own role in an emergency situation. Although the Red Cross is an extremely well known brand, ‘affiliation’ to it as a consequence of first aid training (tested in Course D) was not found to be conducive to increasing the propensity to act. The results also show some decrease in willingness to act in some cases over time. This could be explained by individuals recalibrating their understanding of the unqualified scale in the intervening period. However, it is interesting that across three of the courses (A, C and BC) self-efficacy scores increased two months after learning compared to pre-course scores as shown in Table 4. The score for the information course (B) stayed more or less the same. The learning from this could be interpreted as further support 64

Furthermore, whilst people are more likely to help their family, friends and colleagues than a stranger, their attitude towards helping a stranger can be influenced by providing information about social behaviour and helper qualities, and by encouraging discussion about the humanitarian response that everyone hopes would be available to them or their family if they were the victim of a medical emergency. It seems that learners are moved most by their increased self- awareness as wellinformed helpers.

Conclusions and recommendations While individual parts of the research are not conclusive, taking all of the parts together the evidence is undoubtedly strong enough to advise the introduction of activities to inform and explore the barriers to first aid education for the public. Propensity to act cannot be measured purely by self-efficacy and willingness levels. By articulating common fears around helping in a medical emergency, participants were able to add context to how they measured their self-efficacy and willingness to act. These additional questions enriched the results and helped to distinguish between the value of the different courses in terms of effectiveness.

Taken together, the results of this study show that though the extent of behaviour change can vary, it is possible for course content to increase the likelihood that someone who has learned first aid skills will help a stranger in an emergency, and for the propensity to act to endure because of the combination of information and helper activities. The results of this study contrast with those of Van de Velde’s randomised deception trial in which helping behaviour added to first aid education did not affect the speed of intervention.11 However, this might be explained because of the lack of stratified randomisation of participants which could be seen as a weakness, or due to the contrasting nature of both the additional helping behaviour elements and the type of first aid course. Further study which standardises the training given and the additional elements from the Information and Helper course and compared a randomised deception to the selfefficacy approach would be interesting. Also, a study which tests Bandura’s self-efficacy model in situations of medical emergency would be worthwhile.12 In addition, the results would suggest that further study is required to understand the erosion of skills, willingness and confidence over time.

References 1 Van de Velde, S., Heselmans, A., Roex, A., Vandekerckhove, P., Ramaekers, D. and Aertgeerts B. (2009) ‘Effectiveness of nonresuscitative first aid training in laypersons: a systematic review’, Ann Emerg Med. 54(3): 447-457. 2 Harriet Penrose (2009) First aid research amongst the general public measuring confidence, competence and willingness to act. 3 Hewstone, M., Rubin, M. and Willis, H. (2002) ‘Intergroup bias’, Annu. Rev. Psychol. 51: 575-604.

4 Toi, M. and Batson, C.D. (1982) ‘More evidence that empathy is a source of altruistic motivation’, Journal of Personality and Social Psychology, 43, 281-292. 5 Lamm, C., Batson, C.D. and Decety, J. (2007) ‘The neural substrate of human empathy: effects of perspective-taking and cognitive appraisal’, J.Cogn.Neurosci, January, 19(1): 42-58. 6 Levine, M., Prosser, A., Evans, D. and Reicher, S. (2005) ‘Identity and Emergency Intervention: How Social Group Membership and Inclusiveness of Group Boundaries Shapes Helping Behavior’, Personality and Social Psychology Bulletin, vol. 31, 4: pp. 443-453. 7 Darley, J.M. and Latané, B. (1968) ‘Bystander intervention in emergencies: Diffusion of responsibility’, Journal of Personality and Social Psychology, 8, 377-383. 8 Latané, B. and Darley, J.M. (1970) ‘The unresponsive bystander: Why doesn’t he help?’, New York: Appleton-CenturyCrofts. 9 Beaman et al. (1978) ‘Increasing helping rates through information dissemination: Teaching Pays’, Personality and Social Psychology Bulletin, 4, 406-411 10 John, P., Cotterill, S., Moseley, A., Richardson, L., Smith, G., Stoker, G. and Wales, C. (2011) Nudge, Nudge, Think, Think. Bloomsbury 11 Van de Velde et al. (1997) ‘Can training improve laypersons helping behaviour in first aid? A randomised controlled deception trial’, EMJ 2012: 10.1136/3emermed-2012-201128. 12 Bandura, A. (1997) Self-efficacy: The exercise of control. Worth Publishers.

65

Special thanks Many thanks to the numerous people in our three locations and at British Red Cross UK Office that gave their time and enthusiasm to assist and promote the courses. We are grateful to the educators and the British Red Cross Area Managers for their involvement and support.

66

Special thanks to Charlotte Franolic, Joslyn Kofi Opata, Debra Petts, Chris Godwin, Harriet Penrose, David Hollocks, Alison McNulty, Rifat Comber, Joe Mulligan, Danny Finney, Wendy McNicoll, and Rubi Rai all of the British Red Cross, and to Mark Levine from Lancaster University, now of the University of Exeter.

8

Don’t forget the families!

Equipping accompanying families of international humanitarian staff to thrive Elisa Pepall Centre for International Health, Curtin University

67

Introduction Considerable research has explored the impact of humanitarian work on the employee (Cardozo et al., 2012; Ehrenreich and Elliott, 2004; Eriksson et al., 2012), however scarce research has been undertaken on the experiences of the families of humanitarian workers’ in international settings. Given recognition of the impact of vicarious trauma and chronic stress on the humanitarian worker and his family (McKay and Hulme, 2009), and that family factors are well known to influence worker turnover and retention (Debebe, 2007; Loquercio, 2006), further research into the experiences of families of humanitarian workers is warranted. For families who accompany a humanitarian worker overseas, there are rewarding experiences whilst living aboard; however, there are challenges that can threaten individual wellbeing, relationships and family functioning. Family resilience has been identified as a relevant conceptual framework when considering why some families cope better than others, and as a useful tool when designing strategies to support family well-being (McCubbin et al., 1997; Silberberg, 2001; Walsh, 2006). As a growing field of inquiry, family resilience describes “the path a family follows as it adapts and prospers in the face of stress, both in the present and over time” (Hawley and DeHaan, 1996: 293). This research study adopted a wide-angled view of resilience; and examined the processes that “allow a family to create a path that is adaptive and may even permit them to grow and thrive in response to the stressors” (ibid.). This paper provides a significantly condensed summary of the main research findings from a PhD study titled ‘Strengthening Family Resilience during Accompanied Humanitarian Assignments’. Following a brief overview 68

of the study, the major themes in terms of accompanying family challenges and coping strategies are presented under the heading ‘Findings’ and briefly compared with existing literature. The following section, ‘Key Learning’ brings together the dominant organisational family supports for promoting resilience or thriving amongst expatriate families as advised in the literature and from interviews. The paper concludes with key recommendations arising from this research and directions for further research.

Description of the study The research study used a qualitative approach to explore the experiences of accompanying expatriate families in the humanitarian NGO sector. The research aimed to highlight the main challenges faced by such families and the resilience processes used to manage these stressors. The study also sought to propose recommendations for humanitarian agencies and expatriate partners seeking to promote thriving and resilience amongst such families. The terms ‘expatriate’, ‘families’, and ‘humanitarian workers’ were broadly defined; expatriate including those living and working attached to an assignment outside their home country, families including couples both with and without children, and humanitarian workers referring to all those involved in relief, recovery or development. Underpinned by grounded theory methodology (Charmaz, 2006; Glaser and Strauss, 1967), multiple research methods were used in this study. These included a scoping study of published and grey literature, intensive in-depth interviews with accompanying partners and semi-structured interviews with a number of key informants from the humanitarian sector. Given the lack of prior research and available

literature on expatriate families within the humanitarian community, these methods were chosen to allow collection of a wide range of data, provide varying perspectives and ‘triangulate’ findings that might otherwise be isolated (Denzin and Lincoln, 2005). Various initiatives taken to ensure research rigour or trustworthiness included reference group member review of planned methodologies and checking of emerging findings, interview participant member checking (both during and after interviews), pilot testing of interview-related forms and processes, reflexive analysis of the researcher’s own preconceptions and bias and ensuring the study gained the approval of the Curtin University Human Research Ethics Committee. Scoping study Well suited to emerging topics, scoping reviews represent a viable methodological approach for examining and mapping the breadth of research and conceptual development in a particular area (Rumrill et al., 2010). The ‘Arksey and O’Malley (2005) framework,’ considered the pioneering methodological guide for conducting scoping studies, influenced the scoping study undertaken in late 2011. Whilst it is beyond the scope of this paper (due to size constraints) to present the detailed methodology used to conduct this review or the specific findings identified, it should be emphasised two specific topical areas were pursued: 1. To summarise known information about families of international humanitarian workers. 2. To describe what is known about resilience within expatriate families. The limited number of references identified for each topic (36 and 18 respectively) confirmed the belief that families within the humanitarian sector and resilience within expatriate families are relatively new and emerging topics, subject to limited research. Partner interviews Twenty-three interviews with accompanying partners of international humanitarian non-

governmental organisation (NGO) workers were conducted between December 2010 and February 2012. Recruitment occurred through key contacts known to the researcher (convenience), contacts identified through researcher networking (opportunistic) and recommendations made by interview participants themselves (snowball). Interviews were conducted via Skype (20) or face-toface (3) and included expatriates (20) and those recently repatriated (3). At the time of interview the majority of adult partners (4 males, 19 females) described themselves as in-relationship (21) whilst two were recently separated. The 23 partners from 11 different nationalities, were predominantly tertiary educated and represented 17 different international NGOs (INGOs) and at the time of the interview were living in 16 different countries. Several families were in remote (non-capital city) or those considered hardship postings, including complex safety and security postings (i.e. Kabul, Islamabad). Additional demographic data about participating partners is presented in Table 1. All participants spoke English and gave written informed consent. In-depth interviews were directed using a structured interview guide, audio recorded, transcribed verbatim and coded in full using an inductive process closely related to that described by Charmez (2006). NVivo 9 software was used to assist data management and analysis. Key informant interviews Eight interviews were conducted between August and October 2012 with senior human resources (HR), staff care and managers from various humanitarian INGOs. Key informants (four males, four females) were recruited using convenience sampling and opportunistic sampling. Like the recruitment process for accompanying partners, a number of potential informants were also contacted but choose not to participate in the study. Informants ranged in age from 31 to 61 years, represented seven different nationalities, had between 18 months and 35 years experience in their current organisations, and were employed across five different INGOs. At the time of the interview, 69

TABLE 1. DEMOGRAPHIC SUMMARY OF PARTNER PROFILES. n=23 Participant’s Age 26-30 years

3

31-35 years

5

36-40 years

11

41-45 years

–

46-50 years

4

Duration of Marriage (n=20) 0-5 years

4

6-10 years

6

11-15 years

5

16-20 years

2

21-25 years

2

26-30 years

1

Number of Children 0

3

1

5

2

10

3

3

4

1

5

1

Years in Current Expatriate Posting (n=20) Less than one year

5

1-2 years

6

3-4 years

7

5-6 years

1

7-8 years

1

Years Abroad in Expatriate Postings as a Family

70

1-3 years

5

4-6 years

9

7-9 years

7

10-12 years

–

13-15 years

–

16-18 years

1

19-21 years

–

22-24 years

1

half were living as expatriates (two as single persons, and two with accompanying families). Of the non-expatiate informants, two had prior experience living and working abroad. With the exception of one face-to-face interview, all interviews were conducted via Skype. All informants spoke English, had been employed at least 18 months in their current INGO and gave written informed consent. Key informant data was recorded, transcribed and coded with the aid of NVivo software in a similar process to that described for accompanying partners.

Findings Challenges Interviews with accompanying partners revealed eight dominant challenges impacting expatriate families in the humanitarian sector: 1) relationship concerns (both within the accompanying family itself and with distant family and friends); 2) personal and professional concerns of the accompanying partner; 3) transition and relocation issues; 4) parenting concerns; 5) adverse impacts of humanitarian work upon the family; 6) health concerns; 7) safety and security concerns; and 8) environmental, contextual and cultural concerns. The experience of dealing with a specific crisis or multiple crises whilst away from familiar support networks was also reported by 25 percent of partners. Whilst insufficient literature exists to compare the findings with other research on families in the humanitarian sector, the results of this research are generally consistent with the dominant stressors and rewards reported in the literature affecting expatriate families in general, including corporate and missionary families (Brown, 2008; ExpatExpert.com / AMJ Campbell International, 2008; Haslberger and Brewster, 2008; McNulty, 2005). Growth, coping strategies and resilience processes Interview feedback revealed that whilst accompanying families experience challenges and potential crises, many individuals and

families also grow and thrive whilst abroad. Personal developments commonly reported included improved self-awareness, enhanced social networking skills, and greater clarity concerning what one values and believes about life. Furthermore, families spoke of becoming “stronger” or “closer,” and working “better as a team overseas than we did at home.” Consistent with normal dialogue, partners rarely spoke of resilience processes used to recover from challenges and at times, flourish. However, all participants identified personal and family-level coping strategies used to mitigate stress. Table 2 presents the dominant family level coping strategies identified in this study.

