Dublin City North CYPSC Health and Wellbeing Action Plan - Children ...
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Dublin City North CYPSC
Health and Wellbeing
Action Plan
The Healthy Ireland Fund supported by the Department of Health, the Department of Children and
Youth Affairs and the Department of Rural and Community Development.
1 | Dublin City North CYPSC Health and Wellbeing
Acknowledgements
With grateful thanks and appreciation to all the children, young people,
parents, and organisations who responded to surveys, organised or
participated in focus groups, and contributed to consultation days.
The actions identified in this report have been named as key priorities in our
Children and Young People’s Plan, and we will look forward to working with
Healthy Ireland and government departments and local key partners over the
coming years to see these actions through.
For further information about Dublin City North CYPSC, other publications or
updates on our work, please visit https://www.cypsc.ie/your-county-
cypsc/dublin-city-north.279.html
Alternatively, please contact:
Clíodhna Mahony
Dublin City North CYPSC Coordinator
Tusla Child and Family Agency
01 8467353 or Cliodhna.mahony@tusla.ie
Contents Page Executive Summary 3 Research Methodology 7 Needs Analysis 8 Dublin City North Health Profile 11 Dublin City North Socio-Economic Profile 14 Strategic & Policy Analysis 20 Healthy Ireland Better Outcomes, Brighter Futures CHO9 Strategic Outcomes 23 Cross Priorities Mental Health Physical Health Weight Health Sexual Health Strategic Priorities, Objectives & Actions 28 Cross Priorities Mental Health Physical Health Weight Health Sexual Health Risk Analysis Factors 34 Evaluation & Review 35 Recommendations 37 Appendices 38
2 | Dublin City North CYPSC Health and Wellbeing Abbreviations ABC Area Based Childhood Programme BOBF Better Outcomes Brighter Futures (National Policy Framework Children/Young People) C&V Community and Voluntary CAMHS Child and Adolescent Mental Health Services CHO Community Healthcare Organisations CFL Connecting For Life (Ireland’s National Strategy to Reduce Suicide) CYPSC Children and Young Person’s Services Committee DCC Dublin City Council DCYA Department of Children and Youth Affairs DCN Dublin City North DRHE Dublin Region Homeless Executive HI Healthy Ireland (National Framework for Improved Health and Wellbeing) HSE Health Service Executive HRB Health Research Board LECP Local Economic and Community Plan (Dublin City Council) NDS National Drugs Strategy (Reducing Harm Supporting Recovery) NEPS National Educational Psychological Service NPAP National Physical Activity Plan NSHS National Sexual Health Strategy NYCI National Youth Council of Ireland NYHP National Youth Health Programme OPAP Obesity Policy & Action Plan TUSLA Child and Family Agency VFC Vision For Change (Report of the Expert Group On Mental Health Policy)
3 | Dublin City North CYPSC Health and Wellbeing
Executive Summary
A Healthy Ireland is where everyone can enjoy physical and mental health and wellbeing to
their full potential, where wellbeing is valued and supported at every level of society and is
everyone’s responsibility. Healthy Ireland1 is Ireland’s national framework for action to
improve the health and wellbeing of the people of Ireland. Its main focus is on prevention
and keeping people healthier for longer. Whilst Healthy Ireland is a key policy lever, other
policies relevant to children and young people must be borne in mind.
The Children and Young Person’s Services Committee (CYPSC) is committed to providing
seamless and integrated services for children, young people and families. The overarching
aim of CYPSC is to improve the outcomes for children and young people (0-24 years) in
Dublin City North (DCN) through effective interagency structures, communication and
importantly agreed goals reflecting the five national outcomes identified in Better
Outcomes, Brighter Futures (BOBF): The National Policy Framework for Children and Young
People (2014-2020) 2.
The stated purpose of the indicator set is for BOBF ‘to track progress for children and young
people aged 0–24 across the five national outcomes’, within a DCN context via CYPSC’s own
Strategic Plan. In tandem, our intention is to ensure alignment with our Healthy Ireland
Action Plan for the period 2018-2021.
The five national outcomes that are required for all children and young people are designed
to ensure that each individual is:
(i) Active and healthy with physical and mental well-being;
(ii) Capable of achieving full potential in all areas of learning and development;
(iii) Safe and protected from harm;
(iv) Provided with economic security and opportunity; and
(v) Connected, respected and contributing to their world.
CYPSC’s Health and Wellbeing sub-group provided oversight toward the formulation of this
Healthy Ireland Action Plan comprising representatives from a range of statutory,
community and voluntary organisations with active interests in health and wellbeing.
The vision of the action plan is that the general health and wellbeing (including mental,
physical, weight and sexual health) of our children and young people are valued, promoted
and protected. CYPSC aims to do so in collaboration with our statutory, community,
voluntary and private sector partners across DCN. The overarching objective of the action
plan is to promote positive health and well-being for all our children, young people and their
families in local communities across DCN.
1
Healthy Ireland www.healthyireland.ie
2
BOBF (2014-2020) www.dcya.gov.ie/documents/cypp_framework/BetterOutcomesBetterFutureReport.pdf
4 | Dublin City North CYPSC Health and Wellbeing
Our Healthy Ireland Action Plan has the following objectives:
(i) to strengthen CYPSCs effective leadership for health and wellbeing of 0-24 year olds;
(ii) to provide comprehensive, integrated and responsive health and wellbeing services
in community-based settings;
(iii) to implement strategies for health promotion and prevention;
(iv) to strengthen information systems.
The action plan allows for adaptation at local level in order to take into account of
community specific situations and contexts. Thus, the actions proposed are to be
considered and contextualised, as appropriate, to local priorities and future needs within
communities. The actions are predicated on the following health and wellbeing domains
including cross-cutting and targeted actions within a 3-year timeframe:
Domain Action Collaboration Timeframe
Develop and design annual Statutory, Community Years 1, 2 & 3
health and wellbeing themed and Voluntary (C&V)
promotional campaigns/events. sector partners
Develop targeted interventions All relevant partners Ongoing
and initiatives across a range of
priority areas and marginalised
groups i.e. homeless, Travellers,
new communities, disabilities.
