Early intervention generally and more specifically Strength to Strength;
Adverse Childhood Experiences (ACE’s) what these mean for strength to strength and service provision more broadly;
The Icelandic model and how this could inform future service delivery within an NI context;
The importance of cross-sector partnership, collaboration and sharing of resources to promote equality between service providers and increase potential outcomes for people who use the services.
This chapter will seek to explore Early Intervention generally and then, in particular, within the Extern, Strength to Strength (S2S) programme (Strength to Strength Manual; Extern 2017). It will consider how this programme has developed over its lifespan, moving from individual client work to systemic, holistic support. This move has led us to consider how systemic practice could and should be considered more broadly. The chapter refers to the Icelandic Model (Sigfusdottir, et al., 2008) as a consideration of what works at a macro level and Strength to Strength’s model being used as a successful programme at a micro level.
The work seeks to explore how services can make use of a systemic approach (Stratton, 2005) at practice, policy and provision level, locally and nationally. It considers the need for all service providers to be skilled within their discipline but also have self-awareness and be attuned as to where they fit within the continuum of care and how these interlink. ACE’s (Bellis, 2014) have been used as a way of exemplifying this. Referring to a practice example, this chapter will consider how S2S fits with social work practice and how it aligns with the Social Work Strategy (DHSSPSNI, 2017). It sets out key components for social well-being, namely ‘Relationships and Belonging, Independence and Responsibility, Purpose and Meaning and Safe and Well’ (DHSSPSNI, 2017).
Strength to Strength is an early intervention service aimed at the prevention of offending. The team work with 8-13 year olds and their families to reduce or eliminate issues which may lead to poor long- term outcomes for service users. It is evident even from the project name that we do not focus solely on offending. Our referral pathway identifies young people experiencing difficulties within at least two of three domains: Home, School and Community. Experience gained by utilising the S2S approach has shown that for effective change for young people we must engage with families. Over time we have developed Education components and incorporated Family Therapy to better meet the needs of service users and families. More recently community support has become more prevalent due to the presenting needs of young people and their families.
Early intervention is about taking action as soon as possible to address problems for children and families before they become problematic. It involves identifying children and families that may be at risk and providing timely and effective support (www.eif.org.uk, 2017). Within Northern Ireland, legislation and policy drivers for early intervention have included: ‘Our Children and Young People – Our Pledge’: 2006-2016 (Minister, 2006), Co-operating to Safeguard guidance (Department of Health, 2006), UNOCINI guidance and the UNOCINI threshold guidance (Department of Health, 2006), The UN Convention on the Rights of the Child (UNICEF, 2008), The Children (NI) Order 1995, the Human Rights Act (1998) and the European Convention on Human Rights are some of the key legislative frameworks which have helped shape policy and service provisions within the current context. These policy and legislative documents highlight factors that may contribute to young people and their families requiring service involvement and that prevention and early intervention (Pau Garcia, 2018) are integral to best outcomes for all. Early intervention (Lynn, 2004) is not only about work in early years but also about preventing adolescents and young adults from experiencing problems/difficulties.
Literature highlights the impact of adverse experiences in childhood, such as bereavement, violence, sexual assault and bullying which can result in leading to issues in adolescence and adulthood (Alysse, 2017).
Evidence from Wales and Northern Ireland, has shown association in childhood adversities leading to health- harming behaviours, poor mental health and chronic health conditions such as cancer, diabetes and respiratory disease across the life span. Internationally, (Felitti, 2003) as well as (www.cdc.gov, 2016) research, strongly implicates Adverse Childhood Experiences or childhood traumas in the ten leading causes of death in the United States. Anda (www.cdc.gov, 2016). A lead researcher from Centre for Disease Control and Prevention (CDC),argue that ACEs are distressingly common with the impact of seen in healthcare but also within business, linked to employee absence, homelessness and criminal justice.