Distinguishing between beliefs and behaviours, the table also highlights the similarity between those that emerged from a grounded theory approach to interview analysis, (i.e. from the data itself without being shaped or organised according to a pre-existing model) and Walsh’s (2003) key processes of family resilience.

Key learning Recommendations The research identified specific recommendations aimed at promoting resilience and thriving among accompanying families for both humanitarian organisations and expatriate families themselves. These

Behaviours

Accompanying family coping strategies

Positive thinking, perseverance and acceptance

Positive outlook

Faith, spirituality and purpose

Transcendence and spirituality

Adaptability and consistency

Flexibility

Family connectedness

Connectedness

Social, professional and occupational supports

Social and economic resources

Clarity

Open emotional expression

Communication/ problem solving

Family communication

Walsh’s (2003) key processes in family resilience

Make meaning of adversity

Organisational patterns

Family first

Beliefs

Beliefs

TABLE 2. INTERVIEW DERIVED DOMINANT FAMILY COPING STRATEGIES AS COMPARED WITH WALSH’S (2003) KEY PROCESSES IN FAMILY RESILIENCE.

Collaborative problem solving

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recommendations (which are available by directly contacting the author) were organised according to the five main stages of the expatriate deployment cycle: 1) recruitment and selection; 2) pre-deployment; 3) settling in; 4) sustainment or ongoing management; and 5) transition (relocation or repatriation). Family recommendations were underpinned by the coping strategies or key resilience processes depicted in Table 2. They ranged from ensuring the decision to accept an international accompanied postings is well informed [Adaptability and Consistency] and made as a team [Family First] to taking time out to review the impact of relocation and working demands on family relations [Family Connectedness and Family Communication]. The many similarities between the coping strategies identified and Walsh’s key processes support the assumption that such strategies reflect the key resilience processes used by this specific expatriate population. The similarities also mean it is unnecessary for humanitarian organisations to ‘recreate the wheel’ when seeking to understand family resilience among accompanying families, rather only specific targeted modifications such as stressing the importance of ‘family first’ thinking as opposed to ‘making meaning of adversity,’ are required for this population. Whilst over 17 separate recommendations were developed for humanitarian organisations, the following eight key factors were identified as essential principles or beliefs to providing more meaningful supports for accompanying families. 1. Family-related benefits (i.e. education, health, accommodation, R&R leave) and policies are key to attracting and retaining staff. Therefore these must be regularly reviewed, updated and communicated from the outset to both potential employees and their partners. 2. Leadership must advocate for the relationship between employees and their families. Staff should periodically be reminded that

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family well-being takes precedence over work demands (especially in times of crisis or ill health in the family), and the organisational culture should value work-life balance and family-friendly working conditions. 3. Maintain awareness of and support the professional, emotional, relational and social needs of accompanying families. This involves ensuring leadership and HR staff in general seek direct feedback from accompanying families on their coping and experiences within the organisation; that organisational staff are really responsive to requests for information or assistance; the provision of career and counselling supports for accompanying partners; and, efforts are made to socially network families. 4. Include families in organisational life and validate the support they provide. Identify work-family intersection points, including travel; and appreciate the support given by partners to enable humanitarian workers to perform the work they do. 5. Lengthen accompanying contracts to at least 18 months (ideally longer). Recognise it takes an average of six months for individuals or a family to feel settled, therefore it is not in the best interests of either the family or the organisation to offer short contracts. 6. Identify and prioritise assistance for families with greater support needs. Such families include first time expatriates; families with very young children; those in hardship locations; those relocating from very different contexts; and families unlikely to be easily recognised as actually being expatriates. 7. Embed family support into organisational culture. Stop depending on specific hospitable and social individuals or cultural norms to ensure family orientation and networking takes place.

8. Supervise and oversee the family support provided within the organisation. Higherlevel oversight is crucial, especially in locations where there are few expatriate staff or hostility or distrust exists between national and expatriate staff. Too often senior level management fail to verify that national level staff provide the actual orientation or ongoing family supports assumed to be provided. Whose responsibility? In practice, supporting families can be complex and depends on family life stage, cultural expectations, the deployment stage and the size and structure of the organisation. The aforementioned principles seek to rise above a mentality of ‘if this…then do that’ formula and rather advocate a preventative or ‘big picture’ approach to promoting family resilience. Within organisations, responsibility for supporting families must be shared. Whilst those in senior HR roles should lead and provide guidance about respective strategies; line managers, country directors, other expatriate families and relocating families themselves must all take partial ownership. In scenarios in which the recruiting office differs from the assignment location (e.g. World Vision Australia recruits someone to work for World Vision Cambodia) it is important that HR staff from both offices are involved and that information presented to the prospective employee and partner is not contradictory. Depending on the size of the humanitarian organisation, responsibility for providing different family supports will change in accordance with each deployment stage. For example, regional HR staff may be more involved during recruitment and pre-deployment stages, whilst countrylevel HR personnel may then take greater responsibility upon deployment. As stressed previously, higher level monitoring and supervision of family support should be built into organisational practices. Finally, for organisations using a member-care person, (common among missionary organisations and some faith-based NGOs) such individuals

must be suitably qualified, supervised and assigned a reasonable caseload. Why support families? Beyond obvious benefits for families themselves, providing support for accompanying families aids both the humanitarian organisation and the worker. From an agency perspective, providing family support helps with recruitment and retention; “If you have someone moving with a family, they will stay longer,” and improves worker performance, “There is no way a worker can actually be comfortable and do a good job if the spouse is not comfortable [whilst abroad].” From the employee viewpoint, the presence of a supportive partner or family offers “stability,” and provides meaningful support, including informal debriefing, helping with “work-life balance” and fostering a sense of “normalcy” or routine to life.

Conclusions and recommendations Whilst the concept of resilience is very much in vogue within the humanitarian community (Jütersonke and Kartas, 2012; Kindra, 2013), the application of this concept can be extended beyond just beneficiary communities, organisations and humanitarian staff. Both humanitarian organisations and accompanying families themselves can adopt strategies that can strengthen family resilience; thereby positively impacting both the families’ expatriation and repatriation experiences and promoting enhanced organisational morale, performance and retention. Organisations should not assume families are aware such strategies exist, rather they should take the lead in providing families with education and resources to ensure they are well informed about what they can do to promote their own growth and thriving whilst abroad. This study also highlighted several gaps where research and knowledge is lacking. These included research on non-accompanying families of humanitarian workers (i.e. their 73

experiences and how best to support their needs), and longitudinal-type research tracking the needs of accompanying families during each deployment stage. As far as is known, this study represents the first time accompanying partners themselves have been directly asked about their experiences and challenges within the humanitarian industry. Unlike the missionary (Blocher, 2004; Eriksson et al., 2009; Hay, 2007), military (Riggs and Riggs, 2011; Saltzman et al., 2011), and forprofit sectors (Andreason, 2008; Brookfield Global Relocation Services, 2010; Selmer and Leung, 2003) that have long recognised the significant impact families have on the success of international assignments, the humanitarian community has lagged behind on prioritising family supports. Given the sizable financial investment already borne by organisations when relocating whole families, the recommendations outlined in this paper aim to enhance the impact or value for money associated with accompanied postings. Beyond any moral or ethical obligation, providing greater support for accompanying families makes business sense.

Cardozo, B. L., Crawford, C. G., Eriksson, C., Zhu, J., Sabin, M., Ager, A., Foy, D., Snider, L., Scholte, W., Kaiser, R., Olff, M., Rijnen, B. and Simon, W. (2012) ‘Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: A longitudinal study’, PLoS One [online], vol. 7 no. 9, [Online], Available: http://dx.doi. org/10.1371%2Fjournal.pone.0044948 [25 March 2012].

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Eriksson, C.B., Cardozo, B.L., Foy, D.W., Sabin, M., Ager, A., Snider, L., Scholte, W.F., Kaiser, R., Olff, M., Rijnen, B., Crawford, C.G., Zhu, J. and Simon, W. (2012) ‘Predeploy­ment mental health and trauma exposure of expatriate humanitarian aid workers: Risk and resilience factors’ Traumatology, vol. no. DOI 10.1177/1534765612441978, [Online], Available: http://tmt.sagepub.com/content/ early/2012/03/26/1534765612441978.abstract [16 April 2012]. ExpatExpert.com /AMJ Campbell International (2008) [webpage] “Family Matters!” Survey, Available: www.expatexpert. com/pdf/Report_on_Key_Findings_of_Family_ Matters_Survey.pdf [8 October 2011]. Glaser, B.G. and Strauss, A.L. (1967) The discovery of grounded theory: Strategies for qualitative research, Chicago, IL: Aldine. Haslberger, A. and Brewster, C. (2008), ‘The expatriate family: An international perspective’, Journal of Managerial Psychology, vol. 23, no. 3, pp. 324-346. Hawley, D.R. and DeHaan, L. (1996) ‘Toward a definition of family resilience: Integrating life-span and family perspectives’, Family Process, vol. 35, no. 3, pp. 283-298. Hay, R. (ed.) (2007) Worth keeping: Global perspectives on good practice in missionary retention, Pasadena, CA: William Carey Library. Jütersonke, O. and Kartas, M. (2012) ‘Resilience: Conceptual reflections’ Geneva Peacebuilding Platform, [Online], Available: http://graduateinstitute.ch/ccdp/publications/ publications-issuebriefs.html [28 February 2012]. Kindra, J. (2013) [webpage] Understanding resilience, [Online], Available: http://www. irinnews.org/Report/97584/Understandingresilience [26 March 2013].

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9

Enhancing resilience in asylum seeking, first-generation and second-generation refugee youth: findings from a brief intervention Sara Amalie O’Toole Thommessen City University London Dr Paula Corcoran City University London Dr Brenda K. Todd City University London

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Introduction Individuals who seek refuge from war and persecution in European host countries comprise only a small percentage of the individuals affected by conflicts and human rights violations worldwide. An estimated 80% of refugees are displaced in their neighbouring regions, mainly in developing countries (UNHCR, 2013). Unaccompanied and separated children and youth are particularly vulnerable compared to children and youth who are accompanied by family members or relatives (Derluyn and Broekaert, 2007; Fazel, Reed, Panter-Brick and Stein, 2012; Wiese and Burhorst, 2007) and specialist attention should therefore be provided to this group on arrival in the host society. The risk of exposure to traumatising situations, however, is not only associated with the pre-migration environment; the long journey to host societies poses further threats of human right violations, exploitation, abuse and trafficking (Derluyn and Broekaert, 2007; Fazel et al., 2012) Furthermore, research carried out in highincome countries has found risk factors in host societies to contribute to poor mental health (Carswell, Blackburn and Barker, 2011; Fazel et al., 2012; Silove, Sinnerbrink, Field, Manicavasagar and Steel, 1997; Sultan and O’Sullivan, 2001). Carswell and colleagues (2011) interviewed 47 individuals in the UK who had either been granted refugee status, were still waiting for the final decision or had received a negative outcome. This group had spent three years on average waiting for the final asylum outcome, and asylum seekers living in limbo for a number of years or months has previously been reported in the UK (e.g. Robbins et al., 2005) and USA (Keller et al., 2003). The uncertainty of waiting for a decision on the asylum application, along with 78

further post-migration problems such as fear of being sent back, conflicts with immigration officials, lack of permission to work, poor access to health care, loneliness, isolation, discrimination and loss of culture and social support have been found to be associated with poor mental health. It is hardly surprising that these conditions and circumstances exacerbate mental health difficulties, and indeed, some studies indicate that the postmigration environment can be more predictive of psychological morbidity compared to traumatising events survived pre-migration (Gorst-Unsworth and Goldenberg, 1998) and that trauma symptoms increase over time in the host society (Lie, 2002). Findings from a longitudinal study following refugees in Norway for a period of three years found unemployment and lack of social contact to be particularly important contributing factors influencing stress in the host country (Lie, 2002). It could be argued that such findings were influenced by the traumatised individuals’ already existing depression and anxiety, which may have biased their ability to cope or the way they experienced the host-society in general (Silove et al., 1997). Nevertheless, the aforementioned research examples illustrate that high-income host societies do not always succeed in providing a safe and supportive environment for individuals who have experienced war and conflicts and who have lost all that was familiar to them. Rather than providing an opportunity to regain stability and a foundation to start a new life, individuals seeking asylum in European host societies are at risk of being re-traumatised or traumatised further. Individuals who have fled their country of origin due to war, political conflicts or persecution have typically survived numerous traumatising and life-threatening events.

