reflections and recommendations european communities-that-care projects

My Reflections & Recommendationson the European CTC project

based on Berlin meeting23-24 November 2015

Clemens HosmanScientific advisor to the Europeam CtC project

Emeritus Professor of Mental Health Promotion & Prevention

Foreword

This note on the EU-CtC meeting in Berlin at 23 and 24 of November 2015 reflects mypersonal perception of major messages that were presented by participants during theirpresentations and the discussions, as well as my own reflections on the developments in CtC and recommendations for next steps and the future of EU-CtC.

It is not meant as a formal summary or minutes of the meeting, more as my conclusionsand recommendations in my capacity as advisor of the project.

While the strengths of CtC are sufficiently known in our group, I have concentrated on more critical issues and options for improvement and innovation.

Clemens Hosman2

Content

� EU-decline decline in number of cities participating in CtC: What could be the reasons?

� Some critical reflections on current CtC

� Some Priorities for the Future of CtC

‒ Organizing more external input in the reflection on CtC and its future

‒ Further reflection needed on basics of CtC

‒ Strengthen national and European databases for CtC

‒ Expanding and innovating CtC

‒ Development of new instruments and tools

‒ Expert capacity building

3

EU-wide decline in number of cities participating in CtC What could be the reasons?

� CtC lacks opportunities for showing motivating short-time successes and

among policy-makers doubts exists about achieving a satisfying cost-benefit ratio

� CtC is – despite its intentions – too much a standardized, top down approach in conflict

with trends in strengthening bottom-up local initiatives and social empowerment; ‒ no tools to integrate flexibly with local bottom-up initiatives and social movements

‒ poor attunement to how cities solve problems in step-by-step approach (Matej); city policy making

‒ formula of ‘pre-cooked food products’ versus ‘inspiring, supportive cook books’, ‘intermediate products’

� Crisis in belief of wide usability of “standardized effective interventions + fidelity”

CtC is insufficiently responsive to need for local adaptation, ownership and resistance to adoption

� Dependency of finding/using /supporting Champions at all levels underestimated

� National governments withdraw from being national organizers/facilitators

� Lack of local expertise (trained professionals, staff-turnover) and budgets (financing systems)

4

Some critical reflections on current CtC

� There is a need for a EU-based critical analysis of the fundamentals of CtC. Major reasons: (1) no EU evidence on pretended effects; (2) The basics of CtC have not changed over more then20 years, while innovation is a core driving force across many public /privated sectors; (3) Relevant sciences have generated new basic knowledge that is not yet included in the CtC.

� There exists a divergence in view on how to move forward with CtC. Many prefer fidelity tothe original CtC design and principles, and want to put main effort in further improving its full implementation according to strict and original criteria. Others are in favour of a more creativeinput and to discuss options for innovation of the basics of CtC, as is usual in many sectors

� CtC pretends to be a generic, theory-based & preventive approach to problem behaviors andpositive development in children/youth, however:� CtC is mainly based in research on adolescents and aggressive/violent behavior & substance use

� Strong interest of science and cities in early childhood, where many risk+protectve factors emerge

� Insufficient focus on the social factors that cities hve to deal with, e.g. poverty, inequity, refugees

� Presumption “all countries can build a large collection of evidence-based interventions” from which neighborhoods & cities can choose is not valid: not affordable for many countries

� CtC lacks attunement to actual city policies and insights from current policy science

5

Some Priorities for the Future of CtC

ORGANIZE MORE EXTERNAL INPUT IN REFLECTING ON CTC AND ITS FUTURE

� Invite ‘outsiders’: from science, policy and social innovation field to comment on CtC,to evaluate its strength/weaknesses and suggest options for innovation

e.g. Breton & de Leeuw (2010) Review theories of policy process in HP research; Cairney (2011) Understanding public policy; Publications in Stanford Social Innovation Review (e.g. collective impact)

� Input of new theories and knowledge in (1) developmental factor model of CtC and(2) the CtC dissemination-implementation approach. Current theory basis is too small.

