Cash-First Programme: interim evaluation - updated

Appendix 8: Case Studies

Appendix 8(a): Engaging People with Lived Experience

This case study provides an example of engaging People with Lived Experience to incorporate their views into service design and development. It is based on the Cash-First Delivery Partners in Aberdeen City (where Aberdeen Council of Voluntary Organisations (ACVO), the Delivery Partner, is engaging those with lived experience for the first time), and Aberdeenshire (where there was an established people with lived experience mechanism in Aberdeenshire Council). The case study draws out key learnings from the initial six months of Cash-First work.

Understanding the value of lived experience

Experiencing food insecurity is a very distressing and vulnerable situation to be in. Engaging those with experience of food insecurity in service design and development can help overcome key barriers to accessing support. Be these systemic (such as a lack of programme awareness or issues with application forms and procedures) or psychological (such as lack of consideration for inclusive language and fears of being stigmatised).

Involving people with lived experience in the design stages shapes services around need from the outset reducing the risk of issues with service design. Engagement with experts by experience can also improve individuals’ understanding of services offered, and may help raise awareness more generally amongst communities, for example through informal conversations amongst peers.

Engaging people with lived experience

From the outset, there needs to be an intrinsic belief and understanding that engaging with people with lived experience is valuable. In order for it to work, this should be part of the strategic approach and values of working for the local area.

Both Aberdeenshire Council and ACVO work closely with local networks and partners to identify and encourage potential participants to take part. This might include staff attending or facilitating meetings, events and focus groups with potential participants, using social media channels, and providing strong and engaging communications.

Once people with lived experience have been identified, an important step is providing the opportunity to have an open conversation, either one-to-one or in a small group. This will help ensure individuals are aware of what is being asked of them, any remuneration or compensation that will be offered, boundaries and confidentiality, and what the engagement is seeking to achieve. This also provides an opportunity to signpost or refer to any support services the person may need.

Engagement methods vary depending on whether the Delivery Partner is new to engaging people with lived experience, or if they have an established approach. For ACVO, this is a relatively new focus of activity, and the emphasis is on face-to-face engagement as a means to develop trust, especially with seldom heard or hard to reach groups and individuals. This usually involves working with local partners who already engage these groups and attending events that are already planned.

In Aberdeenshire, where there is an established approach in place, the Council’s lived experience network engages across multiple pathways. The principal route is via online focus groups. Recognising that not everyone feels comfortable in this forum, the network also offers opportunities for people to engage individually, anonymously or within an appropriate setting of their own choosing. Their approach is enshrined in the Aberdeenshire Council lived experience charter, which provides a set of guiding principles for engaging with people with lived experience, and guides these interactions. These principles, and others, are reflected in the “Tips for those considering engagement/continuing to engage people with lived experience” sections below.

Aberdeenshire Council also has an Engagement Officer for People With Lived Experience, indicating a strategic-level commitment to this approach. This not only provides a crucial resource to services across the region who want to adopt this approach, but also signals to services and partners the importance of it. In Aberdeen, while the approach is less well established, ACVO is learning from a range of sources, including from the Food Poverty Action Aberdeen (FPAA) Lived Experience group, which was established earlier this year (2024).

Overcoming barriers to engagement

Barrier #1: Limited or no experience of service design

Many people who access services may never have been asked for their views or may not believe they have anything of value to contribute. The prospect of engaging in this way can be daunting, and lack of understanding, knowledge or confidence may discourage people from becoming involved.

It is important that individuals are fully informed about what is being asked of them before deciding to participate, and that they are given information about this in appropriate formats and languages. People should never feel pressured to make a decision about participation and should be given sufficient time to make an informed decision.

Barrier #2: Digital and other skills barriers

Digital barriers to engagement can exist amongst potential participants. These include poor digital skills and low levels of confidence in using the tools available, as well as lack of access to digital devices.

People being asked to engage will need support and, often, training to do so (for example committee skills, or using digital tools). This should be planned and resourced in advance, so that people feel valued and do not disengage early in the process.

