My last blog (Asset based working – its not just the community bit around the edges) looked at some of the challenges and possible actions required to mainstream asset based working. I was pleased to get a friendly critique from Simon Rippon, Trevor Hopkins and Jayne Hopkins who are doing interesting work in this area. Just to be clear – I don’t agree with everything they say (especially the point about people in my local not understanding participatory budgeting!) but its worth reading and helps develop our thinking. So I have republished their comment as a blog piece below – over to them…….
Thanks Mark, but what a position you put us in! How to champion asset-based thinking and working at a locality level while actually changing the way that health and care systems work.
In Chapter 4 of our new report, ‘Head, hands and heart: asset-based approaches in health care’ published by the Health Foundation in April, we set out and respond to the principal challenges and criticisms of asset-based approaches. This chapter covers many of the points you make in your blog.
Not wishing to re-cover this ground, as our perspectives are there for people to read, we would like to add to this discussion by responding to your call to consider some of the factors that drive current deficit culture and hence behaviour in the current system.
Your blog seems to be aimed at an audience mainly in the ‘public health’ system. Whilst these are important players they are not the sole agents for systematising asset-based approaches.
Positioned in local government, public health has a huge potential to develop asset-based approaches, and some are doing just this. But the majority are stuck in a risk-based delivery model still attempting, not very successfully, to persuade people to change their lifestyles or health risk behaviour. We would argue that PH is complicit in perpetuating this emphasis. Our colleague Lynne Friedli has argued this too in recent published articles and seminars.
Asset based working is not just another public health ‘intervention’ it involves a paradigm shift in thinking about the health and wellbeing of individuals, families and communities based on ‘salutogenic’ principles.
You rightly say that this challenge to community development is not new and requires a “shift in power between professionally led public sector bodies and citizens and communities.” The recent report from Public Health England by Professor Jane South (A guide to Community Centred Approaches to Health and Wellbeing) articulates this well. But this is only part of the problem: power also needs to shift within organisations if professionals and practitioners are to work in asset-based ways.
Research sponsored by The Royal College of Nursing Group found that distribution of power in health and care systems is often hierarchical, based on professional status and gender. Driven by patient safety the NHS especially has attempted to challenge these imbalances in acute services over recent years with very limited success.
It is no better in many voluntary and community organisations as there is often a split between the frontline who ‘get and do’ asset-based working instinctively and the culture and systems within these organisations, often driven by public-sector commissioning procedures and outcome frameworks that are about process inputs and unhealthy behaviours, a deficit based emphasis. In our field work for the Health Foundation report a Community Development Leader commented that his organisation had spent years investing in community and voluntary services to do community work which in turn had built a parallel system and infrastructure that had become dependent on commissioning to survive – with little evidence they had made any impact in community-led action.
Participatory budgeting is a classic system-led response. It is, as John McKnight one of the originators of Asset Based Community Development would contend, building communities from the ‘outside in’ while asset-based working seeks to build community from the ‘inside out’. Even the words are exclusive, ‘participatory budgeting’ – try bringing that topic up for conversation at your local pub on a Friday evening.
Another factor driving current deficit culture is leadership that relies on positional power, direct control and organisational outputs. To support asset-based approaches we require new models of community leadership based on credibility and earned authority rather than positional or professional power. These characteristics will allow the building of new sources of power and influence and “…concentrate on enabling systems, organisations and people to work simply and seamlessly together, maximising the synergy of the collective rather than the individual. They also draw the best from diverse groups to enable a source of collective or shared governance where felt responsibility for achievement is stronger than imposed systems of accountability.” (A real paradigm shift in NHS Leadership? By Robin Douglas and Jane Keep. HSJ – May 3, 2012)
While agreeing that we need ‘a more systemic approach’ – it just depends on what you mean by ‘the system’. In many places local people are active, volunteer, form clubs and associations, help each other out and support more vulnerable people – organising what is seen as asset-based working! This has been happening for centuries and has sprung from local action not service-based ‘system’ action. And may have occurred due to lack of confidence in communities for established ‘mainstream’ public service delivery.
One of the approaches we suggest in our new publication is the use of a ‘Theory of Change’ to understand how asset-based change occurs. Theory of Change is about the central processes or drivers by which change comes about for individuals, groups or communities. This can be based on a formal research methodology and is well suited to asset-based approaches given the iterative and collaborative nature of the process, which involves aspects of systems and complexity thinking.
Our proposition for as Theory of Change toward asset based practice has four key stages
• reframing towards assets
• recognising assets
• mobilising assets
• co-producing assets and outcomes
The stages are not linear, but may be ordered to suit the particular situation and context of the initiative.
In the context of your blog and in response to your challenge to move asset-based approaches, indeed all forms of community work, into mainstream action we suggest we are still in the early days of Stage 1. The reframing of thinking is an obvious but critical stage in the move toward asset-based working.
Understanding how the public health system contributes to such activity is vital – is it to be a joint participant in local place based action? A commissioner of system development? It’s the inside-out or outside-in perspective that is part of the real politic of this agenda.
Reframing can signal a shift in practice culture towards an asset-based model and is a significant step. In our case-study research reframing towards assets was mostly described as an explicit activity or event in teams, groups and organisations. Often the reframing is a systemic action. Against this backdrop, current practice and priorities can be reassessed and new outcomes defined.
Whatever the trigger for the rethink, or the scale of the change envisaged, the first challenge is to change the culture.
Reflecting the values and principles of asset-based working we are growing this approach from the inside out at project and locality level. We would contend that it is too soon for this to be mainstreamed.
“Changing to an asset-based approach offers and creates a new relational perspective. It is not a set of tools or techniques that can be applied without a change in organisational culture and individual practice. It must be a process, not a top-down plan.”
(‘Head, hands and heart’ p.23)
What do you think?