Examples: Epigenetics; early development and trauma research; social factor research, empowerment, dissemination and policy research; innnovation development; sociale movement;

� Compare Strengths & Weaknesses of CtC, Healthy Cities, Prosper, SEL-ENSEC anddevelop a new integrated approach with the best of each: the next generation of CtCCtC and Healthy Cities have been developed from different traditions and science communities

� European identity of CtC: Is there one? What differentiates us? What could EU-CtC add to the CtC-concept? Does Euro-culture and health & social policies makes a difference?

6


FURTHER REFLECTION NEEDED ON BASICS OF CTC

� Develop a more in-depth scientific analysis of how different health & social problemsare related over time (life-span) and across system levels; learn to understand whatthe strategic implications are for effective health and social policy

Targeting earlier problems to prevent later problems; differentiating several ‘smart clusters of narrowlyrelated problems’ and designing models for integral preventive approaches;

� Reflection on the pros and cons of standardization and options for more flexibility, adaption, attunement to and integration with existing or bottom-up policies/practices

� How could new ideas on “collective impact” be integrated in CtC? What conditionsare needed to create collective impact? Develop collective impact theory for CtC.

Better understanding of ‘how’ different interventions could strenghen or complement otherinterventions to achieve larger effects, larger public reach, larger public impact / collective impact. What are the conditions and drivers of public and collective impact?

� Better understanding the conditions needed to enhance sustainability of CtC

7


STRENGTHEN NATIONAL AND EUROPEAN DATABASES FOR CtC

� European epidemiological database with internationally comparable data on youth problembehaviors, risk factors and protective factors from national/local surveys

� National databases of evidence-based effective interventions, and a European database with interventions, evidenced to be effective across multiple countries (e.g. incredible years)

� Collect data about the implementation level of interventions and their public reach in targeted local and national populations. Public reach x effectiveness = Public impact

� Effective is essential in CtC. Develop a more advanced conceptual system of ‘effective’, thatdifferentiates between: efficacy, effectiveness, public impact and collective impact

� Strengthen the set of valid evaluation instruments & indicators that offer data which are are both locally relevant and internationally comparable

8


EXPANDING AND INNOVATING CtC

� Develop a CtC version targeted at pregnancy & early childhood (Healthy Start)

� More emphasis on identifying evidence-based ‘Working elements, principles & factors’, (not exclusively on standardized effective interventions), organized in transparent model

� Develop a theoretical model on conditions needed to implement CtC successfully; measures to asssess local/national profiles of needed conditions, and strategies for their improvement

� Refugee problem: What could CtC contribute? Social development and bonding strategy; enhancing socialization and social integration; programs for traumatized children/adults

9


DEVELOPMENT OF NEW INSTRUMENTS AND TOOLS

� Elaborated and science-based decision tree for selecting interventions for local practicefrom a national database of interventions

� Legal document at EU level about authorship, copyright, opportunities to make national or local adaptations, and how we can avoid claims and ‘bills’ of program owners.

� International harmonisation of criteria for e.g. quality indicators, descriptive dimensions

� Measures to assess community readiness and different implementation contexts

� National CtC lobby groups and Advocacy tools & strategies

� Developing a sustainable EU-CtC network (even without a EU grant? Within EU-SPR?),

identifying major agenda issues and dividing tasks across European partners

10


EXPERT CAPACITY BUILDING

� How could we turn CtC into an effective learning system at local, national and international level? What are the learning targets and tools?

� European and national training programs to develop prevention expertise / experts

� Explore needs and opportunities for professional training in CtC and prevention

� Define types and standards of needed professional expertise at local and national level

� European summer schools

� Training modules and materials that could be adopted by national institutes, universities and NGOs

� Training on priority issues: advocacy; local policies; outcome evaluation; public reach; cost-benefit; working elements, principles & factors; collective impact; creating structural conditions

11

Contact:

Hosman Prevention Consultancy & Hosman Prevention Consultancy & Hosman Prevention Consultancy & Hosman Prevention Consultancy & InnovationInnovationInnovationInnovation

[email protected]

reflections and recommendations european communities-that-care projects

Documents