Cross-Priorities
Collaborate with lead partners HSE, DCC, LCDC, Ongoing
on the development of local and TUSLA, Colleges/
community based responses to Universities, Youth
each of the named priority Services, C&V sector
areas, in an effort to increase partners
coordination of local actions &
align health and wellbeing plans
Develop and maintain online, Dublin CYPSCs (x5) in Years 1-3
user-friendly directory of collaboration with all
services across DCN related to sectors/partners
children and young people to
increase awareness of services.
5 | Dublin City North CYPSC Health and Wellbeing
Develop referral pathways CYPSC, HSE, CAMHS, Years 1-2
guide for children and young NEPS, TUSLA, Schools,
people in communities and Community Mental
progress initiative to reduce Health Services,
waiting lists in Child Adolescent Youth Services, C&V
Mental Health Service (CAMHS). sector partners
Expand, develop and promote CYPSC, HSE, NEPS, Years 2-3
Mental Health
community evidence-based TUSLA, Schools,
mental health support services. Community Mental
Health Services,
Youth Services, C&V
sector partners
Increase access to mindfulness CYPSC, HSE, TUSLA, Years 2-3
training for children, young Community Mental
people, parents or practitioners Health Services, NYCI,
across the spectrum of needs NYHP, C&V sector
from mild, moderate to severe partners
mental health issues.
Develop pilot child/youth Children/Young Year 2
participation approach for People, DCC, HSE,
engagement and expansion of Sports Partnership,
young females in sports and Youth Services, C&V
physical activities through taster sector partners
sessions (e.g. 11-17 years).
Physical Health
Develop and/or support “Let’s TUSLA, DCC, ABCs, Years 1-3
Get Active” initiatives for all HSE, Schools
ages. C&V sector partners
Assess the availability and DCC, HSE, Schools, Years 2-3
accessibility of indoor/outdoor Local Area
play and recreational spaces for Partnerships, Private
all ages and develop agreements sector, C&V sector
for access points where needed. partners
Promote physical activity HSE, DCC, ABCs, Years 1-3
information, events or initiatives TUSLA, C&V sector
6 | Dublin City North CYPSC Health and Wellbeing
to parents online/offline. partners
Distribute evidence-based HSE, TUSLA, Local Years 1-3
advice and guidance on nutrition Partnership, Schools,
courses for parents and families C&V sector partners
e.g. Cook It and Healthy Food
Weight Health
Made Easy.
Development and dissemination HSE, TUSLA, Local Year 1
of mobile play equipment for Partnerships, ABCs,
babies (under 2) to incorporate DRHE, Focus Ireland,
C&V sector partners
weight development activities
for homeless families in
emergency accommodation.
Design and produce a sexual Young People, HSE, Year 1
health video that will deliver key TUSLA, Youth
messages co-designed with local
Services, C&V sector
young people.
partners
Develop pilot social media TUSLA, HSE, Youth Years 1-2
campaign to increase awareness Services, C&V sector
of sexual health and related partners
Sexual Health
issues, using youth participation
model.
Promote evidence-based HSE, Schools, Foróige, Years 1-3
programmes including advice for C&V sector partners
children, young people and
parents.
Support services to access Youth Services, HSE, Years 1-3
evidence-based professional TUSLA, IFPA, NYHP,
training courses in sexual health NYCI, Schools,
and related issues for Foróige, C&V
community based delivery. sector partners
7 | Dublin City North CYPSC Health and Wellbeing
Research Methodology
The formulation of this Action Plan comprised a mixed-methods methodology combining
extensive quantitative and qualitative analysis of primary and secondary datasets, including:
Policy Analyses including Healthy Ireland, Better Outcomes, Brighter Futures, et al
Literature Review including Socio-economic and Health profile datasets for DCN
Secondary research review of prior consultations e.g. mental health, community
mapping, etc conducted on behalf of CYSPC
92 respondents to an online Health & Wellbeing Survey including wide range of
statutory, community and voluntary providers
34 in-depth telephone interviews with statutory, community and voluntary senior
health directors, managers and practitioners
6 Focus Groups with children, young people and parents on health domains including
mental, physical, weight and sexual health conducted across DCN locations including
Cabra, Ballymun, Finglas, North West Inner, Dublin North East and Dublin City Bay
Stakeholder Workshop with 40 organisations from across DCN on emergent actions.8 | Dublin City North CYPSC Health and Wellbeing
Needs Analysis
The key findings from the Stakeholder Survey responses (n=126) revealed the following
health and wellbeing issues from a DCN context, including identified need for3:
Better access to, and resourcing of, mental health services for 0-24 age groups in
clinical, school, and community settings
More support for parenting programmes to empower families general wellbeing
More sexual health education opportunities and options for teenagers
Better collaboration between service providers (statutory, community or voluntary)
More encouragement for regular participation in physical exercise and sport
Preference for better recognition of existing proven models of service delivery to
avoid duplicating rather than creating any new models or health initiatives.
The key findings from the Stakeholder Workshop (n=40) revealed the following health and
wellbeing issues from a DCN context. Summary based on the domains below (Appendix 2):
Mental Health
o Improved access to local services
o Better counselling in local communities
o Positive promotion of mental health and wellbeing
Physical Health
o Regular exercise and sports activities
o Healthier eating on a budget
o More indoor play spaces for children
Weight Health
o Better nutritional advice and guidance
o More after-school clubs and activities
o More weight management programmes in communities
Sexual Health
o Information and advice for adolescents
o Parental supports to facilitate talks with children and young people
o More psycho-sexual education and information
The key findings from the Focus Groups (n=6) revealed the following health and wellbeing
issues from a DCN context, based on the key questions posed below (Table 1):
o What’s important to children and young people’s health and wellbeing?
o What’s available locally in terms of services within communities across DCN?
o What’s good about existing provision of programmes and activities?
o What’s missing and where do children and young people seek advice?
3
CYPSC Consultations, Cruinn Associates (2018)10 | Dublin City North CYPSC Health and Wellbeing
Table 1: CYPSC Focus Groups – Summary of Key Findings11 | Dublin City North CYPSC Health and Wellbeing
Dublin City North - Health Profile
The demographic profile provides statistics on health data within DCN. This is intended to
inform the action plan and enable improvement in health services and help reduce health
inequalities. Accurate health information on smoking, obesity or chronic disease is not
available at a DCN level.
The total population of DCN is 325,385, representing 17.0% of the total population of
County Dublin. There are 22,557 families all with children under 15 years of age. Of these,
the majority (84%) had either one or two children. DCN has a relatively lower proportion of
its population aged 5-9 years old.
