Engaging communities to support integrated health and social care: using asset-based approaches
What are asset-based approaches?
Asset-based approaches can take many forms and are best thought of as a spectrum of options rather than a strict set of rules. This is … determined by what a local area needs … responding to an individual community and its geography, resources, strengths and talents.
NESTA 2020
A strengths-based approach explores, in a collaborative way the entire individual’s abilities and their circumstances rather than making the deficit the focus of the intervention. We should gather a holistic picture of the individual’s life; therefore it is important to engage and work with others (i.e. health professionals, providers, the individual’s own network, etc. with appropriate consent).
DHSC 2019
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.
Explore asset-based places
Why do asset-based approaches matter for integrated care?
Many local partnerships have been growing community-centred approaches by working alongside communities to address the things that matter to their health and wellbeing. These approaches can help to improve access to and effectiveness of services, increase community control and connectedness, take collective action on important issues and build on community assets.
Office for Health Improvement and Disparities 2022
“The legal duties provide a platform to build collaborative and meaningful partnerships that start with people and focus on what really matters to our communities. However, the ambition is for health and care systems to build positive, trusted, and enduring relationships with communities to improve services, support, and outcomes for people.
NHSE 2022
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.
What do asset-based approaches need to succeed?
Our experience of supporting dozens of councils, shows that strengths-based ways of working are only successful when you adopt a whole-place or whole-system approach, involving not just adult social care, but also the NHS, housing, community organisations and local people.
SCIE 2022
Successful implementation depends on maintaining a common vision of what an intervention will achieve and how it will work in practice, continual engagement with the political and organisational leaders of influence, positively addressing the anxieties of existing services and professions, and working with community groups.
IJIC 2021
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.
What is the evidence for outcomes and impact?
It is difficult to draw definitive conclusions about the role and impact of strengths-based approaches as a consequence of the complexity and multi-dimensionality of the models adopted, the vast range of needs the social care system is expected to address, and problems with attribution.
NIHR 2021
Researchers have found that the positive relationship between arts, cultural or heritage attendance and wellbeing exists regardless of where people live. However, people living in hard-pressed communities, deprived and multicultural areas are less likely to engage than those living in wealthier, cosmopolitan or countryside areas.
What Works Centre for Wellbeing 2022
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.