what works in public health approaches to community safety: early reports
DESCRIPTION
This presentation was given at the National Local Government Association Safer Communities Conference in London on 3rd December 2014 andTRANSCRIPT
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Jim McManus, OCDS, CPsychol, CSci, AFBPsS ,FFPH, FRSPH
Director of Public Health, Hertfordshire County Council
What works in Public Health
Approaches to Community Safety:
Some reports from the Lab
3rd December 2014
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Content
• How we’ve used public health approaches to dealing with community safety issues, eg around preventing violence and abuse
• in the context of ‘what works’ with limited resources for CSPs, how the success of these approaches has been measured (especially where these are financial savings)
• what evidence can be presented to help other areas persuade partners to adopt similar approaches
• your suggestions on how councils can work better with public health colleagues for mutual benefit.
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Step 1
How we’ve used public health approaches to dealing with community safety issues, eg around preventing violence and abuse
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Public Health Approaches
• Analyse population need
• Conceptual framework
• Identify priorities
• Identify effective interventions
• Commission where evidence suggests
• Pilot and test where evidence silent
• Evaluate
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Putting Public Health Principles into action:
Getting to an effective intervention
It’s not just about whether it works per se, but who it works for, in what context and so on
A three dimensional model of intervention, stage of lifecourse, level of intervention and domains of community safety
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Three dimensional approaches to public health
Z Axis : TimeframeShort – long term
Y axis : Level of complexity
EnvironmentalLegal/RegulatorySocialBehaviouralBiological
Adapted from Dettels et al (2009)In Oxford Textbook of Public Health
X axis : Lifecourse Stage
Pre-conceptionInfancyEarly yearsAdolescenceYoung adulthoodAdulthoodMid lifeOlder adulthoodFurther detail on conceptual models can be found in Healthier
Herts: the public health strategy for Hertfordshire 2013-17http://www.hertsdirect.org/docs/pdf/p/phstrat.pdf
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Three dimensional approaches to public health
Z Axis : TimeframeShort – long termWe often miss!
Y axis : Level of complexity
EnvironmentalLegal/RegulatorySocialBehaviouralBiological
Adapted from Dettels et al (2009)In Oxford Textbook of Public Health
X axis : Lifecourse Stage
Pre-conceptionInfancyEarly yearsAdolescenceYoung adulthoodAdulthoodMid lifeOlder adulthood
Further detail on conceptual models can be found in Healthier Herts: the public health strategy for Hertfordshire 2013http://www.hertsdirect.org/docs/pdf/p/phstrat.pdf
Z Axis: Intervent
ionTimefra
me
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Three domains approach to community safety
Control and Enforcement
Prevention and Early Intervention
Treatment, care and support
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Applying the three dimensions to each domain
Time Phase
Short -medium Medium - long
Layer
Biological, Psychological
Societal, Environmental, Legal
Lifecourse Stage
Pre conception Old Age
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Example : conduct disorder
Control and Enforcement
What here?
Prevention and Early Intervention
Good evidence for Parenting skills
Treatment, care and support
And???
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Conduct disorder and Parenting Skills
Time Phase
A short term intervention suggests reasonable medium term gain
What about the longer term?
Which Layer is this
Essential a behavioural and social (family) intervention
What do other layers do? Eg school?
Which Lifecourse Stage?