Mollica and colleagues (1999) found that Bosnian refugees who had resettled in Croatia had, on average, experienced seven different traumatic events before and after leaving their home. In line with these findings, Cambodian refugees in the United States reported having survived a mean of fifteen different traumatising experiences pre-migration, while 70% percent reported having been exposed to violence in the host country (Marshall, Shell, Elliot, Berthold and Chun, 2005). A study carried out in the US found 98% of the participating refugee adolescents to have survived direct violence, with the average experience of different kinds of violence being 44% (Berthold, 2000). In refugee samples in the UK and US, experiences of torture have been reported by as many as 54% (Marshall et al., 2005), 74% (Keller et al., 2003) and 81% (Carswell et al., 2011). The effects of trauma have been found to transmit to further generations, and numerous studies have found subsequent generations to be adversely affected by parental trauma and mental distress. In a review of the topic by Kellerman (2001), the influence of parental trauma on children’s mental health included higher risks of personality disorders, disruptive behaviour, overdependence on parents and greater risk of post-traumatic stress disorder (PTSD). Moreover, higher levels of self-criticism (Felsen and Erlich, 1990) and inadequate coping behaviours (Sigal, Silver, Rakoff and Ellin, 1973) have been found in children affected by parental trauma. In recent years, research assessing the intergenerational effects of trauma in refugees in Europe is developing. Studies (e.g. Daud, Skoglund and Rydeliun, 2005; Daud, Klinterberg and Rydelius, 2008; Fazel and Stein, 2003; Montgomery, Krogh, Jacobsen and Lukman, 1992) have found children of traumatised refugees to be disadvantaged compared to other children. Investigations of the intergenerational transmission of trauma have found that children of refugee parents with PTSD show greater anxiety, somatisation, depression, sleep disorders, restlessness, concentration difficulties and learning disabilities compared to refugee children of

parents who do not suffer from PTSD and other groups (Daud et al., 2005; Daud et al., 2008; Montgomery, et al., 1992). As anxiety, restlessness, concentration difficulties and learning disabilities create disadvantages for children in social and educational settings, interventions focussing on assisting these children are crucial. Fazel and Stein (2003) assessed the mental health of refugee children, children from an ethnic minority group who were not refugees, and native British children in a school setting. Results indicated that more than a quarter of the refugee children showed psychological distress and disturbances; significantly higher than the other groups. Adaptation and acculturation to host societies can be long and gradual (Fazel et al., 2012) and is impeded further by the complicated asylum processes and wide-ranging difficulties in the host country. One of the important factors in facilitating adaption and well-being in the host-country has been found to be close, meaningful social relationships. Evidence from both qualitative and qualitative research studies suggests that the perception of social support contributes to well-being in refugee youth and similarly, that the lack of social support is associated with increased mental health difficulties (Berthold, 2000; Carswell et al, 2011). For instance, a positive relationship between perceived social support from friends and family and adjustment to the host country was found in a study of adolescent refugees from the former republic of Yugoslavia who had resettled in Australia (Kovacev and Shute, 2004). Likewise, Gorst-Unsworth and Goldenberg (1998) found poor social support in the host country to be a stronger predictor of depressive morbidity than the trauma experienced. The individual experience of the social world and personal perceptions of social connectedness therefore played an important part in the intervention and assessment measures that were included in this research. In the present study, the main assessment tool with which participants were interviewed before and after taking part in a brief intervention, was a qualitative measure based on George Kelly’s Personal Construct Theory 79

(1955). According to Kelly, individuals develop personal constructions of the world to guide meaning-making. Kelly defined this process as “placing an interpretation” upon what is construed (1955: 35). Consequently, constructs represent an individual’s conceptualisations that are not necessarily shared by others. Interpretations of events can be modified through experience and further knowledge, exemplified by Kelly’s definition of the person as a scientist. To fully understand another individual, requires the acceptance that each individual’s experience is valid and accordingly; that every construction is a personal truth. The Role Construct Repertory Test, a tool to assess individual meaningmaking, was originally developed by Kelly. For the purpose of this programme, the measure was adapted to fit the specific aims of the research study and intervention. The purpose of the present study was not to measure symptom reduction, but a more holistic measurement of individual meaning-making, hope for the future and social functioning. The novel application is particularly apt for individuals experiencing transition between

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cultures and there is no requirement for the articulation of complex ideas. This paper presents qualitative data from a study that was carried out with two groups of young individuals; one group of asylumseeking and refugee youth who had arrived to the host country alone, and another group of second generation refugees. The aim of the study was to assess the usefulness of this form of the intervention in order to explore themes related to the lives and social worlds of individuals from the two groups, and to enable the young people to discuss their individual challenges and coping strategies in a supportive group setting amongst peers. Furthermore, the research aimed to measure whether or not any changes had occurred in participants’ meaning making, their view of their social world or the way in which they experienced life’s challenges after taking part in the brief intervention. As the resulting data from the study is extensive, this paper focuses on one aspect of the qualitative data; the importance of meaningful social relationships.

Method Participants All of the individuals originated from subSaharan African countries. The group of individuals who took part in the second generation refugee group were all born in England, whereas the group consisting of asylum seeking individuals and refugee youth had been in the country for a range of 2–10 years. Six individuals formed the first group and eight young people took part in the second group. There were males and females in both groups and all of the participants were between 18–28 years of age. The programme was carried out in English without interpretation as all participants mastered a good level of spoken and written English.

Procedure The two groups met separately on four consecutive days for two hour sessions. The sessions were led by a therapist with expertise in story-telling and psychodrama, who had worked with similar groups for more than ten years. The four group sessions were designed to engender thoughts on individual challenges, strengths and resilience, and were comprised of storytelling, art and psychodrama. Through these therapeutic activities, themes such as loss, forced migration, plans and hope for the future, identity and gender roles were explored both directly and indirectly.

Interviews The researcher met each of the participants individually for an interview before the group sessions took place and again after the group intervention had been completed. The individual interviews included three different tasks, two questionnaires and one semi-structured interview. The quantitative measures were The General Self-Efficacy Scale (Schwarzer and Jerusalem, 1995) and the Meaning in Life Questionnaire (Steger, Frazier, Oishi, and Kaler, 2006), while the interview measure was based on George Kelly’s personal construct theory (PCT) and was adapted specifically to apply to the aims and target group of this study.

Data analysis All the individual and group sessions were audio-recorded with participants’ consent and transcribed. The data was analysed based on an Interpretive/Constructivist epistemological perspective (Merriam, 2009). According to this approach, individuals are active in constructing their interpretations of the world and multiple interpretations of a given situation or event can co-exist (Hansen, 2004). Similarly, as individuals construct their own personal interpretation of events, so do researchers when analysing a given data set. Thus, rather than claiming to have found results or knowledge in the data, the researcher constructs results and creates meaning in the data through his or her own experiences, assumptions and beliefs (Gilgun, 2005; Merriam, 2009). Interpretations of data are not seen as the only truth, but rather, as one possible understanding of the data.

Results Within this work, themes relating to close, meaningful relationships and social connectedness were found to be essential to participants’ experience of their social world. In the following, examples of extracts where asylum seeking and refugee participants discussed their relationship to individuals that represent a new family in the host country as well as examples of extract about friendships will be presented. Importance of relationships: I trust her as well. Yes, I’ve know her since I was 15, as a young refugee in the country, so she’s been like a mother. Oh, she, she’s done a lot. When you are new in the country, and you can’t find your way – she kind of - that’s why I call her like a Mother - because she kind of showed me the way. And she tried to make it happen, you know. If it wasn’t for people like her, maybe I wouldn’t go to University, or maybe I was just going to forget about my dreams and forget about my goals and - cause I’ve been 81

through a lot – that’s why I call her like a Mother. If I think about my partner, I would say that even though we are encountering some kind of problems now, she has also played a very significant role in my life, because she gave a son to me, who I love very much, and whenever I’m with my son I feel very comfortable, I feel good about myself, and that has helped me to be able to put my past aside, and to put my past away, and that gives me courage; that gives me more courage for the future. And because of that, my partner is really a very important person to me. This makes her a very, very important person to me. They make me feel safe and welcome all the time and I get to understand like, if I had had a mum, what it would have felt like. Because I just see her, like what she does for my friend and how she is with my friend and I just feel like maybe that would be what I would have, if I had my mum as well... And it’s good for me to understand what it would feel like to have a family, so when I see them, I know it makes me sad but then I learn... In addition to relationships that either resembled bonds to lost family members and new family members in the host country, such as partners and children, the individuals spoke about the importance of friends. This friend is like, we do something together; do something – happy and whatever – he doesn’t get angry or upset. He likes to play with young people, who you, and to make them happy, you know, and to do something different with them and to try to help them. You can laugh, you can tickle him or whatever – it doesn’t mind – he doesn’t get angry or something like that. These two people are more about help; family, mum, dad, brother, sister... and this one is more like doing something, playing football or doing something – and it makes 82

me remember when I was back home, and I would normally do something with my friends, like we would be riding bicycles or playing football or playing together or doing something together, you know... that was nice. Yes, someone who understands you and you understand him as well, because a friendship is about you two people helping each other, you know, nobody is selfish – so that’s why we’re friends. Because before choosing a friend, we need to go through somehow, then I can learn if that’s a good friend or not – because you can’t just take anyone in your life and say “that’s my friend” because you need to know if you’re in need, if that friend will be there. A friendship always needs to go through a road; a long road, a long road that we have been through and that’s why I can call him a friend. While discussing friendships and relationships, the individuals voiced how they felt forced to keep secrets about their backgrounds and what they had gone through; secrets that they did not share with their partner or friends out of fear that people close to them would abandon them. These individuals experienced a fear of losing their new friends and family if they were to learn about their past. One participant explained why he could not tell friends at college about his background, due to their comments about asylum seeking individuals: Like at college, after hearing everything what they’ve been saying about asylum seekers, “they are here to get our jobs”, blah blah blah, and then you’re just like, “oh yes, and I’m one of them”... Another participant explained the issue in the following way: At this moment I prefer to leave it like that because I don’t want to face another obstacle again. Now the relationship has reached a point that if I lose her then it might affect me, if I bring it back again maybe just to

square one. Because now I would say I have no family here but they are my family now, right, so if I happen to lose them again - I lost my family once and I found another family again. So I cannot afford to lose this family again. If I happen to lose again this family for the second time then I don’t know what my situation will be. Two of the other participants agreed: Yes, like, because I have been in relationships with British girls and sometimes you can’t... sometimes they just want to know so much about you, and in my head I’m just like, maybe after telling them my problem they might switch – they might change - our relationship might change and stuff like that. So you’re just trying to keep everything in you, it’s not easy; it’s not an easy situation. I can relate to this as well, it’s like the theatre; while you are at the theatre, you know there is a real world outside. There is something else there, like a door at the back of the theatre, which is just normal for us. In the theatre, they just play a role. But at the back there is someone else as well, the real me, there is a real world. In the theatre I play something else, that’s how I feel. I feel like an actor. I’m playing this movie but there is also a real me. People just see the actor, but there is also a real me.

situation as well, and now, already before I’m in that situation I know how I have to handle it, and what I have to do. Because I know I’m going to be in that situation one day. The work was wonderful and it opened my eyes. Yes, even though when I first came, I didn’t know how we were going to do this work, but I kind of enjoyed myself and it kind of opened my eyes as well. And it showed me knew way, I learned new skills, how to handle and tackle my goals in my life, yes, hearing the others talking about what they were talking about, hearing sad things, all of that was kind of a new... I’ve learned a lot. The work was quite good and interesting for me. Yes, I’m really pleased that I did it myself. Group two (second generation refugees) important relationships: Meaningful relationships and social connectedness were main themes in discussions with the group of second generation refugees as well.

The following extracts illustrate how the participants learnt from others in the group.

It’s not that I don’t trust them it’s just I don’t know I’d rather just not like rely on people. Like if I have problems I’ll just tell my mum, just talk about it because I feel like when you tell your friends it just ruins them and I don’t like it. Yes, because I think when they have problems and they tell me it’s sad so I don’t like doing that, my mum is like if there’s something wrong she just knows straight away so it’s not like I can hide it.

Yes, I did learn. Because the story about having secrets that you can’t tell other people because you are scared of their reactions – that is everyone’s story.

My mother is always there for me whenever I need her she is there. Whenever I walk in the house, yes something is wrong today, she will quickly notice.

I learnt from the situation with the person from the group and her partner and their baby, about arguing and listening to each other. I learnt a lot from that – and from that explanation. Because I could be in that

If it was like a normal secret, just normal, I can tell my friends that it doesn’t matter, it’s just if I had a problem or something like that I’d just tell my mum.

The experience of taking part in this work:

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The experience of taking part in this work: Because we are all roughly the same age, even though we are two different genders, like we do face the same issues if that makes sense, especially being from the same culture. It is like when they were bringing up stuff that happens to them and you are like ‘Yes that has happened to me’ and stuff like that. So it is kind of like we can relate to each other. I don’t think there is anything I didn’t like about it; I think I really enjoyed it to be honest. But because obviously we had like a bunch of girls and a bunch of boys who don’t know each other and you get to discuss things that we don’t usually discuss. And meet with people that we don’t know. So it is really eye-opening and always interesting. It was very good talking to other people and hearing their opinions of things and how they think differently to me.