Therefore ACEs are likely to be costing society untold millions financially and through taxation. The Public Health Wales (2016) study on ACEs and their association with disease and health service use, found that for every 100 adults in Wales, 47 had suffered at least one ACE while 14 had suffered four or more (Watson, et al., 2005). Studies such as (Davidson, et al., 2010) (Watson, et al., 2005) show that there is still significant research to be done on the range of adverse childhood experiences and how these may impact individuals through the life span.
The CDC (2017) outline that a combination of individual, relational, community and societal factors can raise the risk of children being neglected and/or abused (www.cdc.gov, 2016). Children are not responsible for the harm they experience however, certain characteristics which have been found to increase risk including: lack of awareness of the child’s needs, child development and parenting skills; parental history of maltreatment in childhood; parental substance use and/or mental health, parental age; low educational attainment and deprivation (Felitti, 2003). Also, non-biological issues such as transient caregivers, parental thoughts and emotions that justify maltreatment and/or lack of awareness of own emotions. Family risk factors include social isolation, violence, family disorganisation and/or separation, parental stress and poor child-parent relationships and negative attitudes/interactions. Community factors include deprivation, residential instability, unemployment, poor living conditions and community violence.
The evidence has led to an acceptance of the influence of family life on a child’s development whilst peers and wider community, societal influences become increasingly important during middle childhood and adolescence (Parke & Buriel, 1998). Social Ecology Theory helps contextualise this, while similar in many respects to Systems Theory, has a broader focus (Bronfenbrenner, 1979). Bronfenbrenner (1979) uses Russian dolls as an analogy for the set of structures, each one inside the next to help explain how each system and sub-system impacts a child / person even when the influences are not directly in contact with that child / person. Each person’s environment is unique, and each person’s development can be deeply affected by events happening in settings where they aren’t even present.
Early intervention has become increasingly recognised as the means of decreasing or eliminating the longer-term impact of childhood adversity and family, peer, community and societal issues. Research (Karoly, et al., 2007) (Feinstein, 2015) (Gosling & Khor, 2010) suggests that early interventions can improve academic attainment, behaviours, labour market success and reduce crime and delinquency. The benefits can be social, economic and fiscal, and can result in short-term immediate impacts as well as long term outcomes. Although there is a wealth of research on Early Intervention, much of this is focused on early infancy (0-5 years) and has particular focus, for example school-based support such as English as an Additional Language (EAL). Much of the service provision is targeted at either children or the parents, and addresses specific areas of need, for example, health and wellbeing, education and behaviours. Evidence (Gosling & Khor, 2010) (Karoly, et al., 2007) and (Canavan, 2016) suggests that outcomes are stronger when support is offered to all within the family and/or community system. There is a gap in the research for the age group of 6-14 years old who could be impacted by adverse childhood experiences and therefore should be a meaningfully targeted group for early intervention service provision.
Attention must be paid to the fact that with age, a child becomes more likely to have been exposed to more than one ACE. Statistics from the Mental Health Foundation (2016) suggest that more than half of all lifespan cases of mental illness begin by age 14, whilst evidence also suggests that the average age of the onset of anxiety disorders and impulsive control disorders is 11 years old. Walker & Akister (2004) suggest that most individuals have significant others whom they can relate to.
We now know, that despite the risks, where there is an increase in protective factors (Vanderbilt- Adriance, 2008) across systems, outcomes do improve. For instance, during late childhood/early adolescence risks are associated with the home, so warmth and parental consistency is important. However, during mid-to-late adolescence, risks are in the community, so monitoring and peer relationships become much more important.