Parents with chidren up to puberty
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Step 2
in the context of ‘what works’ with limited resources for CSPs, how the success of these approaches has been measured (especially where these are financial savings)
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Drugs
Good Evidence Maintenance
Intervention for domestic abuse perpetrators and
victims
Promising evidence Recovery using multi-method approaches including
forensic and clinical psychology
Drug Courts (Adults/Family not Juvenile)
Piloting and Testing Drug Intervention on arrest in criminal justice
Thriving Families
In the lab
No idea Novel psychoactive substances
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Alcohol
Good Evidence Early intervention
Stabilisation and therapy
Intervention for domestic abuse perpetrators and
victims
Motivational Interviewing in settings
Cardiff Model
Promising evidence Enforcement areas
Piloting and Testing Licensing approaches
High Strength Alcohol approaches
In the lab
No idea
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The promising buys for alcohol/drugs
• Drug and alcohol recovery linked to employment
• Drug testing on arrest PROVIDED fast referral into service
• Suffolk/Ipswich high strength alcohol
• Street drinking and eastern European outreach
• Cardiff model
• The 56 Dean Street model for “chem sex” issues
• Unlikely to be cost effective
• Drug testing parents
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Hate Crime
Good Evidence Reporting
Sensitive intervention
Promising evidence Resilience work
Anti bullying and other multimodal strategies
Piloting and Testing
Uncertain Media campaigns
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Domestic Abuse
Good Evidence Whole systems approaches
Perpetrator programmes
Promising evidence Addressing Drug and alcohol related issues in victims
and perpetrators
Addressing Mental Health issues in victims and
perpetrators
Piloting and Testing
No Idea
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Offender Health
Good Evidence Stabilisation of mental health problems
Stabilisation of drug and alcohol problems
Promising evidence GP registration and in-reach to probation caseloads
Greater Manchester offender health trainers (mixed)
Piloting and Testing Doing this locally now
Data sharing
“In the lab”
No idea
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BeNCH – Beds, Herts, Luton, Northans and
Cambridgeshire Probation and PCCs
• Health programme as part of the work
• DPH for Hertfordshire Jim McManus Board Sponsor
• Short term aims:
• To ensure every offender has access to a GP. On release from prison, through the resettlement process and use of ‘through the gate’ volunteers.
• Cross-BeNCH mapping exercise of mental health services for offenders within their IOM, custody, probation centres, etc
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BeNCH (2)
• Medium term aims:
• Review and extend the Hertfordshire Health Needs Assessment (HNA) of the Probation caseload to include Cambridgeshire, Northamptonshire and Bedfordshire.
• Ensuring each part of BeNCH has offenders included as a distinct population/theme within the relevant JSNA
• Long term aim:
• Information sharing protocol between health and criminal justice organisations, to manage the risk and protect the public from offenders who are violent/predators or high risk MAPPA cases, by improving information sharing between criminal justice agencies and health organisations where appropriate, whilst respecting confidentiality.
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Step 3
what evidence can be presented to help other areas persuade partners to adopt similar approaches
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The problem with evidence (with thanks to Prof Harry
Rutter)
All possible
interventions
Interventions with
evidence of
effectiveness
Interventions with evidence of
effectiveness AND evidence of
cost effectiveness
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Evidence we use...not a rigid system
Published
Evidence
Systematic Reviews
Critical Appraisals of Evidence by PH Team
Outcomes data –
NDTMS, PHOF
frameworks
Outcomes for our drugs services are better than
national average
Return on investment model shows this works
Agency data; A and
E data,
Tracking outcomes from national and other sources
Performance data Service data across systems (E European street
drinking)
Formal Evaluations Not our first option
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Step 4
your suggestions on how councils can work better with public health colleagues for mutual benefit.
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Key steps
• Define the public health role in community safety carefully and clearly (terms of reference)
• Look to see where public health skills and mindset (epidemiological approaches to crime, evidence appraisal) can apply to
• Find a model which works for you
• Joint projects
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Herts as an example
• Herts has a community safety public health team with 1 of them embedded in community safety unit
• Mutual Board seats where relevant
• Mutual projects
• 3 domains model
• Commissioning and Public Health skills courses
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A word about governance
• Agencies all adopting the three domains model
• Strategic Drugs Board – PH/Police Joint Lead
• Strategic DA Board – Police and ? Joint Lead
• Joint Offender Health Working Group
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Setting out our stall clearly
1. Public Health Role Definitions
1. Offender Health
2. Alcohol Hospital Admissions
3. Domestic Abuse
4. Licensing
2. BeNCH offender health Summary
3. BeNCH Offender Health Project Plan
4. Herts Offender Health Plan
5. Offender Health Delivery Group ToR
Simple SMART
statements of
what we will and
wont do