General discussion The group of young asylum seeking individuals and refugees had lost everything that was familiar and dear to them, including family and friends. Through conversations in group sessions and individual interviews, the immense importance of social connectedness was a reoccurring theme. When talking about strategies used when bad memories filled their minds, one person said: “I think of this group”. As the extracts above illustrate, these young people have experienced great losses and therefore fear losing everything once again. The anxiety related to telling people about their past led to another main theme for this group; that of trust. Understandably, these young people who have experienced so much suffering and hatred yet are met by distrust in the host society, have difficulties with trusting others. As one individual expressed it: Some people expect you to just trust them straight away, like they are your mum or 84

dad or your blood – they expect you to trust them right away. It’s not possible. Whereas close relationships were also found to be important to the group of second generation refugee youth, their stories differed considerably, as being born in the host society meant that they had their parents and close relatives nearby. One young person, who was living with his parents, explained how his mother was able to tell from the sound of his footsteps and the way he shut the door, whether he was in a good mood or a bad mood. This sense of security of having family members immediately available for support or advice was a privilege that the first group did not share with the second generation refugee youth. In line with previous research indicating how isolation, loneliness and discrimination have been found to adversely affect mental health in asylum-seeking and refugee groups, this study found social connectedness and meaningful social relationships to be the main theme when discussing challenges and the social world. One individual expressed how he had enjoyed having something to get up to each day of that week, while another person expressed that he felt like he had a job for this week, which to him was a positive experience. For some of these individuals, meeting everyday for a week made them to feel part of a group which again, exemplifies the importance of having meaningful and safe relationships. Despite the tremendous hardship experienced at very early stages of life by the group of youth who had entered the UK alone in particular, the findings of this work illustrate remarkable resilience. The young people expressed a desire to contribute to society, to complete their education and to have families. Although the extracts demonstrate that the asylum seeking and refugee individuals have an incredible amount of resilience, their experiences portray a picture of a society which is not facilitating these goals, and which does not provide the necessary foundation to enable the young individuals to fulfil their aims and accomplish their goals.

Unaccompanied or separated children and youth, more than other groups, should be provided with an opportunity to meet and engage in meaningful activities with peers and adults.

Derluyn, I. and Broekaert, E. (2007) ‘Different perspectives on emotional and behavioural problems in unaccompanied refugee children and adolescents’, Ethnicity and Health, 12, 141-162.

This paper will conclude with a poem written by one of the young people who took part in the work.

Fazel, M., Reed, R.V., Panter-Brick, C. and Stein, A. (2012) ‘Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors’, The Lancet, 379, 266-282.

I didn’t even choose to come here It wasn’t my choice to wake up as a teenager here It changed everything in my life I didn’t want to do it Who would, if you had asked them? Not many of us To wake up as a teenager in a different country and to have to adapt And everything changed in life Everything!

References Berthold, S.M. (2000) ‘War Traumas and Community Violence: Psychological, Behavioral, and Academic Outcomes among Khmer Refugee Adolescents’, Journal of Multicultural Social Work, 8, 15-46. Carswell, K., Blackburn, P. and Barker, C. (2011) ‘The Relationship Between Trauma, Post-Migration Problems and the Psychological Well-being of Refugees and Asylum Seekers’, International Journal of Social Psychiatry, 57, 107-119. Daud, A., Klinterberg, B.A. and Rydelius, P.A. (2008), ‘Resilience and vulnerability among refugee children of traumatized and nontraumatized parents’, Child and Adolescent Psychiatry and Mental Health, 2: 7. Daud, A., Skoglund, E. and Rydelius, P.A. (2005) ‘Children in families of torture victims: transgenerational transmission of parents’ traumatic experiences to their children’, International Journal of Social Welfare, 14, 23-32.

Fazel, M. and Stein, A. (2003) ‘Mental health of refugee children: comparative study’, British Medical Journal, 327, 334. Felsen, I. and Erlich, H.S. (1990) ‘Identification Patterns of Offspring of Holocaust Survivors with their Parents’, American Journal of Orthopsychiatry, 60, 505-520. Gilgun, J.F. (2005) ‘Qualitative Research and Family Psychology’, Journal of Family Psychology, 19, 40-50. Gorst-Unsworth, C. and Goldenberg, E. (1998) ‘Psychological Sequelae of Torture and Organised Violence Suffered by Refugees from Iraq,’ British Journal of Psychiatry, 172, 90-94. Hansen, J.T. (2004) ‘Thoughts on Knowing: Epistemic Implications of Counseling Practice’, Journal of Counseling and Development, 82, 131-138. Keller, A.S., Rosenfeld, B., Trinh-Shvin, C., Sachs, E., Leviss, J., Singer, E., Smith, H., Wilkinson, J., Kim, G., Allden, K. and Ford, D. (2003) ‘Mental Health of Detained Asylum Seekers’, The Lancet, 362, 1721-1723. Kellerman, N.P.F. (2001) ‘Psychopathology in Children of Holocaust Survivors: A Review of the Research Literature’, Israel Journal of Psychiatry and Related Sciences, 38, 36-46. Kelly, G.A. (1955) The psychology of personal constructs (2 vols.), New York: Norton. 85

Kovacev, L. and Shute, R. (2004) ‘Acculturation and social support in relation to psychosocial adjustment of adolescent refugees resettled in Australia’, International Journal of Behavioural Development, 28, 259-267. Lie, B. (2002). ‘A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees’, Acta Psychiatrica Scandinavia, 106, 415-425. Marshall, G.N., Schnell, T.L. Elliot, M.N., Berthold, S.M. and Chun, C.A. (2005) ‘Mental health of Cambodian refugees two decades after resettlement in the Unites States’, Journal of American Medical Association, 294, 571-579. Merriam, S.B. (2009) Qualitative research: A guide to design and implementation. San Francisco: Jossey-Bass.

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Schwarzer, R. and Jerusalem, M. (1995) ‘Generalized Self-Efficacy Scale’, in J. Weinman, S. Wright, and M. Johnston (eds.) Measures in health psychology: A user’s portfolio, UK: Windsor. Sigal, J.J., Silver, D., Rakoff, V. and Ellin, B. (1973) ‘Some second generation effects of survival of the Nazi persecution’. American Journal of Orthopsychiatry, 43, 320-327. Silove, D., Sinnerbrink, I., Field, A., Manicavasagar, V. and Steel, Z. (1997) ‘Anxiety, Depression and PTSD in Asylumseekers: Associations with Pre-migration Trauma and Post-migration Stressors’, British Journal of Psychiatry, 170, 351-357. Steger, M.F., Frazier, P., Oishi, S. and Kaler, M. (2006) ‘The meaning in life questionnaire: Assessing the presence of and search for meaning in life’, Journal of Counseling Psychology, 53, 80-93.

Mollica, R.F., McInnes, K., Sarajlic, N., Lavelle, J., Sarajlic, I. and Massagli, M.P. (1999) ‘Disability Associated With Psychiatric Comorbidity and Health Status in Bosnian Refugees Living in Croatia’, The Journal of the American Medical Association, 281, 433-439.

Sultan, A. and Sullivan, K. (2001) ‘Psychological disturbances in asylum seekers held in long term detention: a participantobserver account’. The Medicinal Journal of Australia, 175, 193-596.

Montgomery, E., Krogh, Y., Jacobsen, A. and Lukman, B. (1992) ‘Children of Torture Victims: Reactions and Coping’, Child Abuse and Neglect, 16, 797-805.

UNHCR (2013) ‘The Facts: Asylum in the UK’, [Online], Available: http://www.unhcr. org.uk/about-us/the-uk-and-asylum.html, accessed March 2013.

Robbins, I., MacKeith, J., Davison, S., Kopelman, M., Meux, C., Ratnam, S., Somekh, D., and Taylor, R. (2005) ‘Psychiatric problems of detainees under the AntiTerrorism Crime and Security Act 2001’. Psychiatric Bulletin, 29, 407-409.

Wiese, E.B.P. and Burhorst, I. (2007) ‘The mental health of asylum-seeking and refugee children and adolescents attending a clinic in the Netherlands’. Transcultural Psychiatry, 44, 596-613.

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What do we know about community resilience?

Exploring the concept of community resilience through Capacity for Change Programme Dr Artur Steiner Researcher, Scotland’s Rural College – SRUC

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Introduction ‘Community resilience’ have become buzzwords discussed amongst researchers, policy-makers, practitioners and community activists (Steiner and Markantoni, 2013). A strong political support for community resilience could be associated with the current economic climate and the need to increase the efficiency of public sector spending, and social transformation such as demographic changes and ageing patterns, globalisation and advances in communications technologies which create both opportunities and challenges (Skerratt et al., 2012). It is believed that empowered communities can address local challenges more efficiently than through traditional top-down governance structures (Conservative Party, 2010; Scottish Government, 2012). Consequently, inclusion, self-reliance and sustainability at the community level are seen as important in developing resilience. Understanding resilience Community resilience is a complex term (Wilson, 2012). Magis (2010: 402), for example, defines it as ‘the existence, development, and engagement of community resources by community members to thrive in an environment characterized by change, uncertainty, unpredictability, and surprise. Members of resilient communities intentionally develop personal and collective capacity that they engage to respond to and influence change, to sustain and renew the community and to develop new trajectories for the communities’ future [sic]’. Resilience refers to the adaptive capacity and an ability ‘of an individual or community to cope with stress, overcome adversity or adapt positively to change’ and could be perceived as ‘a

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process which may vary across circumstances and time’ (Hegney et al., 2008: 3). Resilience, therefore, is an ability to absorb disturbance and still retain a similar function, the ability of self-organisation and, finally, the capacity to learn, change and to adapt. Thus, the ability to change rather than the ability to continue doing the same thing could to be a key element defining resilience (Adger, 2000; Magis, 2010). Due to many diversified definitions, the concept itself is criticised for being ‘too fuzzy’ for practitioners. Measuring resilience remains challenging and it is difficult to verify whether certain interventions bring anticipated changes and contribute to developing stronger and more resilient communities (Halley, 2012). There is a lack of easily adaptable and practical tools which would enable to assess and compare community development initiatives. This paper addresses those challenges by exploring resilience with particular reference to rural, place-based communities. Using on-ground work in the Capacity for Change programme (C4C), the paper proposes a method of measuring resilience in a rural community scenario and presents findings from the C4C programme. The paper begins with a background and underpinnings of the Capacity for Change programme. Then, based on existing evidence in the field, it identifies different components of resilience and it proposes a model of measuring it. The methodology of the study is explained and, subsequently, through testing the model in rural areas of Scotland, the paper describes findings from seven villages in Dumfries and Galloway and 178 face-toface interviews. Finally, the paper offers a discussion and conclusions.

Description of the study Capacity for Change Programme C4C was developed as a key part of Dumfries and Galloway’s LEADER programme (a European fund that supports rural development and helps to increase quality of life of rural residents in European countries). Through community engagement, the 24-month C4C programme seeks to enhance the capacity of rural communities and contribute to developing their resilience. C4C targets small, less well-resourced rural communities who have not engaged with LEADER or other major funding streams in a significant way to date. Consequently, C4C supports ‘less capable’ communities, creating opportunities for their development. (For more information, please see Skerratt and Steiner, 2013; Steiner and Markantoni, 2013). Developing model of community resilience Although a number of models focused on resilience outcomes exist, measuring resilience is difficult and there is no universally agreed measurement tool which would enable to provide precise evaluation of the concept (e.g. Aked et al., 2010; Forgette and Boening, 2011; Milman and Short, 2008; Noya and Clarence, 2009). This is because resilience can be seen as a multidimensional concept which incorporates social and economic aspects associated with individual and community life (see Figure 1). FIGURE 1. COMPONENTS OF RESILIENCE IN THE COMMUNITY SCENARIO. Individual social resilience

Community social resilience Resilience

Individual economic resilience

Community economic resilience

In this study, in order to develop a model measuring rural community resilience, a hybrid evaluation (High and Nemes, 2007) combining existing national and international

research evidence with local contextual factors was used (see Table 1). The former enabled the identification of strengths and shortcomings of existing frameworks. The latter, on the other hand, helped to recognise a specific environment including different geographical, socio-economical and political backgrounds. This approach was essential in creating a model that could take into account a particular context and needs of the C4C programme. As presented in Table 1, Stage 1 consisted of a review of academic papers, community toolkits and policy documents; this helped to identify and define four dimensions of resilience. Stage 2 aimed to recognise regional characteristics and the perception of local communities in relation to resilience and adaptive capacity; this scoping-stage study included collecting data from five small focus groups with community members from different villages from Dumfries and Galloway. Themes identified through the focus groups were then classified into the four earlier recognised categories of resilience. Based on the review of the community resilience literature (Stage 1) and gathered on-the-ground information (Stage 2), the most appropriate themes for capturing social and economic as well as individual and community resilience were identified in Stage 3. Thus, the final stage (Stage 3) developed research questions for each of the four resilience categories. In total, twenty quantitative questions (i.e. five questions per resilience category) were included in the model. In order to gain richer data about resilience, additional twelve qualitative questions were added to the model. Before conducting the research, the questionnaire was pre-tested using a small number of interviews. Based on the provided feedback, the content and phrasing was revised to improve the clarity of the questionnaire and, as such, minimise bias in the responses. The model developed has been applied in the monitoring of the C4C programme. (For more details see Skerratt and Steiner, 2013; Steiner and Markantoni, 2013). 89

TABLE 1. HYBRID MODEL FOR ASSESSING RURAL COMMUNITY RESILIENCE IN C4C. Nature and Basis of Resilience

Stage of Elements/Factors of the study Resilience

Individual Social Resiliency Outcomes

National and International Literature Review

STAGE 1

Research Paper 1 Research Paper 2 Research Paper 3

X

X

Research Paper 4

X

X

Other evidence from academic journals, community toolkits and policy documents

X

Theme 1

X

Field work

X X

X

X

X

X

X

X X

X X

STAGE 3

X

X X

X X

X X

X Research questions based on existing research evidence and conducted field work

Community Economic Resiliency Outcomes

X

Theme 3 Other themes discussed with community members

Individual Economic Resiliency Outcomes

X

Theme 2 STAGE 2

Community Social Resiliency Outcomes

Individual Social Resiliency Questions

Community Social Resiliency Questions

Individual Economic Resiliency Questions

Community Economic Resiliency Questions

(X indicates selected aspects of nature and basis of resilience identified in the literature review and through empirical scoping-stage study field work.)

