Janine Ewen – a specialist in trauma, public health, policing and harm reduction – has produced a template and brief guidance for the Global Law Enforcement and Public Health Association (GLEPHA) on how to negotiate a health needs assessment (HNA) involving the police force, while preventing it from becoming an enforcement-led endeavour. Below she outlines a careful approach to conducting an HNA project/research, and advice on how to collaborate on project work that properly represents the needs and safety required for underserved populations at community level. The template can be used for any project that involves criminalised and underserved members of the community. The word choices used in the template are intended only as examples; they do not have to be replicated exactly, but anyone is welcome to use these words.
A direct link to the framework can be found here
The beginnings of designing … or a case of redesigning?
When you are designing a Health Needs Assessment (HNA) and research, it’s almost as if you are immediately trying to safeguard those in need of help. Perhaps the project is being proposed because of proactive policing agendas that have been reliant on raids, targeting or disrupting communities (sometimes presented as promoting welfare), or attempting to eradicate situations. Perhaps the very people who are the focus of the project haven’t had their actual needs and care prioritised, or maybe they haven’t been included in any consultation or designs for the project. Unfortunately, on many occasions I’ve seen all of these conditions at the outset of public health/police partnership work, including HNAs. If we support a public health approach, we need to protect it from early assumptions that public services and the police always know best. Services might assume that they are in contact with or are supporting X, but this might be a partial reality; or the police might be co-opting welfare support by seeking avenues to continue with punitive actions. Therefore, always read the details of a proposed HNA, and ask questions, to ensure that police and health providers have thought about the proposal comprehensively.
Here is an example of part of a response provided while negotiating the terms of the conditions, before an HNA project began.
Police and health provider/representative:
One of the project’s aims: Providing information on the locations of [BLANK] for [BLANK]
The following is from the perspective of the experts who have developed their own networks of peer support and safety:
‘We strongly urge that this aim of the project is removed entirely from the proposal, to prevent such a misuse of data gathered from impacting an essentially criminalised and vulnerable community of people who [BLANK]. Rarely (or ever) have we seen a police force [BLANK] on [BLANK] that despite stated intentions, has not caused harm to [BLANK] themselves. If we feel at any point that the safety of [BLANK] is being compromised by the sharing of intelligence rather than of actual needs, then we will withdraw completely from the project. We are fully committed to partnership working for the development of services for [BLANK]actual and not perceived needs, and commit to ensuring all evidence-gathering that we take part in or lead on is used solely to meet the aim of this project to understand more fully [BLANK], with a view to establishing the safety, health and wellbeing of those involved in [BLANK]. I’m sure this is already understood, but I think it will be an important statement to be made as we bring other agencies and organisations into the plans and project ahead.’
This statement is strong, and I’ve highlighted key words/themes that can be used if you are navigating negotiations or are going to design an HNA from scratch:
- Preventing the misuse of data gathered that could cause harms
- A commitment to partnership working
- The development of services for [BLANK] actual and not perceived needs
- Upholding the principles of using data only to support the aims of the HNA
- Establishing the safety, health and wellbeing of those involved in [BLANK]
- Making an important universal statement that agrees on these aims before going ahead
This example highlights the dangers of conflicting aims at the beginning, and how a plan of action will need to be crafted with great care and diligence. Also, the point about actual rather than perceived needs is crucial. Projects can remain in planning (sometimes over several months) because the police, sometimes with health providers, propose gathering data to fulfil ‘business as usual’ aims. Don’t be afraid to challenge this situation. If it involves redesigning by going back to the drawing board, that’s a good sign that much more has been taken into consideration.
Setting it all out – the case for needs through evidence, gaps and research
You should set out why this piece of work is taking place. Why are you all coming together? Does it link to a local need, including national and international work? Did a review find that there are not enough sources to provide a more detailed picture about X? Below are some statements I have crafted in my own work, and I have highlighted useful concepts that I recommend you include in a needs-based HNA:
- Health and social care challenges (deprivation, a lack of secure accommodation, abuse, etc.)