The key health profile statistics for DCN include4:
DCN has a total population of 325,385 of which 178,944 (55%) rate their general
health and wellbeing as being ‘Very Good’; 91,092 (28%) as ‘Good’; 20,665 (9%) as
‘Fair’; 5,623 (1.73%) as ‘Bad’; and 1,229 (0.38) as ‘Very Bad’5
DCN has a higher proportion of 20-24 years olds (Figure 1) at 9% (national 6.5%)
DCN has a dependency ratio of 38.4% i.e. those aged 0-14 as a proportion of those
aged 15-64 (national rate 49.3%)
DCN has a greater than average birth per 1,000 rate (Figure 2) for those aged under
20 of 19.0% (national rate 12.3%)
Health clinics unequally distributed/located throughout geographic area of DCN.
4
Health Profile Dublin City (2015) http://www.lenus.ie/hse/bitstream/10147/584037/1/Dublin+City.pdf
5
CSO Census (2016) https://www.cso.ie/en/census/census2016reports/12 | Dublin City North CYPSC Health and Wellbeing
Ireland
Dublin City North
Fig. 1. Age Comparison % of Population (Ireland vs. Dublin City North)
Ireland
Dublin City
Fig. 2. Live birth rate per 1,000 for females aged less than 20 years for the census years 2002, 2006, and 2011.13 | Dublin City North CYPSC Health and Wellbeing
Health
The CSO Census of Population 2016 provides an assessment of the general health of the
population. The figure below provides the health assessment of DCN population by
comparison with that of the State (Figure 3).
State Dublin City North
Figure 3: General Health 2016 (Source: CSO Census of Population 2016)
Disability
Dublin City had 9.1% of the population 10-14 years of age with a disability, whilst 9.9% of
the population 15-19 years of age had a disability in 2016 (Table 2). The percentage
population of both age cohorts with a disability is above that of the State.
In 2016, the Health Research Board (HRB) reported that there were 1,397 individuals
registered in the CHO Area 9 registered on the National Physical and Sensory Disability
Database (NPSDD) in December 2016 with a physical or sensory disability. Community
Health Organisation (CHO) Area 9 includes Dublin North, Dublin North Central and Dublin
North West areas.
However, it is acknowledged that many of the State services providing support for young
people with disabilities are located in Dublin City. Almost 6% of the child population in
Ireland have a disability.
Table 2: Persons 0-24 Years of Age with a Disability in Dublin City including DCN (Source: CSO StatBank)14 | Dublin City North CYPSC Health and Wellbeing
Dublin City North Socio-Economic Profile
The key socio-economic statistics6 for DCN include:
Higher proportion of young adults and children live in DCN compared to State levels
41% of areas with DCN are designated in deprivation - living in areas of deprivation
increases likelihood of poor health by 25%
Population growth lower in DCN than the state trend over 20-year period (10% vs
30%)
Above average young dependency ratio of children to working parents- 38.4% of
those aged 0-14 as a proportion of those aged 15-64 (vs. 49.3%)
Lone parent households more likely than any other group to be in poverty
DCN has a high level of households which are local authority rented at 11.5% (vs.
7.8%)
DCN has a diverse population with 24.3% of the population who are not ‘White Irish’
Profile Structure
The structure of the following Socio-Demographic Profile has been designed to accord with
the indicator set that has been developed for Better Outcomes, Better Future (BOBF). The
Socio-Demographic Profile is an element of the analysis designed to identify the needs of
children, young people and families in Dublin City North, and the extent to which services
and resources available in the county are meeting those needs.
Population Profile
In 2016, the total population of DCN is 325,385, representing 17.0% of the total population
of the Greater Dublin Area (1,907,332). In 2016, the Greater Dublin area population
represented 40.0% of the population of the State (4,761,865).
DCN has ten percentage points more of its population aged 20-24 than is the case in the
State. Conversely, it has a relatively lower proportion of its population aged 5-9. In 2016,
there were 22,557 families with all children under 15 years of age. Of these, the majority
(84%) had either one or two children.
Population Density
The DCN area contains the three most densely populated Electoral Districts (ED) in Ireland:
o Rotunda A (23,860 persons per sq. km)
o Mountjoy B (18,014 persons per sq. km), and
o Mountjoy A (17,963 persons per sq. km)
In 2016, the comparative total population density for the State was 70 persons per sq. km.
In 2016 the EDs with the highest Lone Parents Ratio were Ballymun D (65.25), Ballymun B
(56.53), Ballybough A (54.06), Priorswood C (53.25), Finglas South C (53.11), Priorswood B
6
Dublin City North Children and Young People’s Services Committee: Socio-Demographic Profile (2018)15 | Dublin City North CYPSC Health and Wellbeing
(52.71) Cabra West B (52.50) Kilmore B (52.27), Ballymun C (51.32) and Finglas North A
(51.08).
Educational Attainment
Whilst educational attainment levels rose between 2011 and 2016, by the end of the period
seven EDs within DCN were recorded as having more than 30% of their population having
attained primary education only (Figure 4).
Fig. 4: Population with Primary Education Only - Dublin City North
In 2016, there was a total population aged 0-19 of 70,083 in DCN area. Of these, 8,117 were
aged 18-19 (11.6%). The total population aged 20-24 stood at 25,596, which represented
26.75% of the total population aged 0-24 (95,679 persons). For a breakdown see Figure 5.
Fig. 5: Dublin City North - Population by Age Group (0-24)16 | Dublin City North CYPSC Health and Wellbeing
Fig. 6: Dublin City North: Population by Gender (0-19years)
The young dependency ratio is the number of young people of 0-14 years of age as a % age
of the population of working age. The working age population is defined as those of 15 to 64
years of age. In 2016, DCN had a total population of 52,000 of 0-14 years of age. In 2016, the
total working age population of 15 to 64 years of age in DCN was 203,063. In 2016 the
young dependency ratio in DCN was 25.6%. The gender breakdown of 0-19 years olds
within DCN is illustrated above (Figure 6).
