October 2017
Welcome to the ebulletin Welcome to the October issue of Public Health Network Cymru’s e-bulletin. The theme this month is Homelessness. Homelessness is the condition of people without a permanent dwelling, such as a house or apartment. People who are homeless are most often unable to acquire and maintain regular, safe, secure and adequate housing. You don’t have to be living on the street to be homeless. You may be sleeping on a friend’s sofa, staying in a hostel, or living in overcrowded or unsuitable accommodation Shelter Cymru, 2017. There are many interesting articles in this month’s bulletin and lots of resources relating to our chosen topic in the Network’s resource database. Thank you to everyone who contributed to the Public Health Network Cymru Evaluation Survey which closed on 1 October 2017. We received a large number of responses. We are pleased to announce that the winners of the £25 amazon vouchers are Glenn Little from Aneurin Bevan Public Health Team and Jason Celia at Hafal. We have also been running a poll to define the Network’s Seminar Programme for 2018. This closed on 6 October 2017. We will publish the results of this survey shortly. We are currently in the process of planning a Dementia Seminar which will take place in December 2017. Details of this event can be found in the bulletin and will be disseminated to all Network members. Please get in touch with any information you would like to include on the website or e-bulletin by contacting us at publichealth.network@wales.nhs.uk
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Homelessness
Spotlight on Homelessness People become homeless for lots of different reasons. There are social causes of homelessness, such as a lack of affordable housing, poverty and unemployment; and life events which cause individuals to become homeless. -People can become homeless when they leave prison, care or the army with no home to go to. Many homeless women have escaped a violent relationship. Many people become homeless because they can no longer afford the rent. And for many, life events like a relationship breaking down, losing a job, mental or physical health problems, or substance misuse can be the trigger. Being homeless can in turn make many of these problems even harder to resolve. https://www.crisis. org.uk/ending-homelessness/abouthomelessness/
Street Football Wales and the Homeless World Cup: The power of football - Charlotte Pitt, Volunteer at Gibran AFC and Researcher at Swansea University and Wales Probation Service In 2003, whilst working for The Big Issue Cymru, Keri Harris was tasked with getting a team of homeless people to represent Wales at the inaugural Homeless World Cup (HWC). Keri realised that Wales needed a programme that offered social inclusion through sport. Here, Street Football Wales (SFW) was born: a charity using football as a tool to engage with some of the most disadvantaged people in society. Since then SFW, now hosted by POBL group, has grown tremendously. They continue to run leagues throughout South Wales, hosting monthly match days and training for those who have faced social exclusion including mental health problems, those who have been through the criminal justice system, with a large proportion having experienced homelessness. As a volunteer for Gibran AFC, I manage a team who compete in the SFW South-West league and have been struck by the real impact that it has. From someone who has played and watched mainstream football all my life, it has been refreshing to see the degree of respect players show to each other and to referees. SFW offers flexibility and provides consistency to many who have been let down by the system. Through a network of positive relationships, SFW has created a community and to many, a second family. Wales in the Homeless World Cup Throughout the season, SFW coaches scout players for the HWC with an emphasis on those who show commitment and sportsmanship. This prestigious opportunity has a profound impact and has given individuals the chance to represent not only their country but also homeless people across the world. It has enabled them to build resilience, sharing the wins and the losses. For those who have never been abroad, never been given the chance to showcase their talents, this is a once in a lifetime opportunity and one they grab with both hands! Oslo 2017 Homeless World Cup: 15th Edition
‘72 teams, 54 countries with one common ground: Homelessness’ Only a couple of months ago, 500+ players travelled to Oslo and competed in what was one of the biggest HWC tournaments yet. The Welsh squad did the badge proud with the Men finishing 3rd in their group and the Women bringing the Cobana Bowl home!
