Scoping Engagement Report
How to engage with Gypsies and Travellers as part of your work - Appendix 1
To gather evidence from experienced professionals working in a variety of agencies about how to effectively engage Gypsies and Irish Travellers. Objectives:
- Describe practices that result in meaningful outcomes for Gypsies and Irish Travellers
- Describe the process of successful work with Gypsies and Travellers for those working in statutory bodies
- Describe the pitfalls and how to avoid them
Qualitative approach, describing successful working practices in detail using a semi - structured interview. The sample will be approximately four professionals who are have successfully engaged Gypsies and Irish travellers while working for a statutory or voluntary agency.
Four professionals were interviewed, two from voluntary sector agencies, one from the NHS and one from a Children’s Centre. The overarching themes that were identified from their interviews as being key to working with Gypsies and Irish Travellers were; building trust and relationships, community development and successful practices, partnership working, cultural competence and poor practice and pitfalls.
The five overarching themes identified by the interviews help to describe some of the key issues that should be considered before starting any work with Gypsy and Irish Traveller communities. A key premise of successful work that runs through all of the identified themes is that of trust and transparency; the concept that individuals who work with these communities have to be open and honest in order to build trust. It was also obvious from those that had worked with Gypsies and Irish Travellers for a few years that there was a great deal of respect for the community members they worked with and empathy for the stigma and discrimination that people face on an often daily basis.
This report will describe work with Gypsies and Irish Travellers in a variety of statutory and voluntary settings. Based on interviews with professionals working in these settings, this report will identify the main themes that they have identified that that constitute good practice when engaging with these communities. This report will also describe process of successful engagement and methods for measuring success as identified by those interviewed. It will also examine the pitfalls that should be avoided for those who wish to start working with Gypsies and Irish Travellers to improve health and wellbeing.
A semi-structured interview was conducted to elicit detailed responses about successful working practices. The interview and informed consent process are outlined in Appendix 1. Eight professionals who are known have successfully engaged Gypsies and Irish Travellers were identified through contacts at Leeds GATE. Of these eight that were approached to take part, four agreed to be interviewed. The interviews were conducted over the phone and recorded electronically; a third party then transcribed them. The interviews were then analysed and common themes identified that will help to inform the production of a Department of Health toolkit.
Four professionals were interviewed, two from voluntary sector agencies, one from the NHS and one from a Children’s Centre. The following is a summary of their roles and a description of the type of work they do with Gypsies and Irish Travellers; this section will provide context to the responses to interview questions.
Interviewee: Sarah Mann (SM)
Organisation: Friends, Families and Travellers (FFT)
Job Title: Training and capacity Building Manager
FFT is a registered charity. The objective of the organisation is to work towards a more equitable society where everyone has the right to travel and to stop without constant fear of persecution because of his or her lifestyle and culture. FFT responds to the needs of the community as a whole and works with Romany Gypsies, Irish Travellers and new travellers. They were set up following the Criminal Justice Act of 1994, which criminalized trespass and created legal barriers to the rights of individuals to lead nomadic lifestyles. The organisation works locally, regionally and nationally. National work includes a telephone helpline and policy work with the Department of Health, Traveller Law Reform Project and Ministry of Justice. Regional work covers South East, South West and East England and focuses on community development work and capacity building in these three regions. Local work in Sussex includes a community support worker programme, a youth outreach project and a local health and wellbeing team. Their work includes advocacy, legal advice, training for mainstream organisations and capacity building.
Interviewee: Gill Francis (GF).
Organisation: NHS Haringey
Job Title: Health Inclusion Worker for Gypsies and Travellers
The need for this role became apparent after a measles outbreak among the Traveller community in Haringey, which prompted the formation of a Traveller Health reference Group, made up representatives from the local Traveller Education Service, London Gypsy Traveller Unit, the PCT and Health Protection Agency. An existing, and dormant, Traveller’s Health Visitor post was redesigned to work from a whole family approach. The role involves working with Roma, English Gypsies and Irish Travellers to improve health and wellbeing through advocacy, referral and signposting. Clients are supported to access services in an appropriate and timely way and the aim is to work towards clients being able to do these things independently. Another major part of the role is involvement in the development of a Gypsy and Traveller strategy at borough level, alongside Team Hackney. There is also work with statutory and voluntary partners to provide training for health, education and social care staff.