Data sources The C4C model of rural community resilience was used in seven villages participating in the C4C programme. To identify respondents, ‘snowball sampling’ was adopted. Suggestions for initial contacts have been provided by LEADER team members and the C4C project manager. Once the initial contact was made, snowball sampling was a convenient way of accessing the desired sample (Saunders et al., 2003). All interviewees were ensured of anonymity in research outputs.

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Findings Based on 178 face-to-face interviews conducted with villagers from seven rural locations from Dumfries and Galloway, Table 2 presents key quantitative findings from the study. Data presented in Table 2 enable us to comment on different dimensions of resilience including individual social resilience, individual economic resilience, community social resilience, community economic resilience. The following discussion

TABLE 2. LEVELS OF RESILIENCE ACROSS SEVEN COMMUNITIES (VALUES BASED ON MEAN).

Average scores

Economic

Social

Individual

Community

Average scores

Village 1 – 6.43

6.41

6.42

Village 2 – 7.63

6.80

7.21

Village 3 – 7.37

5.84

6.59

Village 4 – 7.63

5.01

6.32

Village 5 – 7.58

6.12

6.85

Village 6 – 8.15

6.25

7.20

Village 7 – 7.10

6.23

6.67

Village 1 – 3.96

3.67

3.81

Village 2 – 4.31

3.96

4.13

Village 3 – 5.00

5.74

5.37

Village 4 – 5.43

4.23

4.83

Village 5 – 5.01

4.97

4.99

Village 6 – 5.74

5.56

5.65

Village 7 – 5.30

4.41

4.86

Village 1 – 5.20

5.04

5.12

Village 2 – 5.97

5.38

5.67

Village 3 – 6.19

5.79

5.99

Village 4 – 6.53

4.62

5.58

Village 5 – 6.30

5.54

5.92

Village 6 – 6.94

5.91

6.43

Village 7 – 6.20

5.32

5.76

summarises quantitative findings from Table 2 and, in addition, qualitative data gathered during the interviews. Individual social resilience Amongst all seven villages, the individual social resilience received the highest scores in comparison to other components of the resilience matrix. In general, respondents claimed to be happy with their life in the villages because of a good atmosphere, friendly and supportive neighbourhood, and a good quality of life in a peaceful, quiet and safe area. Interviewees appreciated no major socio-economic problems and less crime than in cities. The majority of respondents emphasised the importance of beautiful natural surroundings and green spaces with landscape being recognised by some as an acceptable trade-off against the perceived benefits of living in a rural environment. The findings indicate that many people are ready to give up on economic advantages offered by

Overall resilience

urban areas in order to take advantage of life offered by rural locations. Individual economic resilience Individual economic resilience is the second weakest dimension across all resilience dimensions in four out of seven villages. The low scores in individual economic resilience were given due to limited opportunities to use own knowledge and expertise in a local area and very limited opportunities to develop new skills within the villages. Interviewees referred to only a few resources in the villages that can help to improve their personal economic situation and to lack of services that would make their life better. Access to a medical centre, the post office, better public transport, local cafe/meeting point for local people were indicated as important, but frequently missing, elements in the villages. Moreover, in order to access essential services, many villagers have to travel being exposed to additional expenditures associated with transport. 91

Community social resilience On average, community social resilience was stronger than either individual or community economic resilience and weaker than individual social resilience. Across the seven villages respondents claimed that all villagers have an opportunity to engage in a community life and a range of community initiatives, and that information about local events is distributed through door-todoor leaflets, online mailing system, local information boards as well as through word of mouth. The major challenge to wider community participation is, however, lack of time. Also, some respondents indicated that there are limited opportunities for socialising and this has a negative impact on the community cohesion and community integrity. Frequently, as noted by many respondents, there are ‘natural community leaders’ who take decisions on behalf of the communities, resolve problems and actively participate in the life of the village. Although in itself it could be perceived as positive, some interviewees felt that new ideas that emerge from those that usually do not engage in community life are not welcomed. Finally, interviewees generally claimed that community members utilise, maintain and care for existing (often limited) resources in the villages. Community economic resilience Community economic resilience received the lowest scores across all resilience dimensions in all seven villages. A majority of respondents claimed that current services do not meet existing and future business needs and that it would be difficult to develop new businesses in their villages due to limited demand for services. Consequently, respondents did not see significant opportunities for development of new jobs in the villages. Some emphasised that jobs can be found outside their village and that the villages itself are places where people live but do not work. In general, respondents did not have high expectations relating to the economic performance of the villages. According to some interviewees, new business ventures could change the dynamics within villages, bringing undesirable changes; this group of people appreciated peace and safety, 92

perceiving their village as a residential rather business area. On the other hand, however, some interviewees stressed that community members should support new ideas and encourage new business creation claiming that new businesses are essential in building sustainable structures of the village. Overall resilience As presented in Table 2, the highest overall resilience score was Village 6 (score 6.43), followed by Village 3 (score 5.99), Village 5 (score 5.92), Village 7 (score 5.76), Village 2 (score 5.67), Village 4 (score 5.58) and Village 1 (score 5.12). Based on the presented findings, there are a few interesting points to note. Firstly, a high overall resilience does not guarantee that all resilience dimensions are equally strong. For instance, although Village 3 achieved one of the highest scores in overall resilience, its individual resilience in social and economic aspects is weaker than the equivalent from Village 4 (i.e. the second weakest village in the overall resilience score). On the other hand, although receiving a comparably high score in social community resilience, Village 1 is characterised by the lowest overall resilience score. These findings show the importance of ‘unpacking’ of the concept of resilience and exploring its individual components. Despite relatively high level of overall resilience, a community might face specific challenges. Those challenges might relate to social or economic dimensions and/or to individual or community levels. Secondly, economic and social aspects of individual resilience received higher scores than community resilience. As such, personal circumstances were assessed better than those that existed at a community level. This finding could suggest that there is a lack of ‘community glue’ that brings people together increasing cohesion of the villages. Thirdly, due to the characteristics of villages selected for the research and their limited access to services and resources, economic community resilience received the lowest

scores across seven villages; interestingly, however, economic individual resilience received higher scores. This could mean that individuals from communities draw on available external resources in order to increase personal economic resilience.

community resilience dimensions over time (as presented in Figure 2). These characteristics are currently sought amongst (i) policymakers who are interested in building stronger and more resilient communities and who need to assess their policies, (ii) funders who want to increase efficiency of their spending and value for money and (iii) practitioners who through community development projects want to bring positive changes.

Key learning This study explores the concept of community resilience and, through building on existing knowledge, it develops a model for measuring resilience in a community scenario. The model recognises that resilience is a complex concept that integrates different thematic aspects associated with social and economic resilience at different scales, including individual and community levels. Although presented as separate, all components overlap and interact with each other and, therefore, all are essential in developing resilience in the community scenario.

Figure 2 presents a hypothetical situation in which different resilience dimensions increase over a period of time. In the C4C programme, all villages engage in different ways and, therefore, outputs and outcomes of C4C might differ between each of them. Nevertheless, ultimately, the model aims to evaluate outcomes associated with such targeted project investments and help to compare resilience level and to identify and assess aspects of ‘change’ and adaptive capacity of communities in quantitative and qualitative ways. Evaluation of C4C will provide useful data for the development of Dumfries and Galloway LEADER’s post-2013 strategy and business plan (Halley, 2012).

The model creates an important tool which enables to measure resilience in a qualitative and quantitative way. The latter is extremely useful because it allows us to conduct a comparison between different dimensions of resilience amongst different communities. In addition, if a longitudinal is used, the model can help to assess changes in four

Finally, in addition to constructing a model of measuring resilience in a community scenario, the paper offers interesting empirical findings, thus testing the model in a real-

FIGURE 2. SIMULATION OF THE POTENTIAL ‘CHANGE’ IN FOUR RESILIENCE DIMENSIONS. Individual social resilience 10 8 6 4

Community social resilience

2 0

Individual economic resilience

Community economic resilience

After completing C4C Before C4C

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life environment. The findings indicate the importance of ‘unpacking’ of the concept of resilience and exploring its individual components. As shown, some communities are particularly vulnerable or particularly strong in selected dimensions of resilience. The overall score of resilience, therefore, might not be sufficient to efficiently address local challenges or, alternatively, build on existing strengths. Thus, identifying and exploring different resilience components might help to design better local community interventions.

Conclusions and recommendations This paper makes a significant contribution to the current debate on community resilience. The paper bridges evidence from international research and new empirical data from Scotland. In reviewing key academic, policy and practice literature it identifies economic, social and environmental elements of resilience and it highlights multiple scales of resilience at individual and community levels. 94

Another important contribution of the paper is a conceptual model which has been translated into a qualitative and quantitative research tool to explore the changing selfreported levels of individual economic, community economic, individual social and community social resilience over time. The proposed model of measuring resilience can help to ‘capture’ a levelof resilience and create a tool which enables to compare resilience across different locations. Through deploying and testing the model in a real-life scenario, findings highlight that resilience is multiscalar, multi-sectoral and interdependent on a number of factors. Consequently, the paper helps to identify ways in which interventions may be targeted to address particular challenges within communities, at the economic or social and/or at the individual or community levels. This, on the other hand, may present a method in which investments in communities might most effectively be made. Summarising, the paper brings a number of implications for academia, policy and practice. For researchers the paper contributes

to a contemporary debate about definition, measurement and development of community resilience. For practitioners, the study makes a substantial contribution as it allows for the identification of the impact that intervention seeking to enhance resilience may have on the communities within which they are deployed. For policymakers, the paper shows the importance of interlinked social and economic policies, and it presents the importance of understanding the complexity of community resilience.

Hegney, D., Ross, H., Baker, P., Rogers-Clark, C., King, C., Buikstra, E., Watson-Luke, A., McLachlan, K. and Stallard, L. (2008) Building Resilience in Rural Communities, The University of Queensland and University of Southern Queensland. High, C. and Nemes, G. (2007) ‘Social Learning in LEADER: Exogenous, Endogenous and Hybrid Evaluation in Rural Development’, Sociologia Ruralis, vol. 47, no. 2, pp.103-119.

Acknowledgements

Magis, K. (2010) ‘Community resilience: an indicator of social sustainability’, Society and Natural Resources, vol. 33, pp. 401-416.

This research was undertaken as part of the Scottish Government’s Strategic Research Programme ‘Governance and decisionmaking for community empowerment’ 2011–2016. We would also like to thank the LEADER team managing the C4C project and interviewees in the villages.

Milman, A. and Short, A. (2008) ‘Incorporating Resilience into Sustainability Indicators: An Example for the Urban Water Sector’, Global Environmental Change, vol. 18, no. 4, pp. 758-767.

References

Noya, A. and Clarence, E. (2009) ‘Community capacity building: fostering economic and social resilience’, working document, CFE/ LEED, OECD.

Adger, N. (2000) ‘Social and ecological resilience: are they related?’, Progress in Human Geography, vol. 24, no. 3, pp. 347-364. Aked, J., Marks, N., Cordon, C. and Thompson, S. (2010) Five ways to wellbeing. The New Economics Foundation, [Online], Available: http://neweconomics.org/projects/ five-ways-well-being. Forgette, R. and Boening, V.M. (2011) Measuring and Modelling Community Resilience: SERP and DyME, [Online], Available: http://ebookbrowse.com/measuringand-modeling-community-resilience-globalhorizons-submission-pdf-d205829608 [3 Oct 2012]. Halley, R. (2012) Ros Halley, Rural Development Manager, Dumfries and Galloway LEADER Programme, email communication.

Saunders, M.N.K., Lewis, P. and Thornhill, A. (2003) Research Methods for Business Students, 3rd ed., London: Financial Times Prentice Hall. Scottish Government (2012) A consultation on the proposed Community Empowerment and Renewal Bill, [Online], Available: http://www. scotland.gov.uk/Publications/2012/06/7786. Skerratt, S. and Steiner, A. (2013) ‘Working with communities-of-place: complexities of empowerment’, Local Economy, vol. 28, no. 3, May, DOI: 10.1177/0269094212474241. Published online 13/02/13. Skerratt, S., Atterton, J., Hal, C., McCracken, D., Renwick, A., RevoredoGiha, C., Steinerowski, A., Thomson, S., Woolvin, M., Farrington, J. And Heesen, F. (2012) Rural Scotland in Focus 2012, Rural Policy Centre, [Online], Available: 95

http://www.sac.ac.uk/ruralpolicycentre/publs/ thrivingcommunitiespublications/rsif2012/. Steiner, A. and Markantoni, M. (2013) ‘Unpacking community resilience through Capacity for Change programme’, Community Development Journal (submitted, under review).