For example, to remove digital barriers, ACVO conducts all engagements in person. On the other hand, Aberdeenshire Council ensures all participants have access to appropriate devices, and provides digital skills training through the Council’s employability service, if this is required.

Barrier #3: Supporting different life circumstances and cultural differences

Individuals invited to participate often find themselves in highly vulnerable situations. As such, engagement methods need to be flexible and tailored to individual circumstances as much as possible. In practice, this can mean a mix of online and face-to-face meetings, focus groups, and drop-in sessions hosted by relevant third sector organisations or other services, where people with lived experience can speak to project staff openly and safely.

For example, Aberdeenshire Council holds two-hour monthly meetings with its people with lived experience group, with questions to be addressed at each meeting circulated a month in advance to allow time to prepare. Where people join remotely, there is no requirement to have cameras or microphones on, and people can type their contributions into the chat function. Anonymised “personas” can be adopted by participants if needed, ensuring that a safe space is created.

In Aberdeen, ACVO engages people with lived experience through drop-in sessions facilitated as part of existing supports, for example through alcohol and drug awareness charities’ regular meetings. This ensures that people only engage if they choose to. This approach minimises barriers to engagement by being in an already familiar environment and means people do not need to attend any additional meetings in order to engage.

Recognising the level of commitment asked of people with lived experience, both Delivery Partners offer a “thank you” to reflect the time that they have given to the Delivery Partners and for their contributions. This can be in the form of a voucher and can vary according to the level of involvement. A voucher is often considered preferable to cash as this will not affect benefits payments, though cash payments can be made when and if appropriate.

Participants are often dealing with difficult circumstances and may disengage unexpectedly. If participants do not attend an event or engagement opportunity when expected, staff will contact them, in part to check on their wellbeing and to confirm whether they are willing and able to rejoin. Ultimately, every engagement offers an opportunity to signpost or refer for additional support.

It has been recognised by Aberdeenshire Council that some individuals are less comfortable engaging in group settings. This is sometimes due to concerns that their culture or personal circumstances may impact on their ability to contribute openly and honestly. For example, in other projects, Aberdeenshire Council has engaged with the travelling community within a setting of the participants’ choosing.

Tips for those considering engaging people with lived experience for the first time

• Establish a relationship of trust and transparency from the outset. This relies on clear and open communication, and ensuring individuals have the opportunity to ask any questions they may have.
• Local services and networks that can include Third Sector organisations and others are key partners in identifying and reaching potential participants and may offer a safe space to meet. Using trusted partners can also support the representation of untraditional voices.
• Recognising that communities have different needs; it is important to ensure voices are heard from all communities and therefore recruitment strategies should take this into consideration. Engage with people with lived experience in a manner that is suitable to the individual, in terms of both time and methods of engagement.
• There are many different areas that people with lived experience can contribute to, including service design, delivery and interpretation of findings and data. It can also be beneficial for participants to propose topics for discussion at future meetings, as this can both demonstrate committee skills and enable participants to discuss the most pertinent issues to them.
• The purpose is to value the experience, rather than challenging or interrogating the individual.
• Ensuring that every question and conversation with people with lived experience is solution-based and related to making a difference at the end of the process helps to guide conversations. The role of co-ordinators is to listen to the answers, and to offer potential solutions where possible, and to ensure expectations are met.
• People being asked to engage may also need support with their own circumstances, and staff should be aware of referral and signposting routes that can offer this.
• There should be consideration of how to demonstrate the value of and renumerate contributions and ensure the commitment that has been made is respected. This may be in the form a voucher or similar and may vary depending on the type and frequency of engagement.
• There are benefits to individuals as well as to organisations from being involved in service planning and design. These can include increased confidence, awareness and feeling valued in giving their opinions.