Traveller and Roma communities are particularly vulnerable to poverty and social exclusion,
and face barriers in accessing education, training, employment and services7. Census 2016
reports that there were there were 1,156 White Irish Travellers living in the DCN area. The
Census did not include ‘Roma’ as an ethnic identifier, although it is estimated that there are
some 5,000 Roma people living in Ireland.8
Family Structure
o In 2016, there were 76,890 families located across DCN (see Figure 7 for breakdown)
o Of these, the highest proportion 2,755 (3.6%) were located in Ashtown A ED
o 11,494 families were at pre-family stage, with 8,013 at pre-school stage, and 7,752 at
early school stage (Figure 8)
7
Dublin Local Economic & Community Plan (2016-2021) http://www.dublincity.ie/LECP
8
NASC - Irish Immigrant Support Centre (2015) http://www.nascireland.org/wp-
content/uploads/2015/01/PON-2.pdf17 | Dublin City North CYPSC Health and Wellbeing
o In 2016, there were 22,557 families with all children of less than 15years of age DCN
o In 2016 there were 22,047 families with all children of more than 15years of age DCN
o In 2016, a total of 7,049 children of all ages lived in single parent families in DCN
o In 2016, 9,929 children of less than 15 years of age lived in lone mother families and
547 children of less than 15 years of age lived in lone father families in DCN
o In 2016, 11.300 children of 15 years of age and over lived in lone mother families and
2,197 children of 15 years of age and over lived in lone father families in the DCN.
Fig. 7: Families by Age of Youngest Child
(Source: CSO Census of Population, 2016)
Fig. 8: Family Composition
(Source: CSO Census of Population, 2016)
Social Disadvantage
o In 2016, the deprivation score for County Dublin (including DCN) was 4.12. In 2011
the score was 3.74. Of the 93 EDs in DCN in 2016, 13 were classified as affluent
o There were no EDs in DCN in 2016 that were ‘Extremely Disadvantaged’, according
to the Pobal HP classification
o Total of 2,145 young people aged 0-24 live in EDs classified as ‘very disadvantaged’.18 | Dublin City North CYPSC Health and Wellbeing
o There were fifteen EDs classified as ‘disadvantaged’ in DCN in 2016.
o In 2016, a total of 16,208 young people aged 0-24 lived in EDs classified as being
‘disadvantaged’ in the Dublin North City CYPSC Area. Figure 9 below shows the
classification of the population aged 0-24 by HP Deprivation Index 2016.
Figure 9: Affluence and Deprivation Age 0-24
(Source: Pobal HP Deprivation Index: Haase, T. and Pratschke, J., 2017)
SAP Deprivation
The DCN area comprises of 1,255 SAPs, representing a resolution of the demographic data
that is some 13 times greater in magnitude than that of the 93 EDs that make up the area.
There is a significant degree of variation across the DCN, characterising the area as
harbouring extremes with regard to both affluence and deprivation. DCN contains
significant clusters of high deprivation, which are masked by population in-migration of
more affluent cohorts. Measured at SAP level, DCN contains the full spectrum of affluence
and deprivation (Figure 10).
Of the 93 EDs in the Dublin City North CYPSC Area, 13 EDs classify as being ‘affluent’
(Clontarf East C, Clontarf West D, North City, Clontarf East E, North Dock B, Arran Quay C,
Botanic B, Clontarf East B, Drumcondra South C, Clontarf East D, Botanic C, Drumcondra
South A, and Clontarf West C). No EDs classify as being ‘very affluent’, whilst 15 EDs fall into
the category of being ‘disadvantaged’ and two as being ‘very disadvantaged’ (Priorswood B
and Finglas South C). The remainder are classified as being either ‘marginally above
average’ (36 EDs), or ‘marginally below average’ (29 EDs).19 | Dublin City North CYPSC Health and Wellbeing
Fig. 10: Affluence and Deprivation by SAP
Within DCN a significantly high % of both male and females (0-24 years) are at risk of
poverty or being in consistent poverty (see Table 3).
DCN Group Population % At Risk % Deprivation % Consistent
of Poverty Rate Poverty
Male 0-24 Years 48,336 49.4 49.3 47.1
Female 0-24 Years 47,343 50.6 50.7 52.9
0-17 Years (All) 61,966 26.1 31.1 35.7
Table 3: Population at Risk by Demographic Profile - Dublin City North
Childcare Services
A Pobal Early Years Sector Report (2016/2017) recorded that there were 426 Early Years
services provided in Dublin City, comprising 37% community and 63% private provision. The
report noted that there were 16,208 children enrolled in services, with a further 852 places
vacant, representing a vacancy rate of 6%. Comparable figures show 11,124 3-5 year olds in
need of childcare services within DCN during period 2016/17 (Table 4).
Table 4: Capacity for Children Aged 3-5 Years (Source: Pobal Early Years Sector Report 2016/2017)20 | Dublin City North CYPSC Health and Wellbeing
Strategic & Policy Analysis
The following are the primary policy drivers which affect this Action Plan. However,
particular focus is given to the HI, BOBF and CH09 frameworks and operational plans.
Healthy Ireland (HI) – A Framework for Improved Health and Wellbeing (2013-2025)
o National Physical Activity Plan (8 Actions)9
o A Healthy Weight for Ireland – Obesity Policy & Action Plan (2016-2025)10
o Mental Health11
o Sexual Health – National Sexual Health Strategy (2015-2020)12
Better Outcomes Brighter Future (BOBF) - The national policy framework for children
& young people (2014-2020)13
Reducing Harm, Supporting Recovery – A health-led response to drug and alcohol
use in Ireland (2017-2025)14
CH09 – HSE Regional Plan for Dublin North City, North Central and North West15
Vision for Change – Report Of The Expert Group On Mental Health Policy16
Connecting for Life – Ireland’s National Strategy to Reduce Suicide (2015-2020)17
Dublin City Council – Local Economic & Community Plan (2016-2021)18
Dublin City North CYPSC – Strategic Plan (2018-2021)19
Healthy Ireland
Healthy Ireland takes a whole-of-Government and whole-of-society approach to improving
health and wellbeing and the quality of people’s lives. The Healthy Ireland Framework
purports a partnership approach the four goals and sixty-four actions set out and designed
to harness the energy promote health and wellbeing, by encouraging all sectors of society to
9
http://health.gov.ie/wp-content/uploads/2016/01/Get-Ireland-Active-the-National-Physical-Activity-Plan.pdf
10
http://health.gov.ie/wp-content/uploads/2016/09/A-Healthy-Weight-for-Ireland-Obesity-Policy-and-Action-
Plan-2016-2025.pdf
11
http://www.yourmentalhealth.ie/
12
http://health.gov.ie/wp-content/uploads/2015/10/National-Sexual-Health-Strategy.pdf
13
https://www.dcya.gov.ie/documents/cypp_framework/BetterOutcomesBetterFutureReport.pdf
14
https://health.gov.ie/wp-content/uploads/2017/07/Reducing-Harm-Supporting-Recovery-2017-2025.pdf
15
https://www.hse.ie/eng/services/publications/serviceplans/service-plan-2017/operational-plans-2017/cho-
9-operational-plan-2017.pdf
16
https://www.hse.ie/eng/services/publications/mentalhealth/mental-health---a-vision-for-change.pdf
17
https://www.healthpromotion.ie/hp-files/docs/HME00945.pdf/
18
http://www.dublincity.ie/LECP
19
http://www.cypsc.ie/your-county-cypsc/dublin-city-north.279.html (note: Strategic Plan Draft Unpublished)21 | Dublin City North CYPSC Health and Wellbeing
get involved in making Ireland a healthier place to live, work and play. The framework’s four
high-level goals include:
i. Increase the proportion of people who are healthy at all stages of life
ii. Reduce health inequalities
iii. Protect the public from threats to health and wellbeing
iv. Create an environment where every individual and sector of society can play their
part in achieving a healthy Ireland.
