Policy Brief
Families are often faced with a range of different, complex health and psychosocial problems. Place-based approaches aim to address these complex problems by focusing on the social and physical environment of a community and on better integrated and more accessible service systems, rather than focusing principally on the problems faced by individuals. A place-based approach targets an entire community and aims to address issues that exist at the neighbourhood level, such as poor housing, social isolation, poor or fragmented service provision that leads to gaps or duplication of effort, and limited economic opportunities. By using a community engagement approach to address complex problems, a place-based approach seeks to make families and communities more engaged, connected and resilient.

An initiative of The Royal Children’s Hospital, Melbourne Centre for Community Child Health

Issue 23 > 2011

Translating early childhood research evidence to inform policy and practice

Place-based approaches to supporting children and families
Additionally, the circumstances in which children are growing up have changed10. Children now have fewer models of caregiving, community environments are less child-friendly and electronic media has become a dominant feature in children’s lives12,13,14. Social climate change is also evident in the increasing complexity of modern society15. One manifestation of this complexity is the increase in ‘wicked’ problems16 such as obesity, child abuse and social exclusion. These problems are beyond the capacity of any one organisation to understand and respond to, and there is often disagreement about their causes and the best way to tackle them. Wicked problems “cross departmental boundaries and resist the solutions that are readily available through the action of one agency”17. However, government departments typically focus on acute problems and do so unilaterally, rather than coordinating efforts to address factors that lead to wicked problems occuring in the first place. Governments also seek to integrate services so as to improve access and thereby improve outcomes. However, while integrating services is important, it is also important to build more supportive communities. This will ensure that parents of young children have stronger social support and the interface between communities and services is improved so that service systems can be more responsive to community needs18. Both integrating services and building more supportive communities are best done through a place-based approach.

Why is this issue important?
Over the past few decades, the world has witnessed significant and rapid change. These changes have been so fast and so far-reaching, they have had a dramatic impact on the physical wellbeing of the planet in the form of climate change1,2,3,4 as well as on the physical and psychological wellbeing of societies in the form of social climate change5. We can see the evidence of social climate change in the rapid changes that have occurred for communities, families and children. These include: • people’s sense of community has become less tied to locality, as seen in the emergence of online communities • our social relationships have taken on new forms • the structure of the family has changed (e.g. smaller families) • Australia has greater cultural and ethnic diversity • the circumstances in which families are raising young children have changed, for example, more parents work longer hours6,7,8,9,10,11.

Policy Brief 23 > 2011: Place-based approaches

www.rch.org.au/ccch/policybriefs.cfm

What does the research tell us?
Rationale for place-based approaches
The rationale for adopting place-based approaches is based on various factors: Place shapes people’s wellbeing. Both social and physical environments influence health and wellbeing. Children’s daily experience of living and learning in the environment around them is a significant factor in their overall wellbeing6-8,19-23. Feeling connected and having social networks matters for people’s wellbeing. Children’s welfare and family functioning are crucially dependent upon the social support available within local communities24, and social isolation is a risk factor for both child development and family functioning24-27. Some communities are trapped by locational disadvantage28-32. Despite Australia’s recent strong economic growth, some communities remain caught in a spiral of disadvantage such as low school attainment, high unemployment, poor health, high imprisonment rates and child abuse31. When social disadvantage becomes entrenched in a particular locality, a disabling social environment can develop, leading to intergenerational disadvantage. The economic collapse of certain localities30,33,34. Neighbourhoods that were reliant on the old economy have been devastated by globalisation, economic rationalism, restructuring and closure of manufacturing industries. Some of these neighbourhoods have become almost entirely dependent on welfare benefits and publicly funded services. Orthodox approaches fail to reduce inequalities and prevent problems35,36. The strategies that have been used so far to reduce inequalities – such as making existing services more accessible and seeking to alter the individual behaviour of vulnerable people – do not address the root cause of the problems33, and have been unable to produce sustainable change. There has been a disproportionate reliance on the deployment of strategies and programs for the treatment of existing conditions rather than on true prevention, which is defined as occurring prior to the onset of disorder36. A place-based approach addresses the broader problems that impact upon families at the community level (e.g. unsafe physical environments, non-family-friendly transport, limited social connectedness) as well as the barriers to families
2 Policy Brief 23 > 2011: Place-based approaches