Tips for those continuing to engage with people with lived experience

• It is recognised that all lived experience is valid and brings valuable learning and insight, regardless of what an individual’s specific needs may be and what services they may have accessed. There is value for organisations in understanding that all lived experience can feed into the design of a service, even if the people in question may not be accessing or eligible for the service. Therefore, even people not accessing Cash-First services can still provide worthwhile contributions that can influence service delivery.
• Everyone has a right to a voice and view, and co-ordinators and services must be open to hearing all views, including more challenging perspectives, and to take these on board.
• Continuing to be flexible in approach is key in ensuring that engagement is always on the person’s terms. This can be in terms of their time commitments, their experience, or safeguarding their sensitive information. It takes a lot of courage to be vulnerable with others, and it is important for this to be recognised.

Appendix 8(b): Strengthening Local Referral Pathways

This case study provides an example of how local referral pathways can be strengthened. It is based on the Cash-First Delivery Partners in Edinburgh and Glasgow. These areas are taking different approaches and provide different learnings. Both Delivery Partners are at relatively early stages and so this case study draws out key learnings from the initial six months of work.

First step - understanding the current context

Before embarking on a systems change approach, both Delivery Partners devoted time and resources to understanding the current context. Mapping the landscape and understanding the needs of the local populations takes time and consequently, most of the time and resource in the initial six months has been devoted to building a strong knowledge base.

Understanding the local context. Both Delivery Partners have been mapping existing services and provision to understand current pathways and the range of organisations involved. Edinburgh has mapped all of the organisations in the city involved in distributing food to people in need, and is now mapping infant food insecurity pathways. The Glasgow Delivery Partner is undertaking its mapping by working with existing networks and already established relationships, and have learned that the local system is complex and can be fragmented. The Delivery Partner recognises that it is an ever-changing landscape, and so it is important to continue to monitor the system, for example any new organisations or services, or any change in, or cessation of activities.

Building relationships. With a growing understanding of the local system, significant time and resource has been dedicated to building local relationships. Understanding the key players and service processes used is fundamental to develop more effective approaches to service provision and addressing need. Both Glasgow and Edinburgh Delivery Partners are leveraging existing relationships to raise awareness and reach all relevant organisations. This approach, using trusted intermediaries, including the local Third Secor Interface (TSI), has proven effective in reducing barriers to cooperation and knowledge sharing. Third sector interfaces (TSIs) provide a single point of access for support and advice for the third sector; each Local Authority in Scotland has its own TSI. The TSIs in each city have played a central role in helping to develop Cash-First networks and relationships.

Collecting data and intelligence. This is seen as important to decide what is truly needed in the local context, but also as a way of better understanding how things are changing, and hopefully improving over time. Edinburgh has a smaller population and, as a result of the mapping exercise, a relatively well-defined service landscape. Given this smaller population, its approach has been to engage directly with services and service users to understand need, context, and shape referral and support pathways. Edinburgh has engaged with service users and frontline volunteers in food banks and pantries to understand their needs, and test and refine approaches to streamline pathways. The close engagement with experts by experience should result in a needs-led, rather than a service-led, provision.

Glasgow has a much larger population and a more fragmented and complex landscape. It also has more people and households with complex needs. The focus in Glasgow is to access data to understand levels and types of need, the profile of users, causes underpinning food insecurity, and the triggers that force people to access food banks. Glasgow’s No Wrong Door approach aims to streamline access to essential services to address poverty, and foster collaboration. This has been a key resource for the Delivery Partner as it is a valuable source of data and helps the Delivery Partner to access organisations. However, the Delivery Partner has established that the data that exists around food insecurity is patchy and fragmented. There are also challenges to sharing data between organisations and new data sharing agreements will be required. In response, the Glasgow Delivery Partner has established a data sub-group to focus on overcoming these challenges.

Flexibility in approach early on. The Edinburgh Delivery Partner has decided to commit some Cash-First funds to provide cash payments combined with wraparound support. The Delivery Partner will target very specific population groups or localities to test the impact of providing cash in a crisis. These have been identified by working with partners at the City of Edinburgh Council to understand food bank referral rates and barriers to access across localities, and to identify routes to targeting families in temporary accommodation as a priority group. This flexibility within the overall workplan in Edinburgh is a strength as it will enhance the learning and inform how services are shaped and new approaches rolled out.