Interviewee: Karen Harvey (KH).
Organisation: SureStart Children’s Centre, Great Yarmouth
Job title: Manager
Children’s centres are developed in line with the needs of the local community. There is a core set of services they must provide including; child and family health services such as health visitors; childcare and early learning; advice on parenting and access to specialist services like speech therapy, healthy eating advice, help with managing money and help to find work or training opportunities. The Children’s Centre in Great Yarmouth mainly works with Irish Travellers from the local site. A specialist Health Visitor for migrant workers and Travellers runs a clinic from the children’s centre and does outreach work on site, alongside a member of the children’s centre staff. The work with Travellers is relatively new, however mums are starting to bring their children to the centre and a community building is being developed on the Traveller’s site, which it is hoped will facilitate further outreach and activity programmes from the children’s centre and a variety of other agencies including the local GP practice.
Interviewee: Jon Hindley (JH).
Organisation: Healthy Living Network Leeds
Job Title: Projects Manager
Healthy Living Network Leeds are a company limited by guarantee and a registered charity who aim to build capacity and address health inequalities through sharing information and building relationships and trust within local communities. They work to the principles and values of community development, empowerment and self - determination. They aim to enable and empower the people of Leeds to make small changes towards a healthier lifestyle, and encourage a sense of well being through a range of projects and services.
Work with Gypsies and Irish Travellers
Healthy living Network Leeds (HLN) have been working in partnership with Leeds GATE for three years to run Community Health Educator courses for the Gypsy and Irish Traveller communities. The director of Leeds GATE suggested the idea for these sessions around six years ago, but it wasn’t until 2008, when funding became available from the NHS, that the sessions could start.
As a starting point for the pilot programme in 2008 staff from Leeds GATE and HLN went out to into the community to discuss with women what they wanted from sessions like these; what content, where it should be held, how long sessions should run for and so on.
From the start sessions have adapted according to what participants want in terms of structure and content. The sessions are now in two sections; a health topic that participants agree is of importance and a healthy cooking session. Activities include discussions about childhood immunisations, fitness classes, self-defence and relaxation.
Childcare provision and transport enables women to attend and the major benefits of the sessions are not solely from the health information given. The mental health and emotional benefits the women appear to experience come from having the opportunity to step out of normal life for a few hours and being able to discuss more intimate or taboo subjects such as sex education or domestic violence.
The transcribed interviews were analysed with a view to identifying themes that would provide further information about successful working practices, pitfalls to avoid and key issues that people planning to work with Gypsies and Irish Travellers might want to consider.
Theme 1. Building trust and relationships
A very strong theme across all four interviews was the importance of not going into this kind of work cold, but ensuring that there was an introduction from a trusted worker or organisation.
SM discusses how all their new staff members are introduced to community members by someone else ‘who already knows the family or who already knows the individual’. She goes on to suggest that this is critical for the first introduction and that working for a trusted organisation is also helpful to start building relationships.
JH also suggests using an organisation that has already built trust with the communities ‘would be logical starting point for them to start doing some work’, while both GF and KH recall that their own starting points were to link in with agencies or professionals that had already built relationships;
“Well the main thing is that I was linked with those agencies that were involved in the setting up of the job like the London Gypsy and Traveller Unit with Hackney Homes who had relationships with Travellers so I could have an introduction and try and have a bit of credibility” (GF)
“The specialist Health Visitor who’s much more experienced in this area and she’s made a big impact going on site and obviously caring for the women and the children…I’ve had a member of staff that did some training and then was going out to offer some activities alongside the specialist” (KH)
Expectations of new workers
SM suggests that new workers shouldn’t expecting people to confide personal issues to them straight away, but that the worker should accept the presenting issue. Demonstrating success in dealing with what will probably be a technical and ‘non – emotive’ issue helps to build trust in that individual.
GF also mentions that from a statutory agency perspective it’s important not to ‘parachute’ in your expertise and think you’re going to go in and save the community from themselves, but to take time to build partnerships with the community.