accessing services (e.g. fragmented service systems, lack of outreach capacity). Local services are not able to respond effectively to the complex needs of families and communities10,37. Designed at a time when the demands on families were simpler, many local service systems struggle to provide support to all families who are eligible, and to meet the needs of families facing multiple challenges in a holistic way. It is difficult to engage and retain vulnerable families38-44. Some families make little or no use of services, even if they have concerns about their children or are experiencing family difficulties. The reasons for this lack of engagement – more common among vulnerable families – include difficulties negotiating a fragmented service system, not knowing services exist, and an unwillingness and/or inability to access services38. With a focus on collaboration and partnership between services, a place-based approach seeks to reduce these barriers by building integrated service systems that are more flexible and responsive to family and community needs, and have an outreach capacity to engage vulnerable and socially isolated families. Cumulatively, this is a formidable list of factors that provide a powerful rationale for a place-based approach. However, it is important to consider the evidence regarding the effectiveness of place-based approaches.

The effectiveness of place-based approaches
Establishing the efficacy of place-based initiatives, policy and planning is challenging. A lack of well-designed outcome evaluations of place-based initiatives limits the extent to which firm conclusions about their effectiveness can be made45,46. While some place-based initiatives have led to measurable improvements, others have not. Reviews of Australian efforts suggest that it is still too early to tell what difference these will make over the long term37,47. Despite this cautious conclusion, there is some evidence as to what successful place-based interventions involve.

Characteristics of successful place-based interventions
Communities participate, lead and own the intervention. At the heart of all successful place-based partnerships are communities that provide maximum practicable input in all decision making. This is the key to community strengthening32 and extensive community engagement, as well as engagement with public and private sector stakeholders37,48. Knowledge of the local community decreases the amount of time required to identify needs and develop plans and programs, thereby leading to greater efficiency. Investment in capacity building. This investment includes time and resources for communities as well as long-term capacity building of staff48. Adequate time. Problems that have been decades in the making will not be reversed in a few short years32. Similarly, service transformation through behaviour change takes a long time50,51. Adequate funding. Governments can help to support community-strengthening outcomes by investing in core public infrastructure48 and facilitating investment from other sources (e.g. private sector funding) to support initiatives and ideas that flow from the project37, and fund pilot and demonstration projects48. Strong leadership and support from governments. Wiseman (2006) notes that governments can support community-strengthening outcomes by articulating and demonstrating their commitment. Effective relationships between stakeholder groups. Effective coalitions or partnerships between key community stakeholders increase the likelihood that a prevention effort will be successful52. Key factors that contribute to effective relationships between stakeholders include high levels of trust and communication, and the establishment of shared vision and values between service providers. Governance structures need to be established through which the various stakeholders and service providers can effectively engage with users of the service system to develop planning mechanisms that respond to community need, and through which services can be jointly planned and delivered. Evaluation. Processes to rigorously measure and evaluate outcomes need to be built into the project from the start37.

A ‘good fit’. The scale of the project needs to be appropriate to the policy challenges it addresses. The community needs to be prepared to implement a prevention program37 and any programs or interventions need to meet the identified needs of the community and be appropriate for the targeted cultural groups52. The evidence also suggests that a place-based approach is only one feature of a comprehensive community-based service framework that can respond more effectively to the wicked problems that affect communities, families and children53. Other features include: • a strong universal service system backed by a tiered set of additional supports for families experiencing particular stresses • an integrated service system providing holistic support to families • multi-level interventions to address all factors that directly or indirectly shape the development of young children and the functioning of their families • a partnership-based approach based on partnerships between families and service providers; between different service providers; and between government and service providers • a robust governance structure that allows different levels of government, different government departments, non-government services and communities to collaborate in developing and implementing comprehensive place-based action plans. Although there are no place-based initiatives that have all of these features, there are some valuable local and overseas examples that demonstrate many of these characteristics. Australian initiatives include Neighbourhood Renewal in Victoria and the federal Communities for Children program. Overseas examples include Sure Start in the UK and Choice Neighbourhoods in the US. Place-based approaches are typically delivered within disadvantaged areas. However, we know that disadvantage is not necessarily confined to such areas – family problems and poor child outcomes are widespread and not limited by geography. For this reason, place-based approaches can be validly applied within any community.