A good example of collaboration across disciplines and professions comes from Iceland where action was taken to address adolescent substances use. From this, the Substance Use Prevention for Adolescents: the Icelandic Model was established. (Sigfusdottir, et al., 2008) The model is an evidence-based approach which has grown out of a collaboration between policy-makers, behavioural scientists, field-based practitioners and community residents in Iceland. The model focuses on the reduction of risk factors linked to substance misuse whilst strengthening a broad range of parental, school and community protective factors. Although focused on reduction of substance use this model can be applied to a wide range of emergent health issues. Recently, representatives from Iceland visited Northern Ireland to discuss this model, the Public Health Agency (PHA) welcomed their insight and recognised it was a cross-sectoral, systematic approach to tackling substance misuse which is consistent with Northern Ireland’s draft programme for government (PHA, 2017).
Northern Ireland provides a unique context for addressing social issues with religious and cultural divisions still present in society and amongst policy makers. These parties/cultural groups play a significant role in influencing all aspects of life within Northern Ireland. Durkheim (1857-1917) argued that society is seen as being made up of inter-related parts which form a system. One cannot begin to understand the differing individual parts without considering them in relation to the functions of the entire society. Evidence shows that religious background and geographical location impact on the levels of wealth or deprivation experienced (McCaffery, 2013) (NISRA, 2016; HSCNI, 2011).
S2S typically works with young people experiencing behavioural difficulties, problems at school, poor interaction with peers and who have missed a significant amounts of education. The interventions we employ with young people and their families are:
* Thematic individual work which includes topics for study or discussion informed by referral information. Methods include: creative arts, activities, narrative sessions (storytelling, deconstruction), and evidence-based worksheets suited to age and stage, and CBT approaches.
* Pro–social activities promoting positive behaviours for example: in their community activities such as litter picking/volunteering or attending local youth and community groups. We also consider longer-term community support, so would engage young people in local physical activity groups (walking/boxing/running etc.). Activities that can promote independence such as baking and cooking, creating a shopping list and budgeting gives a sense of ownership and develops resilience through modelling positive lifestyle choices.
* Educational support for young people and parents is provided through regular ASDAN (ASDAN, 1997) accredited courses enabling the young people to complete a 12-week educational programme. Where there are identified educational needs the education worker will link with the family and the school to provide additional educational interventions including homework guidance and structure, advocacy in securing additional support in school and working alongside educational psychology.
* Family Therapy, focusing on family relationships. For a significantly high proportion of the families referred, relationships and communication can be strained. It can be evident that experiences relating to the parents’ own histories often have an impact on their parenting capacity and therefore outcomes for the young person. Family Therapy or Family and Systemic Psychotherapy helps people in a close relationship to support each other. It enables them to explore and express difficult thoughts and emotions safely, and to understand each other’s experience and views. It encourages building on strengths and finding a way forward by making useful changes in their relationships and their lives. We find that many parents don’t want to talk about past traumas etc. due to fear of the negative impact this may have. However, building the relationships we do in S2S encourages families to discuss past experiences. At times, these will be managed through family therapy sessions; alternatively we will signpost parents individually or as a couple for more long-term support provided by other agencies. Keyworkers will attend and participate in all family therapy sessions along with a qualified Family Therapist provided through our partner agency Ascert.
* Group workshops. We run tailored group sessions exploring topics with guest speakers, including the police and community members. More recently, we delivered parenting groups when need is identified. Group work can be an extremely powerful tool when supporting parents and young people as it gives them an opportunity in a safe space to discuss issues knowing that others in the group understand. They can learn positive coping strategies from others as well as the staff providing information and support.
*Promoting positive peer interactions. A high number of young people engaging in S2S struggle in group settings and find it difficult to make friends. We make use of group activities to help them develop skills in a safe and protected environment. Usually group activities will involve team work which helps the young people to learn new skills. Further to this we have family activities and family group activities.
The S2S role commences with discussion with parents, then ‘individual getting to know’ the young person sessions. Outcomes Stars are then completed with parents and with the young person. Once this is completed, and a relationship had been established, the worker gathers the whole family to work on a ‘S2S family plan’. The family plan is a significant and vital part of the journey, and staff must employ a number of specialised skills to ensure this is effective, as it can be a challenging and emotive time for the family. The family agree the plan, and select areas of priority which will immediately effect change.