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The Conservative Party (2010) Big Society, Not Big Government: Building a Big Society, Conservatives, London. Wilson, G.A. (2012) Community Resilience and Environmental Transitions, London: Routlege.

11

Resources for resilience

– a response from Down Under Dr. Helen Sheil Director, Centre for Rural Communities, Inc., Australia

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‘Resilient’: power of ready recovery from sickness, depression. Returning to the original form or position after being bent. Buoyancy, cheerfulness.

Macquarie Australian National Dictionary (3rd edition) Macquarie University

Creating conditions for change An Australian native plant Twining Glycine, or Love Creeper, has seed pods that are triggered to explode in the sun’s heat scattering the seeds beyond the parent plant when the conditions for their germination are right. The invitation to present at the British Red Cross Resilience Conference offers such conditions for skills and knowledge developed in rural Australia to germinate in other locations. What works and how in relation to organisations investing in resilience are questions that occupied my life, work, study, research and practice over the last 30 years. This synergy originating from seemingly different worlds inspired me to make the journey from my Australian rural community of Nowa Nowa (population 180) to Greater London (population 8 million). The social change educator Jane Vella offers a seven-step design process: who, why, when, where, what, what for, and how (Vella, 2002:37) for any organisation considering a new direction. My research offers a transferable model of collaborative engagement (the what) and a regional approach (the how) leading to greater community resilience. Named ‘Regional Community Development’, the work identifies universal and transferable strategies drawn from international research and practice and applied to rural communities in Australia. Just as there is a shared language and practice across continents in health and education, there are skills, knowledge and practices which invest in resilience or in their absence dimish it that are applicable across continents. Practitioners concerned with the resilience of communities, whether policymakers, managers, workers (paid or unpaid) at national, regional or community level, are invited to find relevance to their situations. 98

The Red Cross has historically focused on emergency relief during and after disasters. The transition to invest in resilience recognises that involvement of local knowledge and ownership are key elements in facilitating the quality and capacity to care for communities in times of crisis and subsequent recovery (UK Cabinet Office 2010). I have chosen a narrative style to share stories that informed my approach. I am a rural woman. These are my stories.

The beginning It was the 1990s. The combined impact of decisions by the private sector and governments based on the philosophy that ‘bigger is better’ decimated rural communities in Victoria. Banks, schools and hospitals closed, health and welfare funding was terminated, railway lines closed, local governments were forcibly amalgamated and commissioners appointed. Tertiary education programs (including the Diploma of Community Development where I taught) were withdrawn. It was Christmas and I was unemployed with a dependent family. After the shock of dismissal subsided, I began to search for ways to work with my own and other rural communities. If community development was the substance of my work, what did I have to offer those challenging the conventional wisdom that rural communities were an unnecessary liability and their terminal decline inevitable? Generalisations, myths and overlapping government portfolios created barriers for the diverse reality of Australia’s rural lifestyle to be present in public planning (Sher and Sher, 1994). The challenge was to be present at the table.

What did I know? In times of transition education becomes a highly important task. (Freire, 1974: 7) A framework for community resilience originates from community development theorist Jim Ife (1995/2002/http://www. scribd.com/doc/17103404/Jim-Ife-LinkingCommunity 2011). The framework simplifies the complexity of community life, without undermining its connected nature by examining the social, economic, political, environmental, cultural, personal and spiritual. I used this framework to look more closely at circumstances in my community.

How do we know what works? Resilience indicators

A story – dynamic community engagement (what worked) [Our understanding of the world is] dependent on where we stand in human history, what varieties of men and women prevail in society

W

LO

POLITICAL RESILIENCE

NT L LE

Some years previously I had been involved in a Rural Women’s Program that had been memorable for the dynamic engagement that occurred. I chose it as my first case study.

HIG H

CE

When I asked how my community rated on each aspect of community life in 1993 the answer was that it was struggling.

M DIU E M

EX

In Australia where wild fire is a regular event each community displays an indicator registering the degree of fire danger on a daily basis: low/moderate/high/extreme. I adapted this well-known image to initiate conversations of how people experienced their life across the six aspects of community life used by Ife (1995). This records how things are at a particular time and tracks changes and their impact. Used at regular intervals the indicator provides insight into factors which enhance or limit resilience within communities (Sheil, 2000).

Resilience indicator

at this time, the factors that determine the structure of the society and the ways in which it is changing. (Mills, 1970: 78) In 1985, while employed by a Community College to improve access to post-compulsory training, I was asked to establish women’s study groups in nearby rural communities. This initiative was a response to low participation rates in tertiary education by rural women. It was funded for 3 months and a feminist educator Helene Brophy had been employed. With little knowledge of what was involved, but impressed that these would be local groups, I agreed. 99

Participating in this program changed my life and the lives of the many women in the 35 groups established across the region (Brophy, 1986). A subtle shift of ownership marked the beginning of the program as we were invited (not told) to consider how institutions such as health, media, law, education or politics impacted on our lives (Brophy, 1985). We were invited to consider if there was shared interest in a topic that would inspire people to continue meeting? Similar scenarios occurred across the region. Helene met with women in local halls or homes, providing local access, child-care and without fees or proscriptive academic requirements. This approach overcame barriers of prohibitive cost, an alien academic culture, enabled attendance and focused on local issues. All of these had been barriers to rural women becoming involved in tertiary education (Clarke, 1984).

From silence to conversation In the group of which I was a part women began by speaking tentatively of health issues they thought may be connected to aerial cropdusting. Three had experienced miscarriages, others spoke of children having diarrhoea, a milk company had rejected milk from a dairy farm due to the high levels of pesticide – all at crop-dusting time. The effects of sprays and chemicals on ourselves and our families became our topic. We determined the content of our own learning. Private concerns and interests became public action as each group identified a topic and was motivated to engage in relevant learning: 240 women were actively involved in developing the skills, confidence, language and contacts to enable further research and exploration of local issues or events. A regional network, newsletters and festivals supporting this involvement continued for 16 years. This briefly funded short-term program invested in our resilience but was not regarded as formal education and after a succession of pilot programs funding ceased. The experience of this dynamic

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learning inspired my search to determine if this approach could be implemented more broadly?

Theory informing practice In 1992 I had moved and begun teaching in the Associate Diploma in Social Sciences – Community Development. I also enrolled in a Graduate Diploma in Adult Education. Both contributed to my understanding of how theory informed and guided skilled practice. I became aware of the theory underpinning the learning strategies I had experienced in the women’s programs: the importance of creating a safe learning environment, of engaging in dialogue (Freire, 1974) through questioning and of the personal development that occurs when adults have the opportunity to be actively involved in determining their futures (Belenky et al.,1997; Peavey, 2001; Vella, 2002). Community development (Ife 2002; Kenny 1999, 2011) seeks to identify barriers experienced by community members in participating in decision-making rather than focusing on personal deficits. The emphasis is on changing structures rather than moulding people to accommodate organisational frameworks. This perspective recognises the barriers created by institutions when they attempt to impose singular approaches on diverse populations and landscapes. As a rural woman I had experienced the problematic nature of urban frameworks being imposed on rural populations (Kenny, 1996: 109; Gamble and Weil, 1997). The work of Deborah Bird Rose opened my eyes to the systematic way select language, laws and myths promote the superiority of some groups at the expense of others and how this has shaped attitudes and access to decision-making (Rose, 1997). It was clear that strategies to facilitate twoway conversations across these divides was urgently needed if a more inclusive society were to emerge.

Developing a transferable model (the what) Just as the key to a species’ survival in the natural world is its ability to adapt to local habitats, so the key to human survival will probably be the local communities. (Suzuki and McConnell, 1997: 183) The third story is the pioneering of a tranferable model of collaborative engagement which formed the basis of my PhD research. This transferable model then informed a postgraduate University qualification and was implemented at a regional campus. It focused on investing in rural communities through regional workers, all levels of government, regional service providers and regional universities. It was transformative for all participants. Communities successful in establishing ventures such as co-operative health centres, hotels, marketing co-operatives and financial services such as the Bendigo Community Bank (www.bendigobank.com) had a history of working together for mutual benefit. While rural values were often dismissed as conservative these primarily citizen led actions resonated with many people (Onyx, 1996: 99). However, there was little awareness of why, and how, some communities could achieve these outcomes, while others continued to decline. The transition from being a passive recipient of externally provided services, to taking ownership and setting direction from within communities is a significant one. There were few guidelines, little support and usually a high level of distress (Sheil, 1997). Frequently communities initiated this work in isolation and despite government policies. Through research I had begun to find answers to whether facilitated self-directional learning could be relevant in communities. I identified nine contributing strategies: dialogue, time, local community ownership, co-operative culture, visioning, networking, action, reflection and transformation (Sheil, 2000). Each of the strategies contributes qualities that

combine to achieve transformative change. I became aware of programs incorporating only on one or two strategies such as dialogue and networking that had raised expectations but failed to achieve the anticipated level of outcomes. In theory this had application as a transferable model guided by the community development goals of social justice and environmental sustainability (Ife,1995).

Community institutional partnerships (the how) How to introduce this approach into mainstream institutions became the next challenge. The transferability of the model had not been tested and there were questions on 101

whether it would be best to incorporate it into existing programs or as a separate discipline. The priority was to work with interested communities so a format that could be located within communities was essential.

A co-ordinated regional approach

Study circles – a democratic way of working

Skilled facilitators are critical to locating learning within communities. In a strategy to increase the number of facilitators an alliance was developed with a major university and an accredited Graduate Certificate in Regional Community Development (developed from my research) was launched. A professional development manual, ‘Growing and Learning in Rural Communities’ (Sheil, 2000), again funded by Philanthropy, became a text for the graduate program.

Study circles had been used by the Aboriginal Reconciliation Council (1993) to facilitate pastoralists and indigenous people sitting at a common table listening to each other. It was a radically different approach to the traditionally adversarial public forums. The process enabled groups to find common ground on issues that frequently divide communities. The philosophy appealed and the format provided local access, was inexpensive and non-threatening.

‘Building Rural Futures through Co-operation’ Equality is the heart of the matter of democracy. (Larsson, 2001: 176) The ‘Building Rural Futures through Co-operation’ study circle kit (funded by Philanthropy) incorporated the nine strategies and provided a forum for local people to meet and talk together about the future of their community. The study circle guidelines establish respectful relationships and recommend participants take the time to learn democratic ways of working. The developmental process enabled people to gain confidence in speaking about their circumstances, and develop the maturity and tolerance to listen and respect the views of others. The unique heart of each community became visible and featured in policy and planning in a negotiated manner. In every community activities continued beyond the completion of the ‘Building rural futures’ project and many initiatives continue. A factor limiting the more widespread use of study circle kits was the scarcity of skilled facilitators. 102

In a knowledge based economy, innovation and learning are vital to communities leading their own development. (Garlick and Pryor, 2003: 7)

Graduate Certificate in Regional Community Development Continuous enhancement of capacity building depends on the availability of skilled practitioners, on their reflective practice and on research into all its aspects. (Macadam et. al., 2004: xvi) The Graduate Certificate gave workers professional recognition for work that had frequently been dismissed as of lesser value than technical expertise. Their experience as facilitators of collaborative engagement complemented and informed policy development within their organizations. Workers felt less isolated and initiated partnerships of benefit to communities. Students in the Graduate Certificate had access to the resources, skills and knowledge of a major university, enabling them to integrate current issues with theoretical strategies of collaborative engagement. The multi-disciplinary nature of the course reflected the need for an integrated approach to regional development. Participants came from diverse backgrounds including health, recreation and culture, natural resource management, business, local government, environment, agriculture, youth work as well

as from spiritual and women’s groups, adult education, neighbourhood houses, community associations and indigenous communities. Each contributed perspectives of the resilience, stagnation or decline of communities. Responses to the improved practice in communities and workplaces was immediate (Sheil, 2004; Bruce, 2005; Caling, 2005; Twite, 2005). Each student had established a study circle or work based project to apply the theory. This was supported through local government (Gay, Pugliesie and Sheil, 2004) and non-government regional organisations who employed facilitators from within communities (Sheil, Smith and Lane, 2004). Study circle participants (community members) could receive accreditation in a TAFE communications module. This respected the commitment of the time and knowledge of community members and provided access to educational resources such as libraries and academic staff. Seventy study circles facilitated in Gippsland introduced approximately 700 people to the skills of community led facilitation. Participants used these skills in local groups establishing festivals, newspapers, choirs and tackled planning issues such as sewerage and recreational facilities with neighbouring communities (Cartwright and Sheil, 2005). Regional forums demonstrated that communities that learn to work and plan together and are resourced to do so – develop more sustainable, long-term plans for their communities and are more actively engaged in their implementation. Communities shared rather than competed for regional resources, attitudes of workers changed; community members were in the planning process. Stories of frustration, exclusion, mistrust and burnout were replaced with good news stories. The resilience indicators recorded these shifts. Partnerships reflecting the goals of the Draft Strategic National Framework for Community Resilience (2010) were evident in this regional approach nominated as a best practice example of University–Community Engagement (Garlick, 2002: 3).