Wearing the Welsh shirt with pride in Oslo: The Warriors and the Dragons along with staff, volunteers and supporters, including SFW Patron, Michael Sheen
“Since being involved at Gibran and SFW my confidence has increased massively. I’m doing things now that I never thought I would. Getting called up to represent Wales has been one of the best moments of our lives. It’s made me very proud of myself” Dai - Gibran AFC and the Welsh Dragon Tackling Homelessness Homelessness in Wales is on the rise having increased by 57% since last year and set to continue, according to research. Homelessness is after all a reflection of how society cares for it’s most vulnerable people and so it is crucial that we all step up. SFW and the HWC offer a unique solution to the complexities of homelessness. Many people involved have gone through life having felt ostracised and worthless. The use of football has completely turned this on its head: building self-worth and allowing them to see that anything is possible, nothing is out of reach. It really is much more than just a game; it has proved to be a lifeline for hundreds of people.
“Football’s really helped me to get some stability back in my life... I’ve turned my life around. I don’t get into any trouble anymore with drugs or alcohol. I’m now going home clean to my three children.” Dee - Solas Cymru, KSB and the Welsh Warriors What next? SFW are bidding to host the Homeless World Cup in the near future. Soon we could see players from over 50 countries travel to Cardiff competing for the trophies on offer - Watch this space and get behind Wales! Contact details: 01792 572950 www.streetfootballwales.com https://homelessworldcup.org/
Connect & share us via twitter! @sfootballwales @homelesswrldcup
Researching Support Services for People Leaving Prison in North Wales In late 2016, the North Wales Supporting People Regional Collaborative Committee (which covers the 6 local authorities in North Wales), commissioned a small piece of research to look at support services available for people leaving prison. The research was undertaken by Caroline Humphreys and Tamsin Stirling. It took place between January and April 2017 and comprised four main elements: • • • •
investigation of published data and plans from relevant agencies a series of questionnaires and data requests to local authorities and support providers workshops, discussions and interviews, including with 16 service users a websearch for relevant research and practice examples
Although the research was commissioned by the Supporting People RCC, given the topic, there was a clear interface with homelessness/housing options services within the local authorities and third sector organisations providing services to people who are homeless or have experienced homelessness. These teams and organisations were included within the scope of the research.
Some of the main findings were that: • the provision of housing and support is an important part of reducing reoffending (as well as preventing homelessness).The housing and support need to be appropriate and housing/support need to be provided alongside other services in order to meet the needs of individuals leaving prison • there is a range of accommodation and support across the six authorities that can be used to house people leaving prison, including a small amount of accommodation specifically aimed at people leaving prison/ offenders. Despite this, the most commonly used form of accommodation for people leaving prison is bed and breakfast • in general, the use of supported housing and social housing with floating support is lower than might be expected given the availability of accommodation and support reported during the research • leaving prison is a crucial point and the right input at this time and effective pick up from the gate has the potential to contribute significantly to the prevention of unsatisfactory outcomes including homelessness • in focusing on the housing and support solutions that are needed for the range of needs presented by people leaving prison, partnership working will be central to ensuring these are effective; the engagement and input of health (mental health) , criminal justice and strategic housing is vital. The research report sets out a suggested way forward for the 6 authorities with shorter-term and longer-term agendas differentiated. Recommendations are set out in two main areas. Firstly, improving the process when people leave prison and secondly, getting the accommodation and support right, with recommendations about supply, matching of individuals to what is available and timing issues. Unsurprisingly, partnership working is a significant theme in the recommendations. To quote the report:
‘It is well evidenced that housing alone is not sufficient to address all the needs of the vast majority of people leaving prison. In order to respond to the depth and scope of the challenge, it will be essential that all the relevant agencies adopt a wrap-around approach, which, to the person leaving prison, feels that there is a community of services available to them that is clear, visible and straightforward to access. This will require ongoing and sustained partnership working between all relevant agencies.’