We strive to consider all strengths and challenges in context and seek to understand and in doing so we create an environment for exploration and consideration. We identify that key to this is building relationship, having a strong knowledge base, and being clear from the outset about our involvement, boundaries and referring back to the ‘family plan’. This empowers families to identify and more easily accept where change is needed. We have found within S2S that without this ethos and approach we would struggle to engage fully with families and communities. By considering many ideas around the same issue, it supports us to not engage in a reactive response.
Research by Alysse (2017) suggests, parents especially those that experienced ACEs, require appropriate interventions to ensure that this does not increase the risk of their children being subject to adverse childhood experiences. All this would suggest that work with children and their families within this age range is imperative to reducing or eliminating the likelihood of perpetuating ACEs in an attempt to break the cycle of adversity. (Ellis, 2017) Identified that a higher prevalence of poverty, unemployment, and food insecurity led to higher levels of social vulnerability and lower levels of community resilience. As such (Ellis, 2017) suggests that child health systems need to take a life course, intergenerational approach which places child care/welfare within the context of their family and community. The changes we have made within our programme over its lifespan have enabled us to consider the young person within the wider familial and social context.
A significant number of the young people referred to S2S are working towards transition from primary to post-primary or have recently made this transition and identify stress and pressure associated with as particular challenges. Our experience in S2S mirrors research findings linking to the onset of mental health issues with the impact of transitions for young people (Resilience Treatment centre, 2000) (Mandemakers, 2018). We have observed a correlation between anxiety/depression linked to transition and examination pressures. This is not currently recognised as an ACE; however, along with the more widely-accepted ACEs such as neglect, abuse, violence etc. transitions and examinations can act as a significant trigger. Further to this, as (Parke & Buriel, 1998) highlighted family, community and peers are beginning to have more of an influence. (Davidson, et al., 2010) Suggested, there may currently be limitations to the range of ACEs, an example from our experience is the experience of death of a grandparent. Grandparents tend to play significant roles in the lives of some young people and can be the primary care giver. This only goes further to highlight the importance of early Intervention and further research and understanding of the experiences of the age group S2S works with.
The current child safeguarding policy (Health, 2017) as well as (Canavan, 2016) outline the Hardiker model of safeguarding activity and how this should inform service delivery. The Hardiker levels suggest that Level One provision is open access support in health promotion and information whilst Level Four is where significant government involvement is required, which could potentially lead to the removal of the children from the family home (Canavan, 2016) and (Health, 2017). S2S has considered these and adapted a referral pathway to ensure access for all. Further to this, they have adopted the Outcomes Star tool as a way to manage and assess need/risk based on the Hardiker levels. (Canavan, 2016) Suggests that family support policy should be about protection from harm as well as promoting wellbeing and development. S2S service delivery reflects this view and see it as interlinked with the ‘Safe and well’ and ‘Independence and Responsibility’ aspects of the Social Work Strategy (DHSSPSNI, 2017). Canavan (2016) suggests that family support (Level 1) should be available to all and support offered should be able to transcend the levels. This can be difficult as services are usually funded and mandated to work within certain levels. It would be helpful for researchers, policy makers, service users, and providers to develop the concepts expressed by (Canavan, 2016) further and adapt policy and service provision to incorporate the fluidity envisaged in the work. The Icelandic model (Sigfusdottir, et al., 2008) could be used as way of developing this concept further as it is clear that they have a more developed understanding of the application this of model intervention.
S2S was developed in response to research which highlighted the significant numbers of younger children being brought to police attention for activities that would constitute an offence in older children. Leading in the field of early intervention, the project has adapted its approach to strive for best outcomes. Initially the project aimed to work with young people to redirect them from offending which was time-limited. However, over time it was evidenced that a more holistic approach would bring about more lasting changes. This has been supported extensively in the literature (Gosling & Khor, 2010) (Karoly, et al., 2007) (www.cdc.gov, 2016) (Walker & Akister, 2004).
