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Home > Your Health > Equalities in Health > Areas of Work > Income Inequality, Poverty & Social Issues > Inequalities Sensitive Practice Initiative – ISPI

Inequalities Sensitive Practice Initiative – ISPI

ISPI was active from April 2006 to March 2009. It was established to test out and hone ways of developing practice that is sensitive to the impact of inequalities.

Funded by the Scottish Government, the initiative has resulted in key learning which can help NHSGGC improve ‘frontline’ practice and how these changes can be brought about and sustained.

ISPI has been able to demonstrate how a sustainable change in practice can be achieved across four settings:

  • addictions
  • maternity
  • children’s services, and
  • primary care mental health.

ISPI has also been able to make clear recommendation as to how the learning from the initiative can inform the development of inequalities sensitive practice across NHSGGC’s system.

An independent evaluation of the initiative together with a suite of reports and other useful documents from each of the practice settings can be accessed using the following links:

Some of the key documents relating to the initiative are listed below:

Evidence Briefing

The theory that inequalities sensitive practice is an effective approach that can impact positively on health inequalities, draws on literature that describes practice that has been undertaken within NHSGGC, the UK and across wider European and international settings. ISPI commissioned the production of a briefing paper that reviews and highlights this literature. This ISPI Evidence Briefing provides useful information for those involved in efforts to develop and support an inequalities sensitive practice approach at individual and organisational levels. Click here to see report.

ISPI Evaluation Report

An independent evaluation of ISPI was commissioned from Avante Consulting. An action research, dynamic methodology was used in evaluating the initiative, with the evaluators working closely with the initiative throughout its period of activity.

This document details the approach taken within ISPI and describes key learning, messages and recommendations for future development of inequalities sensitive practice.

Case Studies

Case Study 1: Identifying and responding to the needs of adult survivors’ of sexual abuse within addiction services.

Mary’s story

Mary is a thirty four year old female. She has been addicted to drugs for many years and has a history of self harm, homelessness and prostitution. As part of a reassessment Mary was asked sensitively but directly about her experience of past or current abuse. Mary disclosed that she had been abused as a child. No one had ever directly asked before. The addiction worker engaged in discussion about how the abuse has affected her life and current circumstances. The worker recognised symptoms of related trauma and discussed how she could help support her now with these issues.

With agreement from Mary the worker arranged a multi disciplinary review and all agencies invited agreed that together they would provide appropriate interventions and coordinate, monitor and review Mary’s treatment and care.

Mary is currently

  • Stable with drug use through substitute prescribing.
  • Illicit drug free
  • Exited from prostitution
  • Maintaining tenancy
  • Refraining from self harm or suicide attempts
  • Engaging with appointments
  • Attending appointments with a trauma specialist
  • Talking positively about her future.

By proactively asking about abuse issues, the worker was able to identify trauma related issues and work with Mary to address the underlying cause of her addiction.

Case Study 2: Identifying and responding to the needs of people who have worries about money.

The Taylor Family

The Taylors are young couple with 3 children, the youngest 2 are under 5 and each has a disability. Dad works full time in fairly low paid employment with mum at home full time caring for the children. The couple are owner occupiers. Mum finds it very difficult to go out with the children as she is unable to use public transport and taxis are too expensive. Due to the children’s mobility difficulties, Mum and the children spend most of their time at home which means heating the home for most of the day and night. Due to the children’s disabilities mum has to do lots of laundry. These factors are having a big impact on the family’s energy bills. Debt has been accrued with Brighthouse, a high street weekly payment household goods store, totaling £6000 for a suite and a TV. Weekly payments to Brighthouse are £33 with 2 payments remaining on the suite. 

The family Health Visitor suggested a referral to the Healthier Wealthier Children(HWC) project following a diagnosis of significant disability of youngest child. Mum commented she did not think that a child of 2 and half years would be entitled to DLA but was happy for the referrals to be made.

Following referral to HWC the Income Maximiser assisted the family in applying for additional benefits. The family were awarded Middle Rate Disability Living Allowance (DLA) and disabled child element of tax credits. This amounted to an additional £47.80 and £52.21 extra per week respectively. Mum stated that the extra money will help with taxi costs, she can now afford hackney style taxis to get out and about to hospital appointments; this had been a problem in the past with the larger style pram. Mum can also afford taxis to go to clubs and support groups in her area. The extra money will also go towards utilities bills and mum will not have to worry as much about times when she has to heat the house for days at a time, i.e. winter 10/11 was a very worrying time. A benefit check also revealed that the couple were entitled to Council Tax Benefit, they assumed they wouldn’t be as they were owner occupiers, this saved the family £943.44 per year.

The couple were also supported to apply for a mentored loan of £500 from their local credit union and Money Matters, the income maximiser also negotiated the return of the TV to Brighthouse. A TV was purchased from a local supermarket for under £500 with repayments on the mentored loan £12 per week, £2 of which is savings with the credit union.

Engagement with the service has clearly brought about significant improvement for this couple and while this may not be the case for everyone it highlights the potential contribution Health Visitors and other key health staff groups can make to reducing child poverty.