Policy Brief 23 > 2011: Place-based approaches 3

www.rch.org.au/ccch/policybriefs.cfm

Combining approaches
Place-based approaches represent a significant advance on the traditional service system. However, place-based approaches are not sufficient on their own to ensure a sustainable improvement in child and family outcomes. Two other complementary approaches are needed: person-based and national approaches. A person-based approach focuses on direct help to the individual person or family with the problem, regardless of their circumstances or where they live35. A place-based approach addresses the collective problems of families and communities at a local level, usually involving a focus on community-strengthening. These approaches have usually been deployed separately but there are good grounds for combining them30. Such a strategy would be consistent with calls for multi-level approaches to social and behavioural change49. Significantly disadvantaged communities require programs targeted at individuals as well as renewal and development programs that address social infrastructure and the environment (e.g. public spaces, housing etc.)37. Although place-based approaches seek to address the conditions under which families are raising young children, they can only address those factors that can be modified at a community level (e.g. social networks, integrated services). There are other factors that can have a major impact on families and communities that are beyond the control of place-based initiatives. These include national and global economic policies and market forces that can contribute to disparities in housing, employment, education and health. National approaches are needed to minimise the impact of these factors on families of young children.

• involve the community in the development of initiatives and interventions, and provide services and facilities that are more responsive to community needs and more acceptable to families • build the capacity of communities to take responsibility for their own issues over time • create integrated service systems that are able to reach out to and engage families more successfully and respond to their needs in a holistic fashion. This analysis suggests that meeting the needs of vulnerable families and communities requires a threepronged approach – a combination of person-based, place-based and national approaches.

Considerations for policy and programs
Implementing a comprehensive approach – including place-based strategies – to effectively meet the needs of today’s young children and their families is a formidable undertaking that requires a sustained commitment by many stakeholders. • Community involvement should be viewed as a longterm goal of any place-based initiative as it takes time to build community capacity. • Close monitoring of and continuous learning and research from a comprehensive community-based approach will be important to ensure that the future roll-out of the model is fully effective. • More work is needed on developing a full program logic model of the framework for place-based approaches, showing how it leads to improved outcomes for children, families and communities. • Place-based approaches should be seen as just one feature of a broader framework; a combined approach (person, place and national) is required to more efficiently and effectively respond to wicked problems that affect communities, families and children.

What are the implications of the research?
Rapid, sweeping social changes have had widespread impacts on communities, families and children. The current service system is not equipped to deal with the fallout from these social changes and struggles to meet the needs of all families effectively. As an alternative to this current system, place-based approaches: • are an efficient way of addressing place-based disadvantages • address the conditions under which families are raising young children as well as the presenting problems