S2S has developed a holistic strengths-based programme of support and increased service delivery for working with young person and their families, in their home, community and school settings. This is directly in line with the concepts of family support discussed by (Canavan, 2016) and on a much smaller scale the Icelandic model (Sigfusdottir, et al., 2008). These changes would not have been possible without open dialogue between participants, partners and funders evidencing the importance of flexibility and reflection as Canavan (2016) suggests, as well as partnership/collaborative working.
S2S seeks to:
Work in partnership with children, young people and their family in order to build upon existing strengths.
Empower and enable parents and carers to reduce the risk
Strengthen the capacity of parents/carers to parent effectively
Build on protective factors and reducing risk.
Build family strength and resilience.
Strengthen relationships and enhance communication/self-awareness/understanding of one another and empathy.
Increase emotional wellbeing/emotional regulation and identifying emotions.
Improve educational attainment/attendance and engagement.
Link families, children and young people to pro-social activities, projects and initiatives.
Increase multi-agency communication and cooperation.
Achieving these objectives requires intensive engagement with the parents /carers and young people. It requires ongoing communication with the formal and informal support services within the family’s ecology. S2S works to ensure that parents/carers have the skills, supports and strategies that enable them to effectively manage the daily challenges they face, while reducing or eliminating the need to rely on statutory intervention. It is imperative then that S2S fully embraces the concepts laid out by the Hardiker levels in accessing and moving between levels which cannot occur without partnership working.
S2S has been involved and continues to be involved in the step up/step down procedures, community forums and family support hubs. We are aware of challenges with this and believe more could be done to encourage and support true partnership working. The health, education, social care and criminal justice services need to synchronise their efforts. Further to this, if government departments actively worked together on policy there would be a clearer focus and more accurate targeting of services which could lead to avoidance of duplication as well as becoming more cost effective. This continues to be an issue identified across the sector and is something that should be considered more extensively going forward. If we consider the (Sigfusdottir, et al., 2008) Icelandic model, partnership working across departments, service delivery, service evaluation are the fundamental reasons for its success. Therefore it is imperative going forward that our society begins to establish these same shared visions, maybe even more so given our difficult, contentious past.
Systemic Practice embodies many of the core social work characteristics which ensure effective practice including relationship building, strength-based practice, systems thinking, collaboration and being evidence-informed. These concepts are reflected in the S2S model and additional training would be beneficial for driving this forward in practice. This is a challenge for the sector as funding for accessing specialist programmes that would enhance the knowledge and skills of social workers is not readily available.
This brings us back to previous considerations about service provision and partnerships and the cross-departmental nature of our role. All services, whether statutory, voluntary, community, faith-based or private, play a role in the overall support network and must begin to consider more equal access for all in relation to funding, training and delivery. The Icelandic Model (Sigfusdottir, et al., 2008) prioritises multi-agency/cross-sectoral partnerships which has ultimately led to its success. The Social Work Strategy clearly identifies the importance of collaboration and co-production as key characteristics of effective social work practice. As such the considerations highlighted by the Icelandic Model typify effective and responsive social work practice.
Given that many of the families S2S works with have had extensive trauma and exposure to ACEs, our work mainly focuses on the Safe and Well component of the Social Wellbeing quadrant (DHSSPSNI, 2017) however given the systemic, holistic approach adopted by S2S, the work usually will have a ripple effect into all other quadrants. This is apparent in the Icelandic model, which was specifically focused to reduce alcohol and drug use, it has had an impact not only in this area but in health and wellbeing, education and training and independence. Meaning work on one quadrant has also had an impact on the other areas contained in the Social Work Strategy (DHSSPSNI, 2017). The same should be considered within NI.