Another strong theme across all of the interviews was the length of time it takes to build trust with community members once a worker has made links. Two participants also discussed what appears to be almost an ingrained mistrust of professionals from statutory organisations.
GF says that despite introductions by local agencies and doing a lot of legwork on site telling them people about her role, she struggled to build her caseload, as trust was slow to develop. As a result it was six to eight months before she got her first case. She goes on to elaborate that part of the problem is a cultural mistrust of statutory services, especially social workers;
“I would tell people that (my job title), all they heard was worker and then they’d think Social Worker so unfortunately for Social Workers they’re associated in the Traveller community about taking children away and so I think there was a mistrust because of that”.
SM also mentions the widespread mistrust of statutory services within these communities;
“I would add a note of caution which is that workers from statutory services will need to recognise that because they come from a statutory organisation there may always be a barrier or element of fear there because they are linked into enforcement services… it’s likely they work in a social services environment or an education environment or within a planning authority linked to those individuals and that they will have a corporate responsibility…the Travellers they work with will be aware of that because you’re part of that organisation and so people are going to be wary about telling you something that may lead to an unfavourable action against them.” (SM)
She goes on to say that lack of trust and low expectations are even more acute for those who are homeless within these communities;
“…on an unauthorised site the families are going to be aware that in twenty-four hours they might be evicted now how much trust are you going to get? How much are people going to open up to you when you’re into that situation where people are playing a game for survival” (SM)
Slowly building trust
According to GF one reason it may take a while to build trust is due to fears about confidentiality and goes on to suggest that this is something that can take time to overcome;
“…sometimes Travellers will ask you something about somebody else, I’m always very careful not to discuss anybody, so because they’ve seen that when asking about other people I think that’s built trust so that (they know) when they’re ready to talk to me I’ll never talk to anybody else about their issues.” (GF)
SM goes into the issue of trust further, discussing how in her experience the steps to building trust are through practical help, advocacy and outreach and how if problems are resolved successfully and trust built that way this can eventually lead to requests for support with more personal issues such as emotional issues or domestic violence. However she also cautions that it can take several years before you get to this stage.
Theme 2. Community development and successful practices
Community development and confidence
A community development approach was seen as the cornerstone of work with these communities. GF suggests that a community development approach is essential as “I can do crisis management work all day long, week in, week out, if I wanted to but there’s nothing that will lead to a reduction in the need for me if there’s not the development work.”
Initial contact with clients who have become more involved in activities such as training, management committees or peer education has often been the advocacy or support work mentioned above. From this starting point a great deal of work goes into building skills and confidence before an individual can feel empowered to manage their own lives, get further training or become and advocate for their own community.
SM suggests that trust forms the basis of community development work and it isn’t until this base has been formed that individuals within the community can start to feel confident enough to become more involved with other activities. However this can be a time consuming process;
“none of the individuals who came to do that (cultural awareness) training with us for none of them was it their first engagement with us, some of those individuals we will have been working with over a number of years perhaps going back five years or more” (SM)
Offering opportunities for clients to become more involved with activities requires having a lot of opportunities available that might appeal to people and also being aware that people will be "ready to engage with different things at different stages in their lives" (SM).
Expanding on this SM goes on to say that it is important that people using a community development approach have to have realistic expectations about the capacity of individuals who are requiring support around issues such as mental health, domestic violence or accommodation.