Policy Brief 23 > 2011: Place-based approaches 4

www.rch.org.au/ccch/policybriefs.cfm

References
1. 2. 3. 4. 5. Flannery, T. (2005). The Weather Makers: The History and Future Impact of Climate Change. Camberwell, Victoria: Text Publishing. Garnaut, R. (2008). The Garnaut Climate Change Review: Final Report. Cambridge, UK: Cambridge University Press. Intergovernmental Panel on Climate Change (2007). Fourth Assessment Report on Climate Change. Geneva, Switzerland: Intergovernmental Panel on Climate Change. Steffen, W., Sanderson, A., Jäger, J., Tyson, P.D., Moore III, B., Matson, P.A., Richardson, K., Oldfield, F., Schellnhuber, H.-J., Turner II, B.L. and Wasson, R.J. (2004). Global Change and the Earth System: A Planet Under Pressure. Heidelberg, Germany: Springer Verlag. Moore, T.G. (2009). Social climate change and children: Consequences, causes and cures. Invited presentation given at ARACY Conference, Transforming Australia for our children’s future: Making prevention work, Melbourne, 4th September. http://www.aracyconference.org.au/Fri%20IA6%20 1400%20Moore.pdf Barnes, J., Katz, I., Korbin, J.E. & O’Brien, M. (2006). Children and Families in Communities: Theory, Research, Policy and Practice. Chichester, East Sussex: John Wiley and Sons. Hughes, P., Black, A., Kaldor, P., Bellamy, J. & Castle, K. (2007). Building Stronger Communities. Sydney, NSW: University of New South Wales Press. Blau, M. & Fingerman, K.L. (2009). Consequential Strangers: The Power of People Who Don’t Seem to Matter...But Really Do. New York: W.W. Norton. Hayes, A., Weston, R., Qu, L. & Gray, M. (2010). Families then and now: 1980-2010. AIFS Facts Sheet. Melbourne, Victoria: Australian Institute of Family Studies. http://www.aifs.gov.au/institute/pubs/factsheet/fs2010conf/fs2010conf.html Moore, T.G. (2008). Supporting young children and their families: Why we need to rethink services and policies. CCCH Working Paper No. 1 (revised November 2008). Parkville, Victoria: Centre for Community Child Health, Royal Children’s Hospital. http://www.rch.org.au/emplibrary/ccch/ Need_for_change_working_paper.pdf Trask, B.S. (2010). Globalization and families: a dynamic relationship. Springer. Tranter, P. & Malone, K. (2003). Out of bounds: Insights from children to support a cultural shift towards sustainable and child-friendly cities. Paper presented at the State of Australian Cities National Conference, Sydney, December, 2003. Bittman, M. & Rutherford, L. (2009). Digital Natives: Issues and Evidence About Children’s Use of New and Old Media. Paper presented at 2nd LSAC Research Conference, 3–4 December 2009, Melbourne. Centre for Community Child Health (2009b). Television and early childhood development. CCCH Policy Brief No. 16. Parkville, Victoria: Centre for Community Child Health, The Royal Children’s Hospital. http://www.rch.org.au/emplibrary/ccch/PB_16_template_final_web.pdf Mulgan, G. (1997). Connexity: How to Live in a Connected World. London, UK: Random House. Australian Public Services Commission (2007). Tackling Wicked Problems: A Public Policy Perspective. Phillip, ACT: Australian Public Services Commission. http://www.apsc.gov.au/publications07/wickedproblems.htm Bradford, N. (2005). Place-based