Communication as a way of overcoming barriers

Open, high quality and transparent information is recognised as being critical by both Delivery Partners, as open lines of communication can help improve understanding, and overcome barriers to change or resistance to implementation. Currently, engagement and information sharing is largely face-to-face but when relationships are more established, these are likely to take place remotely.

Barrier #1 - Understanding the fundamentals of the Cash-First approach.

There is evidence that understanding is currently inconsistent across local partners. There appear to be some pockets of scepticism about the efficacy of a Cash-First approach along with concerns about how recipients may use the money. This demonstrates the importance of working closely with stakeholders to address concerns, and tackle stigma and misperceptions. An example of how this can look in practice can be found in Glasgow. The Glasgow Centre for Population Health published a Cash-First ‘explainer’ on social media, and shared it with the other seven Cash-First Delivery Partners.

Barrier #2 – Developing a common strategic approach.

For streamlined, cohesive and high-quality service provision within a place-based system, it is important that there is a common set of standards across services. This will include consistent and appropriate language, terminology and adherence to protocols. There need to be resources in place to ensure this leadership is provided.

Barrier #3 – Identifying knowledge and skills gaps.

In undertaking mapping and engaging with frontline services, staff, and volunteers, the Delivery Partners have identified that staff and volunteers do not always have the skills they need to operate within an enhanced and streamlined referral support system. Some of these gaps relate to how they communicate with service users, ensuring a fair and non-judgemental distribution of food, and other ‘softer’ skills, such as interpersonal skills and emotional intelligence, enabling empathy and respect. The two Delivery Partners are organising training events to build skills and knowledge. In addition, in Edinburgh these are being supplemented by a series of networking events aimed to help forge stronger links across organisations and deepen the Delivery Partner’s understanding of local need.

Tips for those planning system change approaches at local level

These tips focus on the early stages of systems change. They highlight the importance of committing sufficient time and resource to lay strong, evidence-based foundations.

• Understanding the range, scope and role of services and potential delivery partners is an essential first step in planning systems change.
• Mapping activities should identify gaps in service provision as well as any unnecessary duplication.
• Building effective networks and partnerships is critical to planning and implementing sustainable systems change. This requires significant time investment and effective communication.
• Regular review of, and engagement with, services is needed to ensure that an accurate and up to date understanding of the support ecosystem is maintained.
• To ensure buy-in and ownership, as well as streamlined service pathways, work will be required to reach an agreed and shared understanding of the objectives of the project amongst all stakeholders.
• There is likely to be a need to establish new data sharing agreements between organisations.
• There may be a need for early work to address misperceptions or negative attitudes towards a Cash-First approach. This may be required at an organisational level as well as with staff and volunteers.
• The knowledge and skills of staff and volunteers are critical to successful systems change and enhanced provision. The process of developing referral pathways should include a skills mapping exercise. Based on this, a learning development plan should be developed and delivered.
• To develop new or enhanced referral and support pathways, Delivery Partners must have a well-articulated scope and clear boundaries to their activities. This is necessary to maintain the focus on project aims and mitigate the risk that, in a complex service landscape, there is pressure to expand objectives and lose focus.
• To design a fit-for-purpose and streamlined pathway, there must first be a very good understanding of the wide range of factors contributing to food insecurity in the locality, how these can be addressed, and which organisations have a role to play at the different stages of the pathway. This can be achieved through engaging people with lived experience, undertaking research with service providers and stakeholders, and through data collation and analysis.
• The journey for each beneficiary should be needs-led and responsive. It must have the ability to adapt to changing circumstances. It must progress at the right speed for the individual(s), recognising that that those with more complex needs may step off, or backwards for a while, before re-engaging and moving forward.