JH discusses that he felt that having the same people each week meant that community members got to know the staff, who have now been consistent figures throughout the three years the project has been running. Now he finds that the women ‘would just say anything to you in the end which was a great compliment really as it meant they felt really easy…’ and that ‘it developed into something quite strong really"
Successful Working Practices
JH suggests that one of the factors that contributed to the success of the CHE programme was ‘maximum informality and as few rules as possible’. KH also discusses the informal approach used by her children’s centre worker and Health Visitor, which helped them to build trust and relationships;
“The Health Visitor was gaining some access to vans but not always, but what we were doing which we found was a really good way of offering something that was what the Travellers wanted and also enable access was that one of our workers had been a beautician in the past and we went and spent quite a bit of money on really good quality makeup and we were offering makeovers and the women loved it, all ages…so then our health visitor was getting access into vans that she hadn’t been into before and lots of chat was happening and so that was a really good”
JH also discusses how a variety of taste, sight, smell, physicality and practical experiences in each session meant that people weren’t getting bored and would come back week after week, which allowed relationships between staff and community members to develop;
“the variety, the pace of it has to be fast you know, I’ve worked with loads of different groups I’ve never seen anybody cook so fast in my life, you have to keep up and you can’t sit around there’s no gaps really no vacuum the only time there’s a vacuum is when they want one is when they want to ‘oh I’ve had enough now I need a cup of tea I need a fag’” (JH)
However JH suggests that ‘the biggest tool for us was humour, that was one of our most successful tools, all of the CHEs’ had a well developed sense of humour and the women have got an incredible sense of humour’ and that key attributes of a successful programme include ‘pace, innovation, creativity, transparency’
Consultation and community led approaches
SM suggests that one of the keys to the success of their training programme in changing attitudes within health and other statutory agencies is due to Travellers developing their own presentations so that the issues being highlighted are those that community members feel are the important points.
JH feels that a process of not dictating rules and ensuring there is consultation and negotiation about the process and content of programmes was essential to the success of the CHE course;
“some element of negotiation some element of consultation and listening so that the women or the men can talk a bit about their lives and you can ask questions” (JH)
In establishing priorities for her work GF reports that she held a focus group to establish what the health needs of the community were;
“we had a focus group with Traveller women to talk about what they felt was important, what they felt the issues were for them around health, one of the recurring themes was about accessing antenatal care … so one of the things we did was simplify information and gave people ideas about the why of things”
As part of another project GF responded to reports of poor reception and treatment from health staff as a barrier to accessing services and as a result has involved Travellers in producing a handbook that demystifies their culture.
Theme 3. Partnership working
All four participants discussed partnerships as being central to the success of their work as they have enabled access to communities, given support and provided opportunities for joint working that can help to address the wider determinants of health such as accommodation and access to services.
GF reports that she had a lot of support from partners from the outset and this has made it easier for her to be successful in her role;
“… very much support and that’s why it’s been very easy to work across the different sectors, the London Gypsy and Traveller Unit and Education the Health Protection Agency and Hackney Homes, they were involved at the outset so they had some ownership. This wasn’t a post that was kind of foisted onto them so I really felt although I’m just one person which can end up seeming quite tokenistic, because I work with other agencies it’s like a virtual team really.”
Interestingly she also talks about partnership in terms of the community as well; ‘trying to build a partnership with the community, definitely, and be prepared for that to take a while’
SM talks about partnerships in terms of building contact with external organisations those clients may be referred to in order to ensure that any barriers to access are removed;
“We were aware of at the beginning of the (community outreach) project that we didn’t want to set ourselves up as a replacement for generic advice access pathways but to approach those service providers and make sure they would be welcoming … that’s another part of the work that we do… capacity building of mainstream statutory and voluntary organisations to get better cultural awareness and better service provision.” (SM)
JH refers to his project as ‘a straightforward piece of strong partnership work with GATE…they’ve built up this trust so they recruit the group members and have trained our staff on cultural competence... we provide tutors and staff as well as lunch and refreshments’.
KH meanwhile talks about their aforementioned starting point with the Health Visitor then goes on discuss to a more strategic partnership approach; ‘the main agencies work really well together and the Health Visitor has a steering group, there must be at least fifteen people sitting there; health advisors, PCTs, housing sitting there, the police are there’
Theme 4. Cultural Competence
All participants stressed the importance of being people educating themselves about culture and history before they started working with Gypsies and Irish Travellers, this was seen as important for providing a culturally sensitive service.