A supplementary document to the research report includes notes from the service user interviews and the practice examples from the websearch. Both research report and supplementary document are available online http://www.conwy.gov.uk/en/Resident/Housing/Advice-and-Support/Supporting-People/North-WalesRegional-Collaborative-Committee.aspx
ACEs and Homelessness? Tell me something I don’t know Charlotte Waite - Lead for Housing and Homelessness, Cymru Well Wales ACEs Hub
As the ACEs information hits hearts and minds, people and organisations are thinking and getting creative with what to do about it. The next question is usually so what? what does it mean to be ACE informed? Aren’t we doing this anyway? In many Homeless hostels in the UK and in Wales Psychologically Informed Environments (PIEs) have been developing for many years. For me, this model has much to offer the ACEs agenda and as this way of working has already been evaluated it can offer a framework to hit the ground running…. So what is it? Well, at its most basic it all about relationships, how people, given their experiences relate to each other and their worlds. It means environments are informed by psychological theories and frameworks. This could be at any level, from the way in which staff members think about the problems that their service users face, or how risk protocols and policies are written. Right up to the way in which a building is constructed and configured. Psychological theories can help staff understand how they think and feel about the way a person is behaving, which may enable them to be more considered in their reaction. It’s useful to understand how trauma, e.g. in childhood or everyday life, can affect the way people cope with difficult situations, so that staff are less likely
to make judgements about behaviours that are difficult or challenging. Psychological frameworks can also be used to help service users understand, why they may experience strong emotions in reaction to others’ behaviours, possibly then engaging in behaviours of their own which are not helpful to them. Helping people to understand the relationship between perceptions and emotions, and the way in which we cope with those, is vital if we are going to help people transform lives. Understanding how we interact with our environment is equally key to improving people’s lives. The systems that govern the way in which an organisation runs, and therefore the way in which behave, can be thought about from a psychological perspective. For example, how does an eviction policy work? How are threats of eviction understood by a resident? How might they interact with an individual’s negative expectations of the way the world will treat them? Understanding how service users may perceive the implementation of systems may shape that implementation. All of these issues throw up questions, which can be answered through evaluation. We can measure the effectiveness of any interventions we try, by being clear about what we hope or expect to change as a result of what we do. Over time, this data may be useful in indicating whether we should continue or stop a particular intervention. Does it work? Solas Cymru have been running a PIE at their George St hostel for young people leaving care for 3 years. The Impact on Young People: • Psychological and emotional needs are better understood by staff • Fewer warnings issued • Fewer young people reported missing • Reduction in evictions and unplanned departures (None this year!) • Increase in positive outcomes and EET engagement Staff: • More confident at managing young people with complex needs • Less staff sickness, improved well-being and job satisfaction Organisation: • Better outcomes for young people with higher risks/needs • Better teamwork and communication between staff • Improved retention of staff and less turnover
Escape to the Countryside This June, our intrepid residents headed out to the great outdoors to learn how to cook on an open campfire and to make woodland crafts. The Actif Woods Project is based in Merthyr Tydfil and their aim is to get people engaged with their local woodlands to promote the benefits of our Welsh open green spaces which they hope will improve their health and wellbeing. The day was a tremendous success with positive feedback from the clients and the organisers. Our client Hope told us “Being able to have a day out with my friends somewhere different was great” and Nathan said “People were lovely and the project was ‘proper’ creative. Everyone got involved and didn’t need any encouragement to complete the tasks. Cooking the doughnuts from scratch is something I learnt to do and now I can show others!” Our clients thoroughly enjoyed their experience and said that it was great to get away from the town and into the countryside. Beck Fawcett an ActifWoods volunteer wanted us to feedback to the group that “It has been a long time since I have worked with such a respectful and enthusiastic team. They were respectful to the environment, adults and to each other. I was delighted with how well they got involved and their consideration in making cups of tea, carrying equipment and praising each other's effort. Working with this group was a delight.” Anna Stickland who manages the project added that “the group were a pleasure to work with. I had a really nice day and I hope they did too. They were all polite and engaged and I had no concerns with them using tools, being around the fire or using the kelly kettle. There was some mild frustration while learning to use the shave horse but they mainly persevered and dealt with this well and were good at encouraging each other. The accompanying staff seemed to see the benefits of getting the group out and they were very supportive.” We will be working in partnership with ActifWoodsWales in future endeavours for the benefit of our future clients. I would encourage anyone interested in this project to get involved. It’s a great inclusive project as its’ local and free. Places are limited so if you’d like more information or to book places contact Anna Stickland at actifwoodsmerthyr@smallwoods.org.uk or call 07765 213514.
