I qualified as a Speech and Language Therapist in 1991 and worked with children and their families for the next 16 years. I became increasingly frustrated at the daily challenges of making a sufficient impact with the little time and resources I had. When the opportunity came to apply for the post of Flying Start Manager in 2007, I felt that the programme had all the right elements to make a real difference and I leapt at it. The next 14 and a half years were a blur of staff and service development, capital projects and driving our understanding of what worked and how. Whenever it got a bit much, I just had to remind myself of what an antidote the programme was to my earlier frustrations and how privileged I was to be in the driving seat.
The Wellbeing of Future Generations and Social Services and Wellbeing Acts have given organisations in Wales a framework to act in a way that tackles the impact of stigma head on with its emphasis on integration and participation. More recently, the Socio-Economic Duty, standing on the shoulders of years of Poverty legislation also helps organisations to frame their thinking when planning services and resources to ensure that there is equity and parity.
Welsh Government Anti-Poverty programmes including Flying Start, Families First and other place-based approaches provide great platforms for realising the ambitions and potential of these Acts and Duty. As mentioned earlier, I had the great privilege of managing and leading Flying Start and Maternity and Early Years Integration in Ceredigion between 2007 and 2021. These are some of my reflections on how these programmes tackled stigma and promoted take up of services so effectively.
- Working in scarcity
Eldar Shafir and Sendhil Mullainathan apply behavioural science to understand the impact that not having enough of things – money, time, healthy food or a healthy work life balance – has on your mental capacity to seek or accept support that will benefit you in the longer term. Scarcity reduces your ‘bandwidth’ for mental processing while your brain is busy processing anxieties and doubts.
Utilising ‘Nudge’ Theory – making the right choices the easiest choices helps to tackle this issue.
- Providing more intensive, home-based support from trusted professionals such as Health Visitors and their teams helped to provide information, advice and support that was more accessible and acceptable.
- Funded, responsive, nearby quality childcare, as well as
- A wealth of parenting and communication development courses within pram pushing distance were seen as an asset by all.
The fact these courses could be provided by people with whom you already had a trusting relationship was genius – it was the magic that made it work.
Families appreciated staff’s efforts to mould services to what they needed, e.g. running courses when children were in childcare, and took up a lot of the opportunities offered to them. In the process, they built supportive friendship groups and communities with their peers.
Welsh Government / Early Intervention Foundation approved Parenting courses were 12 weeks long – no mean feat to get people enrolled. Good delivery necessitated families having strong relationships with staff and other participants, incentives such as a free lunch and delivery by trained, skilled staff offering psychological safety and a desire to ‘work with’ people and not ‘do to’ them.
An asset -based approach supports a focus on strengths and a more enabling narrative. Staff modelled dealing with conflicts of opinion and contributions that challenged the ethos of the programme with respect and due diligence. Finding positive behaviours and comments to highlight and link with good results for every participant meant everyone left feeling buoyant, ready to face the next week’s challenges.
I was keen to remove any stigma from these courses. I utilised behavioural science to ‘normalise’ them – regularly sharing data and appropriately framed stories from course completers.
Ceredigion had a consistently high take up of parenting courses – sustained over many years. I put this down to the incredibly skilled compassionate staff running the courses and the warm welcome extended equally to all. We were able to show that the courses consistently had representation from a range of parents with varying challenges in their lives. 70% or more completed their course and 80% or more showed progress in their parenting self-efficacy. The longer-term aim of this work was to close the gap in educational attainment, and I am so proud to be able to say that our parents and children did it.
- Targeted universalism and outreach
Critics of the Welsh Government’s Flying Start programme weren’t keen on the area post-code approach. For me, the fact that the programme embraced a whole area was instrumental in fighting stigma and ensuring that the hard to reach felt they were taking up services because they were entitled to – in the same way that all their neighbours were. Outreach and strong partnership work with Families First and third sector organisations meant families outside the area could get quality services too. I made sure that any training we had was offered to partners working with families across the county.
- Belonging and benevolence
The Human Givens approach puts some parameters around what it takes to enjoy health and wellbeing as follows
“We now know that having meaning and purpose, a sense of volition and control, being needed by others, having intimate connections and wider social connections, status, appropriate giving and receiving of attention, etc, are crucial for health and wellbeing.”
Working within a defined geographical area allows teams to build a sense of connectedness. Integrated working and co-delivery with statutory and third sector organisations in the area builds and shares the trust and sense of belonging. Staff across agencies demonstrating great trust in each other and giving consistent messages can provide reassurance and an anchor in difficult times.
Families in all of the programmes were given regular opportunities to shape the way in which services were delivered and given opportunities for training and voluntary work.
- Compassionate and kind
Margaret Wheatley writes that we are far more wise, caring and kind than our media would have us believe. I was sure that consistently demonstrating and delivering positive, kind, compassionate services was key to growing hope and belief in our communities. I remain convinced that it helps to tackle some of the more negative effects of stigma and leads to positive, productive engagement.
- ‘Frame’ don’t blame
Frameworks helps to shape or ‘frame’ effective communications through applying social science in studying how people understand social issues.
The narrative we use with and about ourselves and our communities can focus on strengths and build on pride and hope. We need collective action over a sustained period to reframe family, school and community – to focus on what’s strong and not what’s wrong.
I have been lucky enough to work with some great people, and successful organisations and services over the years. My observation was that they founded their success on a grounded, compassionate understanding of everyone’s need to belong and to feel appreciated and valued for their own particular strengths. These people and organisations actively voiced and celebrated the value and strength of belonging and encouraged everyone to do the same.
I tried and continue to try to emulate that philosophy. I’ll never forget one mum’s comment on the Early Years support she had received – ‘You make me feel rich.’ It’s the kind of wealth that bears no stigma.
