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Engaging communities to support integrated health and social care: using asset-based approaches
Asset-based approaches to integrated care seek to build on existing human, social, cultural, and environmental resources when addressing the challenges and realising the aspirations of a community. Based on co-production, they look to combine formal health and social care services with those of communities and informal networks. Their principles are common to those of ‘strengths-based practice’ in which health and social care professionals take a solution-focussed approach to supporting individual people and their families. Both seek to move away from traditional models of care and support which focus primarily on the deficits (i.e. what is going wrong or missing) of an individual or community and in which answers are seen to lie predominantly with professional expertise and resources.
There are many asset-based approaches being deployed in health, social care, and housing services in the United Kingdom. These include local area co-ordination, asset-based community development, community led support, social prescribing, shared lives, and family group conferencing. Whilst all have distinct features, these share many common elements – starting with what matters to the individual or community, recognising the assets that they already hold, creating solutions through collaboration, and engaging people with respect and equality.
Health care, social care and housing support can play an essential role in people’s lives on a crisis and long-term basis. However, much of what enables someone to have a good quality of life and cope with adversity lies outside the reach of formal services – connections with friends and family, engagement in rewarding activities, feeling safe and valued, and having choice and control over what matters to one’s own life. Integrated care should therefore build on these informal resources and not seek to unnecessarily replace or inadvertently compete with them.
Asset-based approaches work with communities to help them to recognise their informal resources and identify what would help to strengthen these further. This enables health and social care services to understand what their contribution should be and how they can collaborate with local communities so that the most is made from the shared resources. Without such approaches, there is a danger that services will provide an integrated care offer that does not reflect what is most important to people and communities and therefore does not achieve the expected impacts in relation to outcomes and efficiencies.
Asset-based principles should be reflected in the overall vision for health and social care systems and within the local culture of decision-making and resource investment. Senior leaders should seek to reframe the narrative that is used in relation to people and communities – moving from one which emphasises deficits and needs, to one which recognises strengths and assets and the value of co-production. This does not mean that challenges will be avoided, but that addressing these will require a collaborative effort and a willingness to share resources and influence. Whilst designated asset-based approaches such as those listed above can make a substantial contribution, it is important that professionals and organisations across the system engage with strengths-based principles and seek to embed them in their practice.
Voluntary and community sector organisations play an important role in developing individual and community assets. They should therefore be engaged throughout the planning, oversight, and review of integrated care systems. Where such organisations are being commissioned to deliver care or wider support, it is important that this balances the need for accountability for public funding with flexibility to be creative and respond to community interests and resources. Asset-based working recognises that inequalities within society results in communities not having access to the same level of resources and that what matters to communities will differ. Understanding and responding appropriately to this diversity requires sustained engagement based on trust and respect, and a skilled and sufficiently resourced infrastructure.
Research of asset-based approaches is at relatively early stage with much of the evidence being drawn from local evaluations and implementation studies. There are limited examples of longitudinal and comparative research which differentiates sufficiently between approaches and relative contributions to observed impacts. Emerging evidence suggests that there can be positive outcomes in relation to reducing isolation and loneliness and strengthening social networks, and that their adoption can result in more creative and relationally based practice by professionals.
Some studies have reported reductions in health service activities such as admissions to hospital and use of general practice but the evidence is mixed with other studies reporting none or even negative impacts, and the degree of change varying hugely between apparently similar approaches. This confirms the need for further research based on robust methodologies with clarity about the nature of the approach and how this will achieve the expected impacts.