The developments over the last 8+ years have seen this project initially focus on the ‘prevention of offending’ and predominantly child-based interventions, through reflection and data interpretation. However, the project now fully endorses a systemic, whole family approach not focused entirely on the risk of offending but also on the impact of childhood adversity on adolescence and adulthood which may include offending. Considering this, the service should become even more accessible and, in turn, more funding to meet the needs should be considered, most notably cross-departmental funding for such projects should be considered given the evidenced impact of ACEs across the lifespan on health and wellbeing.
The primary goal of working from a strength-based perspective is to maximise the strengths and minimise risks whether the service user is an individual, group or community. At the core of this perspective is empowerment. It seeks to promote the service user as resourceful and resilient in the face of adversity. Laursen (2003) and Nissen (2006) noted that in the field of Youth justice, the mainstream model focuses on risks and addresses weaknesses. Alternatively, the strengths model builds on characteristics already present and enhances strengths.
On an individual level, a strength-based approach can improve outcomes such as quality of life, employment and health. On a cultural level the approach promotes positive views of individuals and takes the focus away from blame or judgement. It is imperative to acknowledge that the practices of empowerment, strength based approaches, resiliency and being non-judgemental which Strength to Strength has adopted are also core social work values (BASW, 2012).
The significant changes and developments which have been taken within the early intervention programme and the understanding of the potential impact has led Extern to manualise programme delivery of the S2S project. This is a framework which could and should be replicated particularly, as our project has been evidenced to support with not only prevention of offending, but also parental skills development, reducing negative coping strategies, school attainment and community involvement. All theoretical models used in S2S need to be proven to be effective and commensurate with the aims of S2S in that it needs to complement the strengths-based systemic/ecological focus on which the model is based.
This programme was commissioned at the early phases of partnership and collaborative working with the introduction of Children and Young Peoples Committees (CYCP) and the NI Children’s Strategy – Our Children and Young People- Our pledge (2006), and in the time from this shift in ethos was conceived, to date, It has developed in collaboration and shared/partnership working. However, S2S’s model for a systemic, holistic, interagency framework for working should be considered more broadly.
More needs to be done to eliminate the fragmentation of services at both a local and national level. Although services can work collaboratively, issues linked to competitive funding bids and decision- making relating to sector or governmental policy provision continues to lead to fragmented service provision. Larkin (2015) highlights that policy and service provision trends can be allocated in such a way that funding streams can create fragmented service delivery systems and can set limitations to services effectively or collaboratively working together. Unfortunately, this can have a devastating effect on the services users/clients most requiring the services.
S2S developed the ‘Family Plan’ (Extern, 2017) as an innovative way of working with families to identify strengths and goals. It is used in conjunction with The Three Houses model (Weld, 2008) (Turnell, 1999). These tools have been integral to our role for a significant timeframe and we can see the benefits of employing such tools. The Three Houses comes from ‘Signs of Safety’ (Turnell, 1990) which developed as a strength-based approach in Child Protection. ‘Signs of Safety’ (Turnell, 1999) has been used throughout different parts of the world and is now being rolled out regionally throughout Northern Ireland. This evidences the progressiveness within Extern and more specifically within the S2S project. The HSC Trusts now use of the ACEs assessment tool as part of the ‘Signs of Safety’ implementation. Furthermore, they have worked with the creators to have ‘the conflict’ here added, which has been approved by the creators. It is imperative that models that have been evidenced to work are shared throughout the different agencies. It further cements the idea that research, evidence, collaboration and consistency are key to effective practices throughout social work. Both ACEs and the ‘Signs of Safety’ ethos have been developed over many years and need to be driven forward, which can be challenging in the current political climate.
The social work training and post qualifying development requires social workers to build skills in risk analysis and management, evaluation, critical analysis and innovation, all whilst working in the context of uncertainty, conflict and contradiction. The support offered by Strength to Strength can be transformative and by no means should be undervalued. Given the age range we work within, this service provides an opportunity to reduce, if not remove, long-term service requirement for these families (Bellis, 2014) (Ellis, 2017).