Podcasts
You asked us for podcasts and we listened! Public Health Network Cymru have worked with a number of organisations to produce podcasts which can be downloaded and listened to on the go. All the podcasts are available in the ‘Get Involved’ section of the website. Podcasts pending approval are Going to Hospital with a Learning Disability, Sexual Health and Drink Wise Age Well so keep an ‘ear’ out for these additions.
Shared Practice This month’s project is The Place2Be Cardiff Based in six primary schools in Cardiff, the project supports some 2000 children in some of the more deprived areas of the city. To do this it provides a whole school, integrated, responsive and flexible school-based mental health service; including one-to-one counselling and a self-referral service for children as well as support for teaching and non-teaching school-based staff, parents and carers. The project offers a wide range of interventions, including universal, targeted, individual and group work, to meet children’s and families’ needs. It engages a range of stakeholders (parents, school staff, and staff in other children’s services) in working towards the shared goal of improving children’s mental health and providing support to parents and carers and is embedded in the school system and integrated into the day-to-day life of the school, its staff and pupils. If you would like to add your own project to the Shared Practice Directory there is an easy online form (only accessible to members) and once approved by one of the coordinators your project will then appear on the directory. There is also a Self Assessment Toolkit which can be printed off or completed online and allows coordinators to quality assure the development and delivery of new and existing projects. If you need help completing the toolkit or have any questions please contact one of the coordinators at publichealth.network@wales.nhs.uk
On The Spot This month we have Charlotte Waite on the spot. Charlotte is the Lead for Housing and Homelessness in the Cymru Well Wales ACEs Hub within Public Health Wales.
Where do you currently work and what is your area of expertise?
I am currently seconded in to the Cymru Well Wales ACEs Hub as the lead for Housing and Homelessness. The hub has been set up to help organisations and communities across Wales understand more about ACEs and their impacts as well as what action they can take to become more ACE informed.
This month’s e-bulletin spotlights Homelessness. What do you think are the main challenges facing us in addressing this issue in Wales?
Welfare reform is the biggest challenge by far, these are policy changes from Westminster that are beyond Wales’ control and directly impacting on the steep rise in rough sleepers, the rise in the number of families (with children) in temporary accommodation and the rise in long-term homelessness. The ability of local authorities to respond to increased homelessness is constrained by the limited options they have to house homeless families as there has been a significant reduction in social housing over the past few decades. The private rented sector has not alleviated some of the demand either; private landlord’s willingness to respond to increased demand has been hampered by Housing Benefit caps and Universal Credit, which mean that rent is either unaffordable or the tenant is in rent arrears before their universal credit is administered. Torfaen was one of the first counties in the UK to roll out Universal Credit and Bron Afon, (a large social landlord), reported that on average people are waiting 9-12 weeks for their money to come through, not surprising then that 95% were in rent arrears.
What is the most important message that should be conveyed to professionals and the public around homelessness?