Public Policy: Towards a New Urban and Community Agenda for Canada. CPRN Research Report F|51. Ottawa, Canada: Canadian Policy Research Networks Inc. http://www.rwbsocialplanners.com.au/spt2006/Social%20Planning/Place%20based%20public%20policy. pdf Centre for Community Child Health (2010). Platforms Service Redevelopment Framework. Parkville, Victoria: Centre for Community Child Health, The Royal Children’s Hospital. Edwards, B. & Bromfield, L.M. (2009). Neighborhood influences on young children’s conduct problems and pro-social behavior: Evidence from an Australian national sample. Children and Youth Services Review, 31(3), 317-324. Pebley, A.R. & Sastry, N. (2004). Neighbourhoods, poverty, and children’s well-being. In K. M. Neckerman (Ed.). Social Inequality. New York: Russell Sage Foundation. Popkin, S.J., Acs, G. & Smith, R. (2010). Understanding how place matters for kids. Community Investments, 22 (1), 23-26, 36-37. http://www.frbsf.org/ publications/community/investments/1005/S_Popkins.pdf Sustainable Development Commission (2008). Health, place and nature. How outdoor environments influence health and well-being: a knowledge base. London, UK: Sustainable Development Commission. http://www.sd-commission.org.uk/publications/downloads/Outdoor_environments_and_health. pdf Sustainable Development Commission (2009). Every Child’s Future Matters (3rd ed.). London, UK: Sustainable Development Commission. http://www. sd-commission.org.uk/publications/downloads/ECFM_report.pdf Jack, G. & Jordan, B. (1999). Social capital and child welfare. Children and Society, 13 (4), 242-256. Fegan, M. & Bowes, J. (1999). Isolation in rural, remote and urban communities. In J.M. Bowes and A. Hayes, A. (Eds.). Children, Families, and Communities: Contexts and Consequences. South Melbourne, Victoria: Oxford University Press. Crnic, K. & Stormshak, E. (1997). The effectiveness of providing social support for families of children at risk. In Guralnick, M.J. (Ed.), The Effectiveness of Early Intervention. Baltimore, Maryland: Paul H. Brookes. Nicholas A. Christakis and James H. Fowler (2009). Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives. New York: Little, Brown and Company. Barraket, J. (2004). Communities of place. Griffith Review, Edition 3 (Autumn). http://www.griffithreview.com/edition-3/206-research/485.html Baum, S. (2008). Suburban Scars: Australian Cities and Socio-economic Deprivation. Urban Research Program Research Paper 15. Brisbane, Queensland: Urban Research Program, Griffith University. http://www.griffith.edu.au/__data/assets/pdf_file/0017/53009/urp-rp15-baum-2008.pdf Baum, S. & Gleeson, B. (2010). Space and place: Social exclusion in australia’s suburban heartlands. Urban Policy and Research, 28 (2), 135-159. Vinson, T. (2007). Dropping off the Edge: The distribution of disadvantage in Australia. Richmond, Victoria: Jesuit Social Services and Catholic Social Services Australia. http://www.australiandisadvantage.org.au/ Vinson, T. (2009a). Markedly socially disadvantaged localities in Australia. Canberra, ACT: Department of Education, Employment and Workplace Relations. http://www.socialinclusion.gov.au/Documents/2DisadvantagedLocalities.pdf