- Survival behaviour
- Evidence (or lack of it)
- Diverse needs
- Risks and adverse impacts (short/long term)
- A lack of consultation with X
- Gaps in knowledge
- Needs
- Circumstances
- Criminal justice services
- ‘A partial picture’
Showing your profile of expertise and using needs-based language
What are you (and the organisation/representative) proposing, which can change, transform or reduce repeated cycles of harm? It’s important to showcase any aspects of your work, knowledge and general expertise that have already had an impact; this will give all agencies, the police and partnerships a clear idea of the template you are all working towards (and it’s another way to promote confidence). The statement also adds further value in reiterating the needs-based focus. It clarifies (again) why this is going ahead, and it acts as another point of reference to prevent any ‘breach’ or misunderstandings of the project’s aims. It helps to keep building a healthy vision. I’ve highlighted key words from the above page of the template, in case you are looking to use more needs-based language when designing an HNA.
- Referral pathways
- Informed and non-judgemental support
- Safety, welfare advice, rights and the law, health, housing options, and general wellbeing
- Holistic
- Reduction in isolation and structural oppression
- Removing barriers
- Reporting crimes of violence and exploitation
- Fostering participation and capacity
- Community
- Positive engagement and wider society
Concisely summarising the plan with the police acting in an advisory role only (the need for an agreement)
Most of you will already know that any HNA will require a more concise page of aims, goals and key partners. You can see how clearly the needs-based is emerging…
- Partnership
- Assess needs
- Understand
- Establish
- Safety/health/wellbeing
- Priorities for action related to needs
- Develop an action plan and associated funding strategy to roll out actions/activities
The last point is another way to ensure the agreement of everyone involved that, with the establishment of needs, there should be a post-establishment commitment to pool funding sources together. We want to avoid any project that is only about needs assessment/research and nothing else. It can’t just be about presenting to audiences; there should be a commitment to the impact and resource development arising from public health/needs and harm reduction projects.
You can see in the list of partners and key advisors that the police are included. We are trying to encourage policing to focus on needs, but they are not leading on the project. The reason for this is that an HNA should happen because essentially you are trying to re-centre unmet health and social needs, which requires needs-focused partnerships. I strongly suggest that a written agreement with the police is signed prior to the project, for protection and extra accountability. Although there seems to be excessive ‘micro-safeguarding’, this will prevent fear among the people we are hoping to support more effectively (they might have a history of experiencing violence by the police, being in and out of the system, and feeling pushed to the margins because of criminalisation – this applies to adults, children and young people alike). We have a responsibility to make sure that we have solid protections in place; and there should be no harm perceived in our pursuit of this aim.
A table of goals: from needs to harm-reducing impact and action
You can see within the framework that a table of goals was placed at the end. This provides more structure and clarity towards achieving the objectives and actions, by determining who is doing what in the HNA, the timeframe, completion dates, and intended outcomes (including the intention of reviewing). I view many of these goals as supporting harm reducing practices as well, and I have listed more key words and concept examples from the above template slide to demonstrate this. The slide above is based on the ending of the project:
- To develop a prioritised action and strategic plan for a rights-based approach
- To jointly strategise actions, and lead groups and agencies on each action
- The roll-out of services and sustainability
- To present the results of the needs assessment
- All stakeholders are to participate in seeking funding to establish, scale and sustain service approaches for meeting the safety, health and wellbeing needs of [BLANK]
- Barriers to service provision and acceptability of services by [BLANK] are identified and actioned to be removed jointly
- The framework is to be produced following an action plan that includes [BLANK] in ongoing reviewing of services
Concluding remarks on the importance of a needs-based assessment and how to conduct it effectively
Understanding the unique health needs of underserved populations is crucial for effective intervention. This framework, as an example, offers a practical approach to developing HNAs, by de-escalating tensions arising from enforcement, empowering communities and health providers to address disparities, and to create tailored solutions.
Summary points:
- Achieving a needs-based approach may require negotiating or redesigning what has already been planned – don’t worry if that happens
- Use needs-based language throughout the HNA
- Describe the partnership, and discuss any impactful work by the organisation/representative, to build confidence in a harm-reducing vision
- Make it clear as early as possible that the police are involved in an advisory capacity, as this is the intention of needs-based work. This must be made clear in the HNA (throughout).
- Ask for the police to sign an agreement that all data gathered will only be used to focus on the aims/actions of the project itself (to prevent harmful surprises)
- Reducing harm in HNAs should involve ensuring that there is clarity and promising actionable outcomes – including creating better provision, responses, outcomes and outputs for X
If you are looking for consultancy advice on developing HNAs, Janine can be contacted on her personal email account: janine.ewen@gmail.com