“I think people should educate themselves before because it’s a culture that most people don’t know anything about, so I think it’s to find some training for staff to find out the history and the cultural norms and I think it’s really important to inform yourself before you set foot on site.” (KH)
SM also mentioned this as being key to engaging with people, with particular reference to being concerned about signposting clients to an agency that wasn’t culturally competent;
“…you know… because they’re not going in with that understanding that cultural awareness is important, people do have either misunderstanding or no understanding that there are cultural specifics around working with Gypsies and Travellers, but working particularly around overcoming trust and recognising literacy issues, recognising the level of disengagement and then personal things where you know there are particular cultural relevancies about accessing healthcare or discussing personal issues which people need to understand to be effective” (SM)
SM goes on to discuss how becoming culturally aware and culturally competent is an important starting point for any work, something which she feels people in the health service aren’t as aware of as those in the third sector.
Another interesting theme that emerged, related to this, was the importance of being aware of one’s own prejudices, JH suggests that it was very apparent to the women he worked with when someone had prejudged them;
“I would say was that it was they possibly detected the fact, like they use words like a bit snotty or stuck up her own arse, so I suspect that they thought or put a value on that women or that female tutor that they thought was looking down on them, so I think it was or if they detected any fear or apprehension or anxiety” (JH)
He goes on to say that one of the first steps towards working successfully with these communities would be to look to yourself and examine your own attitudes first;
“I would say the first thing is to be really aware of your prejudices, because we all carry those, so they’d have to be looking to themselves really, without this sounding too like Buddhism, but they would have to look deep into themselves to see how they felt about this community … the next step I would say is to have a bit of cultural competence training.” (JH)
This was a theme that also emerged in the interview with SM, she discussed the importance of managers recognising that their own perceptions and those of their staff will have been coloured by discriminatory and negative media stories. She also suggests that recognising the capabilities and knowledge of staff and being aware that they will need support with cultural awareness is essential, before they start going in to do any work;
“in order to start doing good work they’re going to have to do some learning and get themselves some cultural awareness … and not to expect their staff to suddenly be able to overcome their prejudices without support because that’s unrealistic, that’s unfair on your staff, if you’re planning a new service.” (SM)
She goes on to say;
“ …one of the things I will always say to people, don’t send people in cold and where we’ve really learned that is where if you’re expecting a statutory organisation to initiate work with Gypsies and Travellers you have to recognise the capabilities and the knowledge with your staff first and to deal with that and I think that’s critical at the beginning.” (SM)
GF also mentions negative media stereotypes that shape people’s perceptions and perpetuate acceptable racism towards Gypsies and Travellers, even among professionals. She suggests that a method of dealing with this is to build relationships in order to influence those attitudes;
“I’ve had to now just ride that and build relationships with those staff so that I can be in a position to influence them in a positive way rather than just you know stamp on things and then you just create alienation you know... ” (GF)
She goes on to give more detail about how to challenge negative attitudes held by professionals;
“you have to find a way, without colluding with it, you have to find a way to challenge that in such a way that you maintain your ability to influence them positively and let them reflect on what that really means in terms of how they deliver a service to that person from the community” (GF)
Theme 5. Poor practice and pitfalls
Each interviewee was asked directly about examples of poor practice and pitfalls they may have come across in their own practice. Aside from the fundamental issue of prejudice and training requirements discussed above, other responses included being too formal or appearing to be patronising and not ensuring that the setting you are working in is appropriate to the needs of those you are working with.
Where CHE sessions haven’t gone well JH has attributed this to the women being very alert to guest tutors who might be ‘looking down on them’, who were seen as being wary of them or anxious, or were very formal in the way they ran the session;
“If it was in a very structured school like way …they like chatting but they didn’t like the sessions when they were turned into kind of a classroom, you know ‘we’re going to do this and then we’re going to do this’ if they couldn’t see the point of it or they thought it was like they were at school.”