6. 7. 8. 9. 10.

11. 12. 13. 14. 15. 16. 17.

18. 19. 20. 21. 22.

23. 24. 25. 26. 27. 28. 29. 30. 31. 32.

5 Policy Brief 23 > 2011: Place-based approaches

33.

Klein, H. (2004). Health inequality, social exclusion and neighbourhood renewal: Can place-based renewal improve the health of disadvantaged communities? Australian Journal of Primary Health, 10 (3), 110-119. McDonald, C., Frost, L., Kirk-Brown, A., Rainnie, A. & Van Dijk, P. (2010). An evaluation of the economic approaches used by policy actors towards investment in place-based partnerships in Victoria. Australian Journal of Public Administration, 69 (1), 9-21. Head, B. & Alford, J. (2008). Wicked Problems: The Implications for Public Management. Presentation to Panel on Public Management in Practice, International Research Society for Public Management 12th Annual Conference, 26-28 March, 2008, Brisbane. http://www.irspm2008.bus.qut. edu.au/papers/documents/pdf2/Head%20-%20Wicked%20Problems%20HeadAlford%20Final%20 250308.pdf O’Connell, M.E., Boat, T. & Warner, K.E. (Eds)(2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Report of the Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Institute of Medicine; National Research Council. Washington, DC: National Academies Press.http://www.nap.edu/catalog. php?record_id=12480#description Wear, A. (2007). Place-based partnerships in Victoria. Public Administration Today, Issue 12 (JulySeptember), 20-26. Carbone, S., Fraser, A., Ramburuth, R. & Nelms, L. (2004). Breaking Cycles, Building Futures. Promoting inclusion of vulnerable families in antenatal and universal early childhood services: A report on the first three stages of the project. Melbourne, Victoria: Victorian Department of Human Services. http://www.eduweb.vic.gov.au/edulibrary/public/beststart/ecs_breaking_cycles_best_start. pdf Centre for Community Child Health (2010c). Engaging marginalised and vulnerable families. Policy Brief No. 18. Parkville, Victoria: Centre for Community Child Health, The Royal Children’s Hospital. http:// www.rch.org.au/emplibrary/ccch/PB18_Vulnerable_families.pdf Katz, I., La Placa, V. & Hunter, S. (2007). Barriers to inclusion and successful engagement of parents in mainstream services. Water End, York: Joseph Rowntree Foundation. http://www.jrf.org.uk/bookshop/ ebooks/barriers-inclusion-parents.pdf Watson, J. (2005). Active engagement: strategies to increase service participation by vulnerable families. CPR Discussion Paper. Ashfield, NSW: Centre for Parenting and Research, NSW Department of Community Services. http://www.community.nsw.gov.au/documents/research_active_engagement.pdf Winkworth, G., Layton, M., McArthur, M., Thomson, L. & Wilson, F. (2009). Working in the Grey – Increasing Collaboration Between Services in Inner North Canberra: A Communities For Children Project. Dickson, ACT: Institute of Child Protection Studies, Australian Catholic University. http://apo. org.au/sites/default/files/In_the_Grey.pdf Winkworth, G., & McArthur, M. (2007). Collaboration and systems of support for vulnerable children and their families: improving the interface between primary, secondary and tertiary interventions. Communities, Children and Families Australia, 3 (1), 45-55. Winkworth, G., McArthur, M., Layton, M. & Thompson, L. (2010). Someone to check in on me: social capital, social support and vulnerable parents with very young children in the Australian Capital Territory. Child & Family Social Work, 15 (2), 206-215. O’Dwyer, L.A., Baum, F., Kavanagh, A. & Macdougall, C. (2007). Do area-based interventions to reduce health inequalities work? A systematic review of evidence. Critical Public Health, 17 (4), 317-335. Griggs, J., Whitworth, A., Walker, R., McLennan, D. & Noble, M. (2008). Person- or place-based policies to tackle disadvantage?: not knowing what works. York, UK: Joseph Rowntree Foundation. http://www.jrf.org.uk/sites/files/jrf/2176-policies-people-place.pdf Gillen, M. (2004). Promoting place: elevating place-based discourse and new approaches in local governance in New South Wales. Urban Policy and Research, 22 (2), 207-220. Wiseman, J. (2006). Local heroes: Learning from community strengthening policy developments in Victoria. Australian Journal of Public Administration, 65 (2), 95-107. Schensul, J. J. (2009). Community, culture and sustainability in multilevel dynamic systems intervention science. American Journal of Community Psychology, 43(3-4), 241–256. Greenhalgh, T., Humphrey, C., Hughes, J., Macfarlane, F., Butler, C. and Pawson, R. (2009). How do you modernize a health service? A realist evaluation of whole-scale transformation in London. The Milbank Quarterly, 87 (2), 391-416. Greenhalgh, T., C. Humphrey, J. Hughes, F. Macfarlane, C. Butler, P. Connell, R. Pawson (2008). The Modernisation Initiative Independent Evaluation: Final Report. London: Guy’s and St. Thomas’ Charity. http://www.gsttcharity.org.uk/pdfs/mieval.pdf Stith, S., Pruitt, I., Dees, J., Fronce, M., Green, N., Som, A. & Linkh, D. (2006). Implementing community-based prevention programming: A review of the literature. Journal of Primary Prevention, 27 (6), 599–617. Moore, T.G. and Fry, R. (2011). Place-based Services: A Literature Review. Parkville, Victoria: Centre for Community Child Health.

About the Centre for Community Child Health
The Centre for Community Child Health (CCCH) has been at the forefront of Australian research into early childhood development and behaviour for over two decades. The CCCH conducts research into the many conditions and common problems faced by children that are either preventable or can be improved if recognised and managed early.

34.

35.

36.

37. 38.

Policy Briefs
Policy Briefs aim to stimulate informed debate about issues that affect children’s health and wellbeing. Each issue draws on current research and international best practice. Policy Briefs are produced by the CCCH, with peer review and advice from an editorial board of national experts, and an advisory group of experts in children’s policy and service delivery.

39.

40.

41.

42.

43.

References
A full list of references and further reading used in the development of this Policy Brief is available from: www.rch.org.au/ccch/policybriefs. cfm

44.

45.

Next Policy Brief
Policy Brief 24 will address children’s mental health.

46.

47. 48. 49. 50.

Subscribe
To receive Policy Brief e-alerts please visit: www.rch.org.au/ccch/ mailinglist.cfm

51.

52.

53.

Centre for Community Child Health The Royal Children’s Hospital Melbourne 50 Flemington Road Parkville 3052 Victoria, Australia Telephone: +61 3 9345 7085 email: enquiries.ccch@rch.org.au www.rch.org.au/ccch

Policy Brief 23 > 2011: Place-based approaches 6