The partnership demonstrated ‘evidence of a clear purpose and clear expectations about roles of partners, existence of mutual trust, being results-oriented while generating tangible outcomes both qualitatively and quantitatively for the benefit of the regional community as well as the University…’ (op. cit. 15). The model proved transferable across sectors, rural and urban communities. The university provided pathways, credibility and rigour to regional development. Graduates had access to skills, knowledge and strategies to work effectively and develop active networks. Study circles invited participants to determine how they would work prior to making plans for activities and enabled each group to establish a sound basis for immediate and future projects. In communities that experienced wild fire or flood the local facilitators co-ordinated the response with relevant agencies. Accurate information on weather/ fire conditions was distributed through local networks and emergency services and later recovery efforts were locally co-ordinated. External organisations carried out their roles with maximum impact and minimum trauma (Davies, 2003). Graduates continue to be employed in key regional positions. It is a cost-effective approach to nurturing trust, skills and knowledge in communities, organisations and governments. The relevance to the Red Cross could be on the multiple levels of policy implementation to support their staff, to develop resources for use within communities. For communities in crisis study circles incorporating these nine strategies will enable people to find their own voices and be part of planning for resilient futures.

The future While there is now a plethora of community building, community strengthening, capacity building (Kenyon 2002; Ife, 2002: 79), leadership, innovation and social entrepreneurship programs all have 103

independently developed resources that lack transferability and frequently fail to contribute to wider knowledge. Like the Centre for Rural Communities other dedicated organisations such as Borderlands (www.borderlands.org. au), who produce the largely print newsletter ‘New Community Quarterly’ and offer a master’s course, and Commonground, wellknown for group work skills (http://www. groupwork.com.au/commonground.html), work in effective but limited ways. A comprehensive regional report notes that there is limited university activity ‘in developing, maintaining and supporting graduates focused on [rural] capacity building… [and] TAFE is not currently relevant in dialogue about [rural] capacity building’ (Macadam, 2004: 61). The report acknowledges the diversity of situations in which practitioners are engaged commenting that there is ‘considerable room for enhancing the connectivity between universities and the communities in which they are located’ (Collits 1999; Garlick 1998). Workers consistently report the challenging nature of facilitating the transition to more inclusive practice. The positions frequently lack status, are short term and require high personal commitment. The Graduate Certificate in Regional Community Development demonstrated that these complex and challenging roles benefited from an informed and resourced approach. However, there continues to be a tension between supply and demand. Regional universities operate under a business model creating pressure to market centrally and internationally. Monash University now offers a Graduate Certificate, Graduate Diploma and Master of Regional Education and Community Development through external delivery. From a community perspective the regional partnerships and dynamic engagement have been lost. It would appear timely to provide a forum for discussion between our communities, institutions, Universities and government on 104

ways to better resource community resilience. The Red Cross Resilience Conference offers this opportunity.

References Belenky Field, M., Clinchy McVicker, B., Goldberger Rule, R. and Tarule Mattuck, J. (1997) Women’s ways of knowing: The development of self, voice and mind, US: Basic Books. Brophy, H. (1985) Rural Women’s Program, Victorian College of Agriculture and Horticulture, Sale. Brophy, H. (1986) Rural Women’s Program, Community College of TAFE, Bairnsdale. Bruce, L. (2005) ‘Evaluation and Change,’New Community Quarterly, no. 4, Summer, 25-30, (www.ncq.org). Caling, T. (2005) ‘Bruthen Study Circle,’ New Community Quarterly, no. 4, Summer, 31-38, (www.ncq.org). Clancey, D. (2005) The story so far, (audiovisual) Monash University, Churchill. Clarke, V. (1984) Potential of rural women in Gippsland Educational Opportunities: Needs and Employment, McMillan Campus of Victorian College of Agriculture and Horticulture, Sale. Council for Reconciliation Australia (1993) Australians for Reconciliation, Melbourne. Cox, E. (1995) A truly civil society, The Boyer Lectures, ABC, Sydney. Davies, S. (2010) ‘The Buchan Neighbourhood House response during the 2003 fire emergency’, New Community Quarterly, vol. 8, no. 4, Summer, 39-41 (www.newcq.org). Freire, P. (1974) Education for critical consciousness, Sheed and Ward, London.

Freire, P. (1994) Pedagogy of Hope, New York: The Continuum Publishing Company. Gamble, D. and Weil, M. (1997) ‘Sustainable development the challenge for community development’, Community Development Journal, vol. 32 (3) July, 210-222. Garlick, S. and Pryor, G. (2002) Compendium of Good Practice University – Regional Engagement Initiative, Department of Transport and Regional Development, Canberra. Garlick, S. and Pryor, G. (2003) Campus and Community: the benefits of engagement, Department of Transport and Regional Services, Canberra. Garlick, S. (1998) Creative associations in special places: enhancing the partnership role of universities in building competitive regional economics, Report for Southern Cross Regional Research Institute, Commonwealth of Australia. Ife, J. (1995) Community Development: creating community alternatives, Longman, Australia. Ife, J. (2002) Community development: community based alternatives in an age of globalisation, Pearson Education Australia, Frenchs Forest. Ife, J. (2011) /http://www.scribd.com/ doc/17103404/Jim-Ife-Linking-Community, 2011. Kenny, S. (1996) ‘Contestations of community development in Australia’, Community Development Journal, Oxford University Press, vol. 31, no.2. April 104-113. Kenny, S. (1999) Developing communities for the future (2nd edition), Melbourne: Thomas Nelson. Kenyon, P. (2000) Community Builders Resource Manual, Bank of IDEAS, York.

Larson, S. (2001) ‘Seven aspects of democracy as related to study circles’, International Journal of Lifelong Learning, vol. 20, (3) 199-217. Macadam, R., Drinan, J., Inall, N. and McKenzie, B. (2004) Growing the capital of rural Australia. The task of capacity building, Rural Industries Research and Development Corporation, Canberra. Macquarie Dictionary (Australian) 3rd edition, (1997) Macquarie University, NSW. Mills, C.W. (1970) The sociological imagination, UK: Penguin. Onyx, J. (1996) ‘Community development in Australia: trends and tensions’, Community Development Journal, Oxford University Press, vol 31: 99-103. Peavey, F. (2001) Strategic questioning, Crabgrass, San Francisco. www.crabgrass.org. Productivity Commission Review (1998) Impact of Competition Policy Reforms on Rural and Regional Australia, Commonwealth Government, Canberra. Sheil, H. (1997) Building Rural Futures through Co-operation, Centre for Rural Communities Inc. Churchill. Sheil, H. (2000) Growing and Learning in Rural Communities, Centre for Rural Communities Inc. Churchill. Sheil, H., Pugliese, T. and Gaye, L. (2004) ‘Local values and knowledge shaping community involvement. Role of regional university,’ New Community Quarterly 2, no. 4, Summer, 13-20. Sheil, H. and Cartwright, C. (2005) ‘Margins to Mainstream: role of regional university,’ New Community Quarterly, Summer, vol. 3, no.4: 14-21. Sheil, H. and Smith, N. (2006) ‘From the margins to the mainstream. The ‘other’ 105

informing knowledge and wisdom,’ The Changing Nature of Australian Country Towns, (eds.) Rogers, M. and Jones, D., Victorian Universities Regional Research Network, Ballarat. Sheil, H., Smith, N. and Lane, A. (2004) Stories my community told me, www. ruralcommunities.com.au. Sher, J. and Sher, K. (1994) ‘Beyond the conventional wisdom: rural development as if rural people and communities really mattered’, Journal of Research in Rural Education, vol. 10, no. 1: 2-43. Smith, N. and Pearce, J. (1995) Business plan Centre for Rural Communities, Churchill. Steinem, G. (1992) Revolution from within, UK: Corgi Books.

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Study Circle Resource Centre, Pomfrey, USA (1997) www.cpn.org.sections/affiliates/study_ circles.html. Suzuki, D. and McConnell, A. (1997) The sacred balance, New South Wales: Allen and Unwin. Twite, B. (2005) ‘The Bena study circle’, New Community Quarterly 2, no. 4, Summer, pp. 13-20. United Kingdom Cabinet Office (2010) Draft Strategic National Framework for Community Resilience. Vella, J. (2002) Learning to listen, learning to teach, New York: Jossey-Bass Publishers.

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British Red Cross emergency response in Cumbria

– How we’ve enhanced ERiC’s resilience David Taylor Volunteer, British Red Cross

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Introduction

The problem

Emergency Response in Cumbria (ERiC) is a British Red Cross volunteer-driven initiative which has been three years in development. It is a pragmatic solution to a series of problems which were compromising the resilience of our emergency response capabilities in the county. It is based on a model of “Proactive Localism” and is an example of resilience in practice which has been borne out of experience and been proved to be effective.

It was, however, those “first few hours” which continued to trouble me, as I knew we could have done better, and with repeated If only-s, I set about analysing how we could have improved our initial response. The problem, I concluded after much deliberation, was one simply of place and time. That is, how do you design an emergency response capability which ensures that your resources, both people and equipment, are in the right place at the right time? Ours initially were on the wrong side of roads blocked by floods, unsafe bridges and landslides, leading to a delay in the arrival on scene of the Red Cross staff who had made their way across the Pennines from the Area Office in the North-East, initially to Carlisle, to await a request for help from the Local Authority.

Definition For the purposes and the context of this paper, I am defining resilience as: The ability of the British Red Cross in Cumbria to remain a trusted partner by maintaining its ability to respond to emergencies and provide the expected level of service, irrespective of the disruption to normal transport and communication networks, through the adaptation of existing protocols.

Background Although the response phase of the Cumbria Floods of November 2009 lasted only a few days, the recovery support work of the British Red Cross went on in to the spring of 2011, giving plenty of time to reflect on the service that we had delivered. With the exception of the first few hours, I have to say I was pleased, indeed proud, to have been a very small part of that huge operation, which had offered so much practical and emotional support to hundreds of people when they were at their most vulnerable.

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The reason that we were not deployed earlier to Cockermouth was due to a delay in our activation by the County Emergency Planning Unit, who in turn were having to deal with multiple simultaneous flooding incidents right across Cumbria, giving rise to confusion, misinformation and real difficulties in identifying and, more importantly, prioritising key problem areas. Residential homes were being evacuated, rest centres opened, but no requests for help were forthcoming to us until very late on. By this time, the only realistic way around the county was either by boat or helicopter, and given the large distances involved, the emergency services – even having called on the help of multiple Mountain Rescue Teams – were overwhelmed with the demands being placed on them and a major incident was declared.

This delay in deployment was exacerbated by the fact that Cumbria is part of the British Red Cross North-East and Cumbria Area, a vast geographical expanse of over 5900 square miles and 175 miles by car from north to south. The Area Office, which is where most resources and staff are based, is in Newcastle, on the other side of the Pennines from Cumbria, and often in these weather conditions trans-Pennine routes are either blocked or closed. Even in good weather, the distances involved make a rapid response to an incident in, say, the south-west of Cumbria impracticable, with a 140-mile, 1 hour 45 minute-journey to Cumbria’s West coast – the site, for example, of the Sellafield nuclear installation.

The local solution

The location of this Area Office in Newcastle is, however, for perfectly justifiable reasons of population distribution. For example, County Durham and Tyne and Wear have a joint population of over 2 million, whereas the whole of Cumbria is less than half a million, making it the second least densely populated

It struck me that these problems posed by the intractable combination of topography, demography and remoteness from the Red Cross Area Office, which were compromising our emergency response capability in Cumbria, may be solved, at least in part, by adopting a decentralised approach. That is,

county in England. With the exception of the small towns of Windermere, Keswick and Cockermouth, Cumbria’s population is mainly concentrated around its perimeter, most notably in the four “corners” of Carlisle in the north-east, Workington and Whitehaven in the north-west, Barrow in Furness in the southwest, and Kendal in the south-east. Apart from the M6 running up the east of the county, most roads are rural and vulnerable, making journeys even within the county indirect and very slow, giving a journey time of well over 1 hour 30 minutes to drive from the south to the north of Cumbria.