In a DCN context, it is the role of the local Children and Young People’s Services Committee
(CYPSC) to coordinate the implementation of key actions within HI framework for ‘local
health partners to engage with local authorities in their work to address local and
community development, with the aim of co-ordinating actions and improving information-
sharing for improved health and wellbeing’ (Healthy Ireland Framework Action 2.2).This sets
the framework within which this Strategic Health & Wellbeing Action Plan has been drafted
based on extensive consultation on priority health domains with key stakeholders including
statutory, community and voluntary groups, parents, children and young people. In
addition, other relevant health policy drivers have guided this plan alongside HI framework.
Better Outcomes, Brighter Futures
Alongside this framework from Healthy Ireland is ‘Better Outcomes Brighter Futures’ – The
national policy framework for children & young people (2014-2020) is the Department for
Children and Youth Affairs (DCYA) six-year strategy, that sets parallel priorities in ensuring
that all children and young people achieve the best possible outcomes so that they might
achieve their full potential in the future. Whereas the Healthy Ireland policy bases the
routes through which its targets will be realised in existing systems and structures, BOBF has
a much more explicit focus on involving parents and young people in the design and review
of actions to achieve its target outcomes (Figure 11).
Fig. 11: BOBF – National Outcomes Framework22 | Dublin City North CYPSC Health and Wellbeing
HSE Dublin North City and County
Nine Community Healthcare Organisations (CHOs) have been established in Ireland to
deliver Health Services at a local level across both the statutory and voluntary sector in the
community setting in partnership with the National Primary Care, Social Care, Mental Health
and Health and Wellbeing Divisions. The CH09, within the catchment of Dublin City North
CYPSC includes:
Dublin North City
Dublin North Central
Dublin North West
CHO health and wellbeing services are provided to a population of 621,216 in Dublin City
North and County Dublin. The appointment of a Head of Health and Wellbeing (November
2016), means their role is to oversee progress in the implementation of priority health and
wellbeing projects both within CHO divisions and with external partner agencies.
Implementation of the priority actions identified are dependent on the continued support of
health promotion, national screening services and the national programme priority leads.
Priorities during 2017 included:
Accelerated implementation of the Healthy Ireland Framework through Healthy
Ireland in the Health Services Implementation Plan 2015-2017
Reduce levels of chronic disease and improve the health and wellbeing of the
population
Protect the population from threats to their health and wellbeing
Create and strengthen cross-sectoral partnerships for improved health outcomes
and address health inequalities
The measurement of the delivery of service in CHO9 is performed through a suite of Key
Performance Indicators (KPI’s), which are reported on monthly and published in the
divisional performance reports (Appendix 2).23 | Dublin City North CYPSC Health and Wellbeing
Strategic Outcomes
Cross Priorities
Population Outcome
All families, parents, children and young people including disabled persons and new
communities (Migrants, Travellers and Roma) in Dublin City North are healthy and happy.
Why this outcome matters?
Every parent, child and young person enjoys the best possible standard of health and well-
being and have access to appropriate facilities, services and amenities in local communities.
What are the key issues?
According to the CSO Census (2016) from a total population of 325,385, 178,944
(55%) rate their general health and wellbeing as being ‘Very Good’.
91,092 (28%) rate their general health and wellbeing as being ‘Good’.
20,665 (9%) rate their general health and wellbeing as being ‘Fair’.
5,623 (1.73%) rate their general health and wellbeing as being ‘Bad’.
1,229 (0.38) rate their general health and wellbeing as being ‘Very Bad’.
In 2016, the Health Research Board (HRB) reported that there were 1,397 individuals
registered in the CHO Area 9 registered on the National Physical and Sensory
Disability Database (NPSDD).
Between 2011 and 2015, there were 9,348 cases treated for problem drug use
(including alcohol) who resided in the Dublin City North area. Of these, 1,500 (16%)
cases were aged less than 25 years (NDTRS, Unpublished data, 2011-2015).
Between 2011 and 2015 there were 283 poisoning deaths in DCN, of which 28 were
less than 25 years. For the same period, there were 254 non-poisoning deaths, of
which 16 were less than 25 years (NDTRI, Unpublished data, 2011-2015).24 | Dublin City North CYPSC Health and Wellbeing
Mental Health
Population Outcome
Children and young people are mentally healthy.
Why this outcome matters?
Every child or young person should enjoy the best possible standard of mental health and
emotional well-being and have access to age appropriate counselling, care and support
when needed.
What are the key issues?
Children and young people, and in particular adolescents who are suffering from
mental health problems (including those related to identity, alcohol, drugs and
substance misuse) have access to appropriate and timely mental health services and
feel reassured to seek help and support without fear of being stigmatised, ignored or
mistreated.
Concerns have been raised about the mental and emotional well-being of children
and young people, and the provision of adequate services which are child-centred,
child-focused, age appropriate and child-accessible.
By giving children the opportunity to access appropriate and timely support, we will
help them to grow healthier and happier. By implementing a collaborative approach
involving statutory agencies and the relevant stakeholders we can ensure that
prevention, health promotion, intervention and rehabilitation services are at the
forefront of service planning and coordination and all children and young people
have age appropriate, accessible and timely mental health services.