It was also important that those delivering activities didn’t have their own agenda, but were there in a supportive capacity in order to provide information
“Where we had tutors that were very formal or perceived as a little bit patronising the sessions failed.” (JH)
SM discussed what she knows doesn’t work, particularly if your starting point is to hold a meeting;
“what we know doesn’t work … is that you set up an independent meeting at a location which perhaps people aren’t familiar with like a village hall which they wouldn’t normally use that they wouldn’t feel secure or confident about visiting … we’re aware that a lot of Gypsies and Travellers are not mixing and are not engaged with mainstream community services and won’t have the confidence” (SM)
She goes on to add it is essential to ensure that a venue is chosen that people are going to feel comfortable in;
“we would try to set up an initial meeting either on a site in somebody’s home where it’s agreed with the people that would like to come to the meeting is most convenient for them …overcoming that confidence barrier to get an initial setting an initial meeting is critical.” (SM)
Expectations from Managers
This was a theme that emerged particularly in relation to monitoring and evaluation. Many of the outcomes that people mentioned were soft outcomes that are difficult to measure such as increased confidence or knowledge and it was recognised that not only do these take a long time to achieve, but that due to the length of time it takes to build trust, client numbers might be low. This is something that managers don’t always appear to appreciate, which GF neatly summarised as;
“There has to be an understanding above that health professionals’ grade, the management need to understand … I did have one statement from somebody who said oh you’ve got to get your activity up you’ve got to get your numbers up and to me that demonstrated lack of understanding … having an understanding from management that the needs are complex and that it’s time consuming is a really key thing so it’s not just about numbers … it’s about not the quantity of work but the quality.”
The five overarching themes identified by the interviews help to describe some of the key issues that should be considered before starting any work with Gypsy and Irish Traveller communities.
It was interesting to note, however, that a key premise of successful work that runs through all of the identified themes is that of trust and transparency; the concept that individuals who work with these communities have to be open and honest in order to build trust. It was also obvious from those that had worked with Gypsies and Irish Travellers for a few years that there was a great deal of respect for the community members they worked with and empathy for the stigma and discrimination that people face on an often daily basis.
The advice contained in these four interviews should help to guide both managers and policy makers to work out an appropriate strategy before commencing any work with communities in their own locality.
Helen McAuslane April 2011
Leeds GATE Toolkit Survey
Leeds GATE have been commissioned by the Department of Health to write a toolkit to help professionals working in statutory agencies to work effectively with Gypsies and Irish Travellers. We have identified you as someone who has experience of working with these communities and whose work has led to meaningful outcomes for those who are involved.
The aim of this interview is to answer the following questions:
- Describe practices that result in meaningful outcomes for Gypsies and Irish Travellers
- Describe the process of successful work with Gypsies and Travellers for those working in statutory bodies
- Describe any pitfalls and how to avoid them
What will follow is a series of questions that seek to answer these questions. Your answers will be used to inform the toolkit and illustrate key points. You can choose whether you and your organisation are identified in the final publication, if you choose to remain anonymous all identifying characteristics about you and your organisation will removed from your answers. If you choose to be identified we will ensure that anything that could identify individuals you are working with will remain confidential. You do not have to answer all of the questions and you have the right withdraw from the interview at any time, even after we have finished.
This interview should take around 30 – 45 minutes, your answers will be recorded and transcribed by a third party, who is also bound by confidentiality. If you have any objections to this please let me know.
1. Do you want you or your organisation to be identified in the final publication of this toolkit? YES/ NO
Job title, organisation, size of Gypsy/Traveller population in your area. Do you work with Gypsies, Travellers or both?
3. Describe your current or most recent work with Gypsies/Travellers
- Who is involved?
- How many Gypsies/Travellers?
- How does it work? e.g. funding, practicalities (frequency of meetings, transport etc…)
4. How did this work start?
- What was the impetus? (e.g. policy, health needs assessment, your own observations, voluntary sector colleagues…)
- Was there a statutory requirement?
- Was there support for the project from colleagues and managers?
5. From that starting point how did you get to where you are now?
- How long did it take?
- What were the steps along the way
6. How do you know what you are doing is working?
- what outcomes do you measure ?
- How do you monitor and evaluate ?
- How long did it take before you started seeing or hearing about any changes?
7. What, if anything, went wrong?
- How did you rectify this?
- Could it have been avoided, if so, how?
8. Have you come up against any difficulties in doing this work?
- How did you resolve them?
9. What constitutes good practice when working with G/Ts, particularly when you are working in a statutory role?
10. What constitutes bad practice?
11. What advice would you give a fellow health professional who wanted to start working with Gypsy and Traveller communities?
12. Any other comments