We can’t have failed to see the duvets in doorways and perhaps the explanation card, ‘relationship breakdown’, from those hoping to be seen as human and not a faceless social problems. Much harder to fit on a card would be: domestic violence and abuse; being unable to continue living with family; no accommodation upon release from prison; eviction from social housing and being unable to access social housing due to previous breaches of tenancy; eviction from emergency hostel; rent arrears, low incomes and benefit issues. Or even, as almost every report of homelessness to a local authority sites: mental health problem or even: adverse childhood experiences. These are all the reasons people in Wales become homeless. It’s not true we are all two missed pay checks away from the streets ourselves. Most of us have the resilience, resources and the networks to cope with a challenging time, but if you don’t the system is stacked against you. And there-in lies the problem. ….So we need to DO something, help in some way, give money, give food, give hats, give tents…These are
compassionate gestures meant to alleviate suffering and our own discomfort. But if we continue to concentrate on crisis, we’ll always get crisis. Alleviating crisis does not address the reasons people become homeless and to my mind there-in lies the solution…..we need to work further ‘up-stream’ and get creative about prevention.
Do you think Wales could be doing more to improve homelessness?
Wales is already world leading in its legislative response to homelessness. Under the Housing Wales Act (2014), all Welsh local authorities are now required to work with anyone facing homelessness, whether through family breakdown, rent or mortgage arrears or eviction, and to help all those who actually become homeless, rather than those who reach certain thresholds of priority need. This is recognised as trailblazing legislation, Welsh councils have transformed the way they work by intervening earlier and more creatively to prevent homelessness. The impact of the legislation appears to be positive with more people being prevented from becoming homeless than before though the impact is masked by the increase in people vulnerable to homelessness due to welfare reform. Yet despite huge structural challenges this is so much more like what John Bird, founder of the Big Issue describes as “fences at the top of the cliff and not the ambulances at the bottom”. Of course there’s more to be done, whilst the Act is a step in the right direction we could better equip Housing and Homeless staff and leaders to build resilience and relationships both for those at risk of or already homeless but also with each other. Working with people in desperate need, with complex problems, can be wearing and if we don’t skill and care for our staff to do the job well then the service being delivered is compromised, whatever the Act might say. To build on resilience and relationships we also need to think about timing; to be threatened with homelessness or to be homeless is isolating, frightening, humiliating and stressful, relentlessly so and so it is exhausting. It is in this mental context that we expect problem solving to begin, resources to be found, forms to be completed, pathways to be followed, behaviour contracts and budgets to be kept… “There is nothing in the prospect of a sharp, unceasing battle for the bare necessities of life, to encourage looking ahead, everything to discourage the effort” (Jacob Ribs, How the Other Half Lives)
If you were granted 3 wishes what would they be?
1. To make Psycholically informed ways of working a priorty; 2. To make Housing First a reality in Wales (an approach that offers permanent, affordable housing as quickly as possible for individuals and families experiencing homelessness, and then provides the supportive services and connections to the community-based supports people need to keep their housing and avoid returning to homelessness). 3. To win Strictly with Alijaz
What are your personal interests/hobbies?
Day dreaming (not in work time obvs), trying to keep fit, love a walk, the theatre and a bit of writing, having fun with the kids doing ‘love bomb’ nights where they get to choose entirely what we do and eat, so I’ve enjoyed (!) many a long night playing monopoly, making slime and eating mostly sugar.
The Grapevine This section of the ebulletin is dedicated to news from the network members. You can submit news on the work being undertaken in your area, write us an article, showcase an upcoming project or show off your achievements! If you would like to submit an article for the Grapevine, please email publichealth.network@wales.nhs.uk The article should be no longer than 500 words and pictures are always welcome!
Doorstep to Desk - Encouraging partners to work together to help more children walk or cycle to school
Every child needs to be active every day. However, only 36 per cent of children and young people in Wales achieve the recommended 60 minutes of physical activity every day. Evidence shows that walking and cycling to school is an effective way to build more physical activity into a child’s life. However, figures from the National Survey for Wales indicate that 49 per cent of primary school aged children regularly walk to school; and only 2 per cent regularly cycle to school. We also know that even for journeys of less than half a mile to school 30 per cent of children will be driven. We would like to see children feeling confident and supported to make walking and cycling their first choice for getting around.