Most current services in DCN based on a non-medical model i.e. ‘Talking Therapies’.
Recognition of role and impact on family and parenting, and so services seek to
involve all family members affected by mental health.
Some integration of mental health services between local schools/community group.25 | Dublin City North CYPSC Health and Wellbeing
Physical Health
Population Outcome
Children and young people adopt a physically active and healthy lifestyle.
Why this outcome matters?
Every child and young person enjoys the best possible standard of physical health and have
access to appropriate health care and support when they need it.
What are the key issues?
Tackling health inequalities together with a shift towards prevention and early
intervention will be central to our approach. Ensuring that parents, pregnant
mothers and families are supported and informed of the benefits of looking after
their own health and well-being, including child health and nutrition, will help instil
positive health choices from birth and pre-conception. This will help to ensure that
children and young people develop active and physical healthy well-being lifestyles.
CYPSC will work to ensure that provision of health care services and programmes for
children and young people with a disability is of the same quality and standard as
that provided to others. Such services should be tailored to include early detection
and intervention, and designed to provide timely support.
Concerns have been raised about the physical health and obesity levels of children
and young people, and the provision of adequate services which are child-centred,
child-focused, age appropriate and child-accessible.
Majority of physical health in DCN relates to sport and after-school activities via
access to local sports clubs in the community e.g. GAA, Football, etc.
Limited sports options for females (0-24 years) in DCN e.g. Netball, Gymnastics, etc.
Some integration of services with local schools and community providers in DCN.
Recognition of key role of parenting in encouraging engagement with physical health
activities for children and young people via sport, play, recreation, dance or hobbies.
Variety of physical health activities on offer and initial signs of ‘social prescribing’.26 | Dublin City North CYPSC Health and Wellbeing
Weight Health
Population Outcome
Children, young people and families maintain a healthy weight.
Why this outcome matters?
Every child or young person maintains an optimum weight health for their age and size and
have access to appropriate weight loss or weight management support when they need it.
What are the issues?
Health outcomes can be affected at a very early age and even before children are
born. Low birth weight can be a determinant of infant mortality or disability, and
affect health outcomes into adulthood. The cause of low birth weight can include
premature or multiple births and babies born to mothers who have used drugs,
alcohol or cigarettes during pregnancy. The proportion of low birth weight babies
has remained low in Ireland as has the country’s breastfeeding rates remaining the
lowest in Europe and a continuing problem with mothers smoking during pregnancy.
Numbers of children and young people who are either overweight or obese
(assessed using Body Mass Index (BMI) is also a cause for concern and a barrier to
achieving a positive health outcome. There is a clear link in this area to the outcome
relating to play as children become less active, not taking time to enjoy play or
leisure, their health is affected.
Most prevalent services and activities currently offered in DCN relate to cookery
classes plus passive offers of diet/nutritional advice in community settings.
Recognition of the role of parents in encouraging and maintaining healthy diet and
linkages with schools via healthy eating programmes and breakfast clubs.
Children and young people would like to eat healthier food and eat less sweets/
chocolate but issues arise on access and availability in school or at home is a barrier.
Young people worry about weight and becoming obese as teenagers increasingly
‘body image’ conscious and wary of prevalence of social media’s negative influence.
Access to public parks is an issue within DCN as parents feel their children unable to
walk, play or exercise on safety grounds due to increasing anti-social behaviours.27 | Dublin City North CYPSC Health and Wellbeing
Sexual Health
Population Outcome
Young people have age appropriate healthy sexual relationships.
Why this outcome matters?
Every young person should enjoy the best quality of relationships and have access to
appropriate sexual health advice and support when needed.
What are the issues?
Majority of sexual health activity delivered in DCN relate to education programmes.
Limited instances of sexual health programmes in DCN that work with parents or
whole family approach to sexual health or educational activities. However, examples
include the Irish Family Planning Association (IFPA), National Youth Health
Programme (NYHP) and Strengthening Families Programme (SFP) all incorporate
sexual health and relationship topics into their service delivery, respectively.
Recurring references to sexual health services and activities being coordinated and
integrated into schools via Relationships and Sexuality Education (RSE) Programme.
Religious traditions in Ireland remain a barrier for children and young people to
access appropriate sexual health education programmes in school/home.
Cultural attitudes remain on sexual health being a ‘taboo’ subject matter and
parents often embarrassed to discuss matters with their own children.
Issue of consent confusing for children and young people as lack of understanding
and knowledge of the legal age and fundamental requirements to consensual sex.
Increasing prevalence of pornography and use of social media heightens awareness
of sexual matters and how these pertain to forming healthy sexual relationships.
Increased awareness of domestic/sexual violence and effects these have on children
and young people witnessing or being abused by person known to self or authorities28 | Dublin City North CYPSC Health and Wellbeing
Strategic Priorities, Objectives & Actions
The following tables illustrate the key strategic priorities, objectives and actions of Cross
Priorities plus Mental, Physical, Weight and Sexual Health and associated policy links via:
o Healthy Ireland (HI) – 4 Goals
o Better Outcomes Brighter Future (BOBF) – 5 Outcomes
o National Physical Activity Plan (NPAP) – 8 Actions
o Vision For Change (VFC)– Report of the Expert Group On Mental Health Policy
o Connecting For Life (CFL) – Ireland’s National Strategy to Reduce Suicide
o Obesity Policy & Action Plan (OPAP)
o National Sexual Health Strategy (NSHS)
o National Drugs Strategy (NDS)
o Dublin City North Strategic Plan (CYPSC)
o Dublin City Council Local Economic & Community Plan (LECP)
The CYPSC Action Plan needs to take account of current delivery of services and how these
may need to be streamlined or reconfigured to meet the future needs of children and young
people and their families. CYPSC will support the implementation of focused services
delivered within local communities across DCN with the focus of attention in achieving our
intended actions universally for the general health and wellbeing of all population groups.
In addition, a number of targeted interventions in mental, physical, weight and sexual health
domains involve a series of planned actions within the 3-year timeframe of our planned
implementation across Dublin City North on a collaborative interagency basis with our
partners from statutory, community, voluntary and private sectors, respectively.