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having resources already in situ would surely make our response more reliable, robust and rapid – without knowing it, I was actually looking at enhancing our resilience. Time and place – simply identify suitable volunteers who already live in strategic locations and provide them with sufficient training and initial equipment to “hold the fort until the cavalry arrives” from over the Pennines, or even another Area. The idea of reducing Cumbria’s exposure by making it initially more self-sufficient seemed to me to be sensible and a concept which received the early backing of our Operations Director, Judi Evans. Once we received the go-ahead, this volunteer-led initiative rapidly gained momentum, fundraising over £5000 for the equipment which was purchased only after great deal of thought and consultation with those who had experience of rest centre environments and the diverse and unexpected challenges they present. The equipment is designed both for the service-user and for the volunteer helping run the rest centre, and ranges from blankets to nappies, from hygiene packs to maps, and from admin materials to phone chargers, plus the resilient Airwave radios for communication with the Area Emergency Planning Team. The key to this equipment is where it is stored – in the four corners of the county in the Red Cross centres in Carlisle, Workington, Barrow and Kendal, with the result that no populated part of Cumbria is now more than 30 miles from this vital local resource. Depending on the activation, these four sets of equipment can either all be deployed to one incident or three can be left in situ should further incidents occur simultaneously across the county. Alongside the equipment procurement, the selection and training of local volunteers to Team Leader (Bronze Officer) capability was also underway, with the role specification that they would be able to support and work professionally alongside Category 1 and 2 Responders on the ground before arrival of staff from Newcastle. In addition to liaison, 110

this role would also include providing local situation reports from the incident scene back to the Red Cross Control Room in Newcastle, requesting as necessary, additional resources from both Area and National assets as well as managing volunteers from both the Red Cross and other partner agencies. Because the response involves local volunteers travelling much shorter distances than would otherwise be the case, these Red Cross personnel are more likely to get through and arrive safely as they can apply their local knowledge to the road conditions and choose the best route based on the latest local information at the time. It is also quite feasible that local 4x4 vehicles, so common in rural communities, could be utilised to transport local volunteers to where they are needed. Cumbria is unusual for its plethora of Mountain Rescue Teams, a dozen in all, with 4x4 and even tracked-vehicle capability, who are asked to attend a vast range of incidents. These teams are just one example of the local contacts on the ground from all three sectors which local volunteers have networks within to ensure the best possible outcome for the service users. In Cockermouth, the Red Cross worked alongside, to name but a few, the WRVS, Rotary, the Lions, Churches Together and the Salvation Army. But as with all communities, it is often local contacts which can open doors, for example, to source beds and bedding, clothing or toiletries, access photocopying facilities or the internet. There is always someone who knows someone who can find a local solution to a problem – a resilient solution without the need for outside assistance.

The proactive solution It was recognised at a very early stage that this initiative had to be developed in conjunction with, and with the approval of, both the County Resilience Unit and the Civil Contingencies Unit, a job made easier in Cumbria since they share the same office on the same site at the police and fire

headquarters. This turned out to be a valuable relationship-building exercise and resulted in enhanced Red Cross credibility that ensures our resources are utilised most effectively. The key to this relationship was to introduce our local volunteer Team Leaders to these Senior County Managers and Chief Inspectors, as we recognised the importance of mutually putting a face to a name of the very people who would be working together on a future local incident. To this end, our credibility was strengthened by having recruited one of our Team Leaders, John, from 24 years in the Cumbria Fire Service, and Graham, an acting Paramedic of 30 years with the North-West Ambulance Service, who was first on scene at, and played a major role in, the Grayrigg train derailment – very useful credentials. The result of this exercise was that the Red Cross Emergency Response in Cumbria Initiative, with all the resilience of the Area and national assets behind it, received the approval of both these bodies, and the Red Cross was invited to have a place on the Cumbria Strategic Coordination Group and

included in the National Resilience Extranet. The effect of this is that we would not only hear about incidents as they are occur and develop, but would also have a place at the decision-making table, allowing our response to be proactive and therefore anticipatory. The use of this insight combined with local “on the ground” information from volunteers around the county enables us to make a safe anticipatory response to proactively relocate personnel and equipment ahead of an incident reaching crisis point and/or road closures, in liaison with the County Resilience/Civil Contingencies Units. Especially on “slow burn” incidents, such as flooding, we can now ensure that we have the capability to deliver the expected level of service by anticipating where problems are likely to occur and travel early to be on scene in a timely manner. The advantages of this early, rather than delayed arrival, is that our effectiveness onscene is enhanced as we are not walking in when the crisis is already at an advanced, often chaotic, stage and in addition, as we are not having to play catch-up having started 111

on the back foot, our efficiency over the longer term is far better. This is particularly important when registering and supporting large numbers of evacuees as the quality of the records and the initial relationship-building can determine both the effectiveness and efficiency of the subsequent recovery work.

Conclusions and recommendations Since ERiC went live on the second anniversary of the floods in November

2011, it has already been activated twice and continues to be developed to become even more professional and reliable. As a result of this initiative, it is clear that the resilience of the emergency response capability of the British Red Cross in Cumbria has been enhanced, a fact that is appreciated by the county’s Category 1 and 2 Responders. I would therefore recommend that other parts of the country which have similar problems caused by topography, demography and remoteness from their main resources, consider a similar resilience enhancing initiative based on “proactive localism”.

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How communities are naturally resilient –

mapping of community assets on the Wirral, Merseyside Gayle Whelan Community Asset Researcher, Liverpool John Moores University

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Introduction A community asset can be defined as anything that can improve the quality of community life; this could be an individual, group, project or initiative. Community assets are considered as “the primary building blocks of sustainable community development, building on the skills of local residents, the power of local associations, and the supportive functions of local institutions” (Kretzmann and McKnight, 1993). Assets draw on existing community strengths to build stronger, more sustainable, and resilient communities.

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The findings from this two-year project will identify how communities determine their own health and well-being outcomes, and what factors are important for sustaining community resilience. This will provide evidence to inform allocation of public health funding, and future development and delivery of services.

Study description

This project seeks to identify community assets on the Wirral, North-West England. With a population of approximately 310,000, the peninsula has more than a thousand services, projects and initiatives that run with the aim of improving health and well-being. These are delivered by public, private and third-sector organisations, covering small communities, towns, Wirral-wide and some extend into Merseyside and the North-West.

This project aims to map community assets on the Wirral, using four phases: • Toolkit – development of database, category definitions (November 2011–June 2012) • Identifications of projects for evaluation (June 2012) • Asset evaluations using social return on investment analysis (July 2012–July 2013) • Final project report providing summary of community asset evaluations, conclusions and recommendations (July 2013– November 2013)

The Applied Health and Wellbeing Partnership (a collaboration between Public Health, Wirral and the Centre for Public Health at Liverpool John Moores University) is currently undertaking a two-year project to map these community assets, highlighting how and why initiatives can promote resilience and improve health and well-being. With large pockets of extreme deprivation existing in Wirral, this project seeks to explore how community assets have developed, by understanding how they occurred and why, who the benefactors are, and how the assets impact upon health and well-being of the individual, and overall community. The project also aims to explore wider impacts of assets on the social, economic and physical aspects of the community environment.

Toolkit The first stage of this project involved identifying the types of community assets present in Wirral. Through meetings with local community members, staff in Public Health, Wirral and internet searches, an initial 52 community assets were identified. Assets were placed on a Microsoft Access database. Data included details of the projects, where it was based, who it served and contact details. Each asset was assigned a number of categories according to: population group, health need and health behaviour change. Further sub-categories were applied which detailed the type of social support, environmental, education and learning skills offered by the asset. Assets were then further themed using the Public Health Outcomes Framework

(Department of Health, 2012), a tool which aims to increase healthy life expectancy and reduce differences in life expectancy and healthy life expectancy between communities. The domains cover improving the wider determinants of health (domain 1), health improvement (domain 2), health protection (domain 3) and public health and preventing premature death (domain 4). Categorising assets by the NHS Public Health Outcomes Framework helps to understand the role assets play in addressing public health needs. Identification of projects for evaluation Using the Public Health Outcomes Framework domains and assigned categories, a number of projects were identified for further evaluation. These were chosen because they covered the majority of categories and were therefore a representative sample of assets contained on the database (see Table 1). Assets for evaluation included: • Get into Reading – a social inclusion shared reading project • Taiko Drumming for Health – drumming sessions for children and disabled adults • Life Expectancy Wirral – an initiative to reduce health inequalities between communities • Invisible Injuries – a charity which supports individuals experiencing negative life experiences are suffering emotionally from specific life events • Fruit to Suit – a social enterprise to support children to set up and run their own healthy food tuck shops in their primary schools • Stick n Step – provides free specialist conductive education and support services to children with cerebral palsy and their families and carers • Ferries Family Groups – A support network for families • Wirral Food Bank – provides emergency food and support to local people in crisis. As well as analysing and understanding what assets are and the impact they have on health and well-being and how they contribute to naturally resilient communities, it was also

important to look at the value of the asset, both in the sense of its cost and worth to the community it served. The project team felt it was important to include this element in the research to help commissioners understand more about an asset and its impact on health and well-being. It was decided that a social return on investment (SROI) analysis would be included as part of the evaluation process where possible. Asset evaluations using Social Return on Investment The aim of each evaluation is to evidence the benefits of community assets in relation to health and well-being, and the social value that is gained from engagement with each project. With the Public Value (Social Value) Act 2012 requiring public authorities to consider how services they procure might improve the economic, social and environmental well-being of communities, it is also timely to consider the wider impacts of community projects on the areas they thrive in. SROI has been chosen as the most appropriate method of analysis for this evaluation as it involves assessing the social, economic and environmental impact of community assets through direct involvement with key stakeholders – service users and service providers. The SROI process involves identifying changes as a direct result of an individual’s engagement with a project. The analysis uses a combination of qualitative, quantitative and financial information to estimate the amount of ‘value’ created or destroyed by the project, which is typically expressed as: ‘For every £1 invested in the project, £x of social value is created’ (Nicholls et al., 2012). Final project report Once all SROI evaluations have been conducted, a final project report will be written outlining and summarising the findings from all evaluations, along with a selection of case studies, which will ensure that all categories on the database are covered by our evaluation. The final report will summarise what has been learnt about community 115

assets and the impact this has on improving health and well-being and what implications the findings have for those involved with procuring and commissioning public health services. The report will also highlight what has been learnt about assets and their origins and the individuals involved in delivering and accessing them. The project aims to uncover the benefits that a community can gain from its assets in relation to health and well-being whilst uncovering what has been learnt about assets and resilience within communities.

findings demonstrate the positive impact that assets have on individuals and their community. A number of common themes across projects have been identified: assets have been shown to typically empower individuals, improve confidence, self-esteem and self-worth, and provide opportunities to learn new skills and meet new people. The real worth for many involved in the research was the social aspect; meeting new people, gaining new friendships and social inclusion were some of the many gains identified, all of which contribute to making resilient societies.

Limitations

The research highlights that assets are typically developed from a personal circumstance/ life event and are led by individuals/groups who are highly motivated to help others in similar circumstances to improve their own health and well-being. Those leading the asset initiatives also reported gaining as much from engagement in the project as the services users did.

The research involves SROI analysis which relies heavily on qualitative research. The nature of the SROI evaluation in attempting to quantify the unquantifiable (for example, the value of self-confidence for an individual, or for improved or increased friendships) is that it was often quite difficult to elicit meaningful financial outcomes from participants. The SROI analysis itself is dependent on the responses given by the research participants, which are subjective to that group at that particular time-point. SROI evaluations do not rely on large numbers of participants. While the numbers involved in each evaluation may be quite small, these are a good representation of the groups involved.

Findings At the time of writing, this two-year project is half way through. To date, an interim project update has been produced (April 2012), and the first evaluation has been completed (Get into Reading). Taiko Drumming for Health and Life Expectancy Wirral are in the report write-up stages, and all other projects are at the data collection stages, with write-up starting shortly. The use of SROI to ascertain social value of the project was the best method with which to understand the benefits, and health and well-being changes that result because of engagement with a community asset. Initial 116

While many participants experienced different circumstances and were engaged with different assets, the research found that they did share many of the same outcomes and their responses to financial valuing of this were quite similar, irrespective of which asset they were involved with. This is a preliminary finding and will be something the final report will consider in much greater detail.

Key learning This project aims to uncover the role that assets play in dealing emerging public health needs, and will consider if what we have learnt can be replicated elsewhere. Is there a model for a successful community asset, and a model for a resilient community? What are the factors that typically make communities resilient and individuals more empowered to tackle their own health needs? This project will highlight the worth of community assets and the role they play in health and well-being. How a community responds to emerging health needs through

its development of assets highlights a community’s natural resilience. It is hoped that the project will also uncover what individuals can do to improve their own health and associated outcomes without necessarily replying on the NHS. The SROI evaluations will also emphasise the worth of the community assets to the individuals and communities where they thrive, and that this will be the basis for understanding more about the worth of community assets.

Conclusions Understanding assets is essential to learning more about the health needs and responses of a community. This work is helping to uncover the strengths of a community in determining its resilience through the development and sustainability of community assets. Resilience is natural response, often to a life event, personal experience or shared phenomenon. Developing assets to deal with emerging health needs is most often inexpensive, and produces far more social worth and value for individuals and the community than is first input – highlighted by positive SROI ratios. In conclusion, community assets are thriving, empowering individuals to improve their own

health and well-being in a meaningful way. They help improve communities by valuing the worth of an individual and what they can give. Assets are also resilient against changing economic times and emerging health needs: they respond to need and are often created, developed and enhanced by the very people living in these communities.

References Department of Health (2012) Improving outcomes and supporting transparency, Part 1: A public health outcomes framework for England, 2013-2016. London: Department of Health. Kretzmann, J.P. and McKnight, J.L. (1993) Building Communities from the Inside Out: A Path Toward Finding and Mobilizing a Community’s Assets. Ilinois: Institute for Policy Research. Nicholls, J., Lawlor, E., Neitzert, E. and Goodspeed, T. (2012) A Guide to Social Return on Investment, [Online], Available: http://www.thesroinetwork.org/publications/ doc_details-/241-a-guide-to-social-return-oninvestment-2012. Last accessed 27.02.2013.

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Credits Editing and layout: Green Ink (www.greenink.co.uk) Photos: Mathew Percival/British Red Cross

The British Red Cross Society, incorporated by Royal Charter 1908, is a charity registered in England and Wales (220949) and Scotland (SC037738).