That is why Public Health Wales has established a national stakeholder group with representatives from a wide range of organisations. The group is working together on a joint programme of action to increase levels of walking and cycling to school in Wales. Stakeholders collaborated to produce the Doorstep to Desk visual resource and animation. These can be used to encourage partners, local and national agencies, to work together to make small improvements, that will have a big impact across Wales. Parents and children are influenced by many factors when they decide how they are going to get to school, including the physical features of where they live and how it feels to travel through their community. Professionals from diverse sectors, including; planning, housing, transport, police and environment can collectively contribute to creating better spaces which make walking or cycling to school an easier choice. Active travel to school could play a significant part in building a healthier, happier and fairer Wales, as well as contributing towards a lower carbon society, and safer, well-connected communities. How can you contribute to making walking and cycling to school an easier choice? Join the conversation at #DoorstepToDesk
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Run by Place2Be, a leading UK children’s mental health charity.
Suitable for: those interested in
counselling or working with children and young people Place2Be’s Level 2 Award is active,
When: One day per week (Fridays) for
hands-on and highly child-focused.
eight weeks Where: Llandaff North & Gabalfa Hub,
What you will learn:
Gabalfa Avenue, Cardiff, CF14 2HU.
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Counselling skills and theory
Cost: £450
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Techniques to improve
Next steps: Before applying for
communication with children
Place2Be’s Level 2 Award, you will need to
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book a place on our Taster Day to see
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whether the course is right for you.
theory Taster Days: 6th October, 20th October, 20th November 2017 The Level 2 Award also provides a progression route onto further counselling
Level 2 Award: 1st December 2017–9th February 2018
training. For more information or to book a place on our Taster Day, please visit our website www.place2be.org.uk/qualify or contact us: qualify@place2be.org.uk | 0207 923 5558
News Round-Up Welcome to the News Round-Up. Click on the headings of the news item to take you to the full news story on the Public Health Network Cymru Website.
Smoking New figures estimate the number of deaths and hospital admissions caused by smoking
New estimates published by the Public Health Wales Observatory suggest that over 5,000 deaths every year in Wales are attributable to smoking, which is around one in six of all deaths in people aged 35 and over.
Older People Telling the elderly to take it easy ‘a mistake that costs UK billions’
Encouraging older people to take it easy is damaging their health and costing the UK billions in social care, according to experts in ageing.
Mental Health Sleep and Mood in Bipolar Disorder
Evidence suggests that sleep loss, as well as being a core symptom and early warning sign of impending mood episodes in people with bipolar disorder, can also trigger relapse, particularly mania.
Children & Young People 15% Rise in Childline Counselling Sessions About Suicide Last year Childline carried out an average of 62 suicide counselling sessions a day.
Click Here for more news on the Public Health Network Cymru website
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November
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How understanding Adverse Childhood Experiences (ACEs) can help integrated service delivery Webinar Future of Sport 2017: Early Years to Employment London
Could Scottish land reforms come to Wales? Glyndwr University
Young People, Sexuality & the Digital World (new FPA course in Wales) Old Colwyn Mental health and wellbeing in children and young people Cardiff Introduction to Professional Registration for Public Health Practitioners in Wales Events Conwy Business Centre, Llandudno Junction An Introduction to Self-harm and Suicide Conwy
Click Here for more events on the Public Health Network Cymru website
The Health Buzz
Street Link We are a service that enables the public to alert local authorities in England and Wales about rough sleepers in their area. We aim to offer the public a means to act when they see someone sleeping rough, and provide the first step someone can take to ensure people sleeping rough are connected to the local services and support available to them.
Contact Us Capital Quarter 2 Floor 5 Tyndall Street Cardiff CF10 4BZ www.publichealthnetwork.cymru If you have any news or events to contribute to the next edition please submit them to publichealth.network@wales.nhs.uk Deadline for submission is the 3rd Friday of every month.
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