Principles
The following set of practice principles underpin the delivery of this Action Plan including:
Working in partnership is an integral part of outcomes-led planning. Partnership
includes children, families, professionals and communities; thus involving service
users and providers in the planning, delivery and evaluation of services is ongoing;
Be outcomes-led and strive for the minimum intervention required;
Have a clear focus on the feelings, safety and wellbeing of children and young people
Reflect a ‘strengths based perspective’ which is mindful of resilience as a
characteristic of many children’s and families’ lives;
Promote the view that effective interventions are those that strengthen informal
support networks;
Promote social inclusion, addressing issues on ethnicity, disability and disadvantage;
Facilitate evaluation based on attention the outcomes for service users and thereby
facilitating ongoing support for quality services based on best practice.
Our key actions are highlighted in the following tables.29 | Dublin City North CYPSC Health and Wellbeing
Cross-Priorities
Actions In Collaboration With By When Policy/Plan Links
- HI
Develop and design annual health and wellbeing Statutory, Community and Voluntary Years 1, 2 & 3 - BOBF
themed promotional campaigns and events sector partners - CYPSC
- LECP
- HI
Develop targeted interventions and initiatives All relevant partners Ongoing - BOBF
across a range of priority areas and marginalised - CYPSC
communities i.e. homeless, Travellers, new - LECP
communities, disabilities.
- HI
Collaborate with lead partners on the HSE, DCC, LCDC, Youth Services, Ongoing - BOBF
development of local and community based Colleges, Universities - CYPSC
responses to each of the named priority areas, in - LECP
an effort to increase coordination of local
actions and align health and wellbeing plans.
- HI
Develop and maintain online, user-friendly All sectors Years 1-3 - BOBF
directory of services across DCN related to Dublin CYPSCs (x5) - CYPSC
children and young people to increase - LECP
awareness of existing services.30 | Dublin City North CYPSC Health and Wellbeing
Mental Health
Actions In Collaboration With By When Policy/Plan Links
- HI
Develop referral pathways guide for children and CYPSC Mental Health & Wellbeing Years 1-2 - BOBF
young people in communities and progress Subgroup, HSE, NEPS, TUSLA, - CYPSC
initiative to reduce waiting lists in CAMHS. Schools, Community Mental Health - LECP
- VFC
Services, Youth Services, C&V sector
- CFL
partners - NDS
- HI
Expand, develop and promote community and CYPSC Mental Health & Wellbeing Years 2-3 - BOBF
evidence-based mental health and wellbeing Subgroup, HSE, NEPS, TUSLA, - CYPSC
support services. Schools, Community Mental Health - LECP
- VFC
Services, Youth Services, C&V sector
- CFL
partners - NDS
- HI
Increase access to mindfulness training for CYPSC Mental Health & Wellbeing Years 2-3 - BOBF
parents and practitioners across the spectrum of Subgroup, HSE, NEPS, TUSLA, NYCI, - CYPSC
need. NYHP, Community Mental Health - LECP
- VFC
Services, C&V sector partners
- CFL
- NDS31 | Dublin City North CYPSC Health and Wellbeing
Physical Health
Actions In Collaboration With By When Policy/Plan Links
- HI
Develop pilot child/youth participation approach Children/Young People, DCC, HSE, Year 2 - BOBF
for engagement and expansion of young females Sports Partnership, Youth Services, - CYPSC
in sports and physical activities through taster C&V sector partners - NPAP
sessions (e.g. 11-17 years). - OPAP
- HI
Develop and/or support “Let’s Get Active” TUSLA, DCC, ABCs, HSE, Schools Years 1-3 - BOBF
initiatives for all ages. C&V sector partners - CYPSC
- NPAP
- OPAP
- HI
Assess the availability and accessibility of DCC, HSE, Schools, Local Area Years 2-3 - BOBF
indoor/outdoor play and recreational spaces for Partnerships, Private sector, C&V - CYPSC
all ages and develop agreements for access sector partners - NPAP
points where needed. - OPAP
- HI
Promote physical activity information, events or HSE, DCC, ABCs, TUSLA, C&V sector Years 1-3 - BOBF
initiatives to parents online/offline. partners - CYPSC
- NPAP
- OPAP32 | Dublin City North CYPSC Health and Wellbeing
Weight Health
Actions In Collaboration With By When Policy/Plan Links
- HI
Distribute evidence-based advice and guidance HSE, TUSLA, Local Partnership, Years 1-3 - BOBF
on nutrition courses for parents and families Schools, C&V sector partners - CYPSC
e.g. Cook It and Healthy Food Made Easy. - NPAP
- OPAP
- HI
Development and dissemination of mobile play HSE, TUSLA, Local Partnerships, Year 1 - BOBF
equipment for babies (under 2) to incorporate ABCs, DRHE, Focus Ireland, C&V - CYPSC
weight development activities for homeless sector partners - NPAP
families in emergency accommodation. - OPAP33 | Dublin City North CYPSC Health and Wellbeing
Sexual Health
Actions In Collaboration With By When Policy/Plan Links
- HI
Design and produce a sexual health video that Young People, HSE, TUSLA, Youth Year 1 - BOBF
will deliver key messages co-designed with local Services, C&V sector partners - CYPSC
young people. - NSHS
- HI
Develop pilot social media campaign to increase TUSLA, HSE, Youth Services, C&V Year 1 - BOBF
awareness of sexual health and related issues, sector partners - CYPSC
using youth participation model. - NSHS
- HI
Develop/ promote evidence based information HSE, IFPA, Schools, Foróige, C&V Years 1-3 - BOBF
including programmes and courses for children, sector partners - CYPSC
young people and parents. - NSHS
- HI
Support services to access evidence-based Youth Services, HSE, TUSLA, IFPA, Years 1-3 - BOBF
professional training courses in sexual health NYHP, NYCI, Schools, Foróige, C&V - CYPSC
and related issues for community based delivery. sector partners - NSHS34 | Dublin City North CYPSC Health and Wellbeing
Risk Analysis Factors
In identifying potential risks to the delivery of this Action Plan it is acknowledged that while
every effort will be made to mitigate these risks, it may not be possible to eliminate them in
full. Particular focus will be required to mitigate risk in the following areas:
The impact of increased demand for services beyond the planned and funded levels
arising from changes in demographics, particularly within the context of delivering
population-based health services within DCN.
The capacity to recruit and retain highly-skilled and qualified practitioners,
particularly in high-demand professions such as Mental Health specialists.