Reflection on the service/Practice
Strength to Strength, although small in scale, has considered and developed the concepts of systemic, holistic early intervention over a significant period and found these to be at the core of ‘what works’ in practice. The challenge, however, is having these same principles applied not only when working with service users but as organisations whether that be governmental, statutory, voluntary, private, community and or educational. The core characteristics of social work are that of partnership working, consideration of the whole person, social justice, flexible, knowledge-informed and evidence-based. We need to translate the way work with service users into more collaborative, relationship based practices across sectors and organisations. As mentioned previously, the Icelandic model used all departments to become involved to see overall change. The Icelandic Model provides us with a basis for this.
Considering the impact Adverse Childhood Experiences can have over the life span, having services dedicated to building resiliency, reducing risk and encouraging community, educational and family engagement are pivotal to the overall strategy for NI. Strength to Strength services work in a systemic, holistic way which following two positive evaluations evidences its effectiveness, although more research is required on the longitudinal impact as well as the range of ACEs. However, this cannot be done without responsive policies, service provision and cross department holistic engagement and more equality to access to funding and developmental models.
The history and the underpinning values of social work propose that we should become real vehicles for change. Working from a health and social care perspective to improve life chances, change the narrative within NI and become champions for Early Intervention, trauma informed interventions and service provision at each Hardiker level identifying the vertical and horizontal connections and providing multi-agency provision which embraces and embodies this.
Early intervention is not just for early years there should be early intervention supports offered throughout the lifespan which is cognisant of the impact of ACEs. There is significant work required in the area of early intervention outside of early years. Further research and development on the longitudinal impact of intervention is required. Although a barrier to this could be that of data protection and information sharing as laid out in recent GDPR legislation (Data protection Order , 2018). Therefore there is the potential for policy to address these issues.
ACEs have an impact through the lifespan, however social work and the Social Work Strategy (DHSSPSNI, 2017) are a cornerstone for improving overall outcomes for young people and adults impacted by ACEs. The evidence has highlighted that ACEs can impact all aspects of life - mental health, well-being, education, employment and health. Therefore, any move towards tackling the adverse impact of ACEs will take time, planning, collaboration, co-production and a cross-departmental strategy.
Delivering Evidenced informed practice has been highlighted not only within the Social Strategy (DHSSPSNI, 2017) but also within the Codes of Practice (NISCC, 2015) and throughout literature. It is imperative then that we begin to identify, research and, where possible, evidence practice that is seen to effect change. Systemic practice, strength-based, early intervention are all evidence-based and are present within the Social Work Strategy. These need to be considered more widely and developed further throughout Social Work and across departments. Both the Icelandic model and our own Strength to Strength Model go in some way of showing the significance of outcomes if these are considered and implemented into the foundations of practice.
Northern Ireland, through its history has shown that more ACEs may need to be considered. ACEs assessments within Northern Ireland include the impact of ‘the conflict’. Therefore, there is potential for more research into further ACEs. Also, given that Northern Ireland does have such a unique past which still can be seen so evidently today, a whole systems approach of that Icelandic Model may be what is needed to reduce or even remove the longstanding impact of its history.
As social workers we should aim for the same characteristics for our profession as we do for our service users. Collaboration, co-production, strength-based, evidence-based methods and processes should seek to embody these, with more cross-departmental support, better access to training and development for all.
Over the years S2S has developed through learning from what has worked and what hasn’t. It developed into a robust service and has used evidence informed practice throughout. Although on a much smaller scale, this project has seen the positive impact of collaboration, systemic practice and person-centred planning or whole family planning. It is this knowledge that has led us to the belief that there is something to be learned from the Icelandic Model. If practiced effectively and with cross departmental support and innovative funding streams such as those adopted within Iceland, Northern Ireland has the potential to further develop the concept, to promote the model within a Northern Ireland context.
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