Maintaining a focus on Healthy Ireland and BOBF policy initiatives in the context of
day to day service demands.
The capacity and resources to continue to develop and involve staff in driving change
in health and wellbeing by improving a culture of cooperation in CYPSC and partners.
The capacity to exert effective influence over our statutory, community and
voluntary partners in the context of regulatory and professional practice pressures.
The delivery of comprehensive health and wellbeing programmes prioritising
prevention and early intervention approaches in the context of competing strategic
priorities and concurrent health policy programmes.
The ability to address unavoidable public policy changes in areas which have not
been funded.
The changing socio-demographic, population, health and wellbeing needs
particularly in areas of social deprivation across DCN to ensure equity in allocation of
resources and access to services in local communities for children, young people and
their families.35 | Dublin City North CYPSC Health and Wellbeing
Evaluation & Review
Information management in the use of outcomes and indicators represents a multi-agency
outcomes measurement model that can be used by partnerships based on key measures
about developing and implementing such a model in practice. Whilst many ‘Outcomes
Measurement’ models and frameworks exist e.g. Outcomes Based Accountability (OBA),
Social Return On Investment (SROI), Cost Benefit Analysis (CBA), et al, a multi-agency
outcomes-based model representing a continuous process of improvement is dissected into
the following components:
1. Identification of Outcomes: the first step in the process is the development of
outcome statements. However, these are not expressed as statistical targets, but as
statements of common purpose, of aspiration and intent.
2. Definition of Measurable Indicators: a hierarchy of factors, indicators and measures
are developed associated with each of the outcome statements. Examples of life
factors that relate to the above outcome statements e.g. play/leisure perceptions.
These in turn are broken down into measurable indicators.
3. Data Collection, Analysis and Reporting Data: is based solely on the measurable
indicators and is collected across all of the agencies involved in the action planning
process. This data is returned to a central point to be collated and analysed to
provide a cumulative annual overview of progress towards outcome statements.
These results will be presented as an annual composite monitoring report.
4. Review of Achievements Against Outcomes: identification of areas for improvement
and action planning can be used as a performance management tool to critically
review progress against outcomes and to develop strategies for improvement and
the associated action plan. This may lead to the review of measurable indicators
associated with outcome statements.
The outcomes model is illustrated as a cyclic process as below (Figure 12).36 | Dublin City North CYPSC Health and Wellbeing
Fig. 12: Linking CYPSC local Area/Healthy Ireland Action Plan37 | Dublin City North CYPSC Health and Wellbeing
Recommendations
Whilst Dublin City North CYPSC strategic health and wellbeing plan (2018-2021) focus is on
children and young people 0-24 years, cognisance needs to be made of other population
groups which are key to co-delivery of the desired outcomes and actions therein, including:
o Focus on priorities in relation to youth mental health and those listed in the Healthy
Ireland and Better Outcomes, Brighter Futures strategic policy frameworks.
o Focus on activities for mental health in particular with raising awareness of existing
services and targeting parents, schools, and youth services across Dublin City North.
o Focus on empowering and supporting parents via local programmes and services.
o Improved inter-agency working arrangements and more effective relationships
across statutory, community and voluntary providers.
o Desire for more joined-up and connected activity between current services available
(as providers not all fully aware of each other’s health and wellbeing services).
o Wish to see strengthening of existing, proven activity, and focus on increasing
capacity of current mental health services in the community supported by statutory
provision.
o Widespread recognition of the important role of parents in supporting young people
to be able to access, engage in, and maintain involvement in, positive behaviours
and activities.
o Relatively high incidences of services already working with schools in DCN – build
and expand on these e.g. mental, physical, weight and sexual health programmes.
o Recognition that service design and investment won’t be enough - needs to be
consideration for how wider changing social and economic lifestyles and norms limit
people’s time and access to avail of services in local communities.
o Take cognisance of the multiple external factors that limit individuals and families
being able to access/engage in services and support e.g. gang violence, addiction
issues, employment patterns.38 | Dublin City North CYPSC Health and Wellbeing Appendices Appendix 1: CHO9 – Health & Wellbeing Performance Indicators 2017 (Source: HSE)20 20 https://www.hse.ie/eng/services/publications/serviceplans/service-plan-2017/operational-plans-2017/cho- 9-operational-plan-2017.pdf (Health and Wellbeing Performance Indicator Suite pp 57-59).
39 | Dublin City North CYPSC Health and Wellbeing
40 | Dublin City North CYPSC Health and Wellbeing
Appendix 2: CYPSC Stakeholder Workshop Consultations (World Café Conversations @ Croke Park Conference Centre, 21st March 2018)
MENTAL HEALTH #1 Improved access to MH services #2 Better counselling in community #3 More MH wellbeing promotion
ACTIONS
CAMHS
HSE 2
Providers
TUSLA
Current
Service
ABCs/FRCs
Youth Services
Mind Out Programme
Community Counselling
Make access as local as possible CAMHS v general community counsel. Adopt a universal approach Parents C&YP
Familiarity of local MH services Developing age app. referral pathways Early Years teaching MH earlier in lifecycle
Parent Role/Emotional Intelligence Role of Family Support Hubs Engaging in positive recreation/activities
Linking of current MH services Holistic MH impacts on Families Develop MH ‘Community Champions’
Early intervention delivery model Consider other mediums e.g. drama, Access & Affordability to MH services
Current Gaps in Provision
Homeless/Unemployed/Travellers art/play therapy Building Resiliency Skills/Tools for C&YP
Waiting Lists/Assessment Times Reduce negative stigma of MH SPHE Implementation ad-hoc MH delivery77
Promotion of positive MH a priority Focus developing C&YP participation Streamlining of MH&WB training progs.
Influence of SM on MH perceptions Role of Schools in MH support/signposting77
Access to mindfulness/play therapy Role of Family Social Workers in MH prom.
Access GP/Child/Adult MH services Pathfinder/Smile projects
Postcode Lottery effect across DCN DES Policy/No MH on Schools Curriculum
Acute/Crises Beds @Temple/Mater Reduce negative stigma of MH
Rapid Access to MH A&E (4wk avg.) Parent MH programme link Drugs/Alcohol
OOH/SENO lack service consistency Cultural MH awareness esp. young males
MH postcode lottery catchments Better Start/Barnardos Ireland progs.
Alternate strategies e.g. PATS/MindfulnessYou can also read
