Service user particapation
Consider aspects of service user and carer
Participation in theory and practice in relation
To an incident that has occurred in your day-to-day work.
The essay will look at service user participation by looking at a case scenario (appendix A) and what the highest level of involvement that user had. The essay will then look at barriers to involvement, how it is promoted and look at how reflective practice can inform Social Work practice. The user involved is a ten -year -old male, who has Autism spectrum disorder. He had been in his placement for seven years when the Local Authority had to remove him from foster care.
The UN Convention (1989) on the right of the child states 'Child participation is the right of the every child'. Article twelve states 'Children have the right to be heard and considered in decisions affecting them'.
The Oxford 'English' dictionary (1997) defines participation as 'take part or share in something'. O'Sullivan (1999:32) describes participation as 'involving the user in decision making'.
O' Sullivan's (1999) model relates to direct work with users and uses four levels of involvement, 'being in control, a partner, consulted and being informed'. This is a very broad model as it is related to specific decisions, rather than the users.
Shier's (2001:107) model is based on five levels. This includes 'the child sharing power, being involved, views taken into account, supported to express their views and being listened to'. This is also very broad and is very descriptive with lots to think about. However, at each level, individuals have different levels to commitment to involving children.
Arnstein's (1969:217) model is the foundation for many models, has eight levels and is presented as a ladder. This is the model that the essay will be looking at in relation to the user participation. As it is self explanatory and easier when working with children. At the higher end users exert maximum power and control, whereas at the lower level there is manipulation.
Figure 1. Arnstein's eight rungs on the ladder of participation
The user had some degree of participation as he took part in the event (level 6), as described in the case scenario. He had some control over the incident by talking about his experience, but was limited due to the nature of his disabilities. He had the choice of where he wanted people to sit and whom he wanted in the room. He told the workers what he wanted to tell them. However, he was removed for his own safety due to the Local Authorities policy on allegations made against foster carers, and with guidance on the Childrens Act 1989:4 'The child's welfare should be the paramount considered' His views were considered, however, once he had described what happened his participation level moved down to level 3 (Informing), as he had no say in where he was going to be moved due to the lack of foster carers available.
The user then went down to level 1 (manipulation) as he did what the workers suggested but he had little understanding of the issues, even though it was explained to him.
Thoburn (1995) however, stated that 'Individual case variables are influential upon the level achieved, and that the nature of the statutory role does not necessarily preclude the achievement of partnership in some cases'. However in official guidance (DoH 1995B) they state' that there are different models of participatory practice appropriate to different situations'. Some children may be involved because the Local Authority knows that they should involve them. This can lead to 'Tokenism' where they are involved but they have little ability to influence decisions. In some societies, children's voices are rarely heard, and have little opportunity to ...
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Thoburn (1995) however, stated that 'Individual case variables are influential upon the level achieved, and that the nature of the statutory role does not necessarily preclude the achievement of partnership in some cases'. However in official guidance (DoH 1995B) they state' that there are different models of participatory practice appropriate to different situations'. Some children may be involved because the Local Authority knows that they should involve them. This can lead to 'Tokenism' where they are involved but they have little ability to influence decisions. In some societies, children's voices are rarely heard, and have little opportunity to participate.
Empowerment means that users can become more powerful as a result of engaging with professions to help solve problems. The child in scenario did not understand his own needs. However, others may have an understanding but find it difficult to articulate them. Therefore working to his agenda is crucial.
There are many approaches to empowerment such as advocacy, social model and medical model.
Advocacy is an unconditional ally for an individual who is vulnerable, and who wants to be heard, there is a balance to consider between independence and absence of role conflict and advantages of know-how. There are many forms of advocacy such as self, peer, legal and by health and social care professions. The scenario showed self advocacy by getting people to listen to him, and something was done about his concerns.
McDonald (1999:153) reflects that the role of advocate implies 'partnership and a sense of belonging to the person on whose behalf the advocacy is taking place'. Payne (1995:193) argues that 'care managers may think that they act in the best interest of users', but are guided by policies. Payne went on to say that advocates 'need to be separate from the agency providing the service'.
Social model looks at a disability as a 'social state', rather than a medical condition. This approach looks at the person as a whole and is person centred. The scenario has aspects of this approach as he was given his chance to be listened to and was given all the time he required.
However, the medical model looks at the disability as the problem and focuses on that. This model is not person centred. There were aspects of this in the scenario due to no carers available to meet his autism.
However, the user was empowered by the workers listening to his experience and moving him out, there was communication between the workers and the child instead of speaking with the adults, and he was informed of what was happening. Due to the child being accommodated his birth family was also informed of his move and allowed him to stay there.
Involving users in decision-making is not always easy, and cannot be achieved overnight. However Social Workers should keep the channels of communication open, to help build up trust and respect, consult with relevant people when forming their view, remembering that responsibility for resolving the situation is shared. It is important to recognise that users not only have a right to be involved, but a right not to be involved, or at least to choose for themselves when and how to be involved.
Barriers involving users include lack of confidence, feelings of powerlessness, lack of information about opportunities to participate, lack of understanding of the situation and previous negative experiences.
Users have become accustomed to being invited to participation that is tokenistic, where agendas dominated by professionals or agency jargon, are confined to existing services or predertmined decisions, where their experience is negative. They have become used to influencing processes without influencing outcomes, to having their participation managed. There is a wide variety of ways of allowing children to participate. These include writing stories, drawing, games and using puppets.
It is important for authorities to be clear why they want to involve users, and to be clear about what is expected of them and what can be expected back. Include people from the very beginning, in setting the agenda like in the scenario where the child chose who could be present and where he wanted every one to sit. This made him feel in control even though there was an agenda. Parents should be kept informed about child protection processes, invited to meetings, and receive copies of reports and conference minuets.
Coulshed and Orme (2006:73) state 'statutory agencies are not practiced in open decision making with users of their services; therefore workers are not used to asking the opinions of the users. Therefore, the choices can be limited by the lack of information and a lack of support for decision making'. As children with disabilities 'are not seen as bona fida participants (Beresford 1997:23)', but as images of disability this adds to those of childhood to question the reliability of their information. An example of this is in the scenario as he was not able to make a decision in where he lived due to the lack of foster carers in the area. On the other hand, he made a decision to tell of his experience.
The worker may lack confidence and a skill in communication therefore engaging with users is difficult as is developing trust and a working relationship. Pressures on time limits and case loads, for example in the scenario the user finished school at three pm and at two thirty was still unsure where he was going.
There are three levels of oppression. Individual which relates to 'individual attitudes and actions, institution which is formal cultures of agencies and their procedures for doing things, structural which is about power and includes beliefs, attitudes and values' (Dominelli 1997:8)
Various things need to be considered such as age, sex, ethnicity, religion and family background. Workers need to be clear about their own values and the professional values of social work and how they shape what they can and can not do. Like in the scenario the user was suspected of being in need of protection from abuse, the worker had to balance the need to ensure the child's safety against the danger of breaking up the family.
We should attempt to see the world from the user's perspective. Self awareness is also vital in relation to how we understand family situations. Workers need to recognise that they are not objective and that their views and understanding are influenced by personal values.
The General Social Care Councils Code of Practice states
'You must protect the rights and promote the interests of users and carers (1), strive to establish and maintain trust and confidence of users and carers (2), protect them from harm (3), and take responsibility for improving your knowledge and skills (6)'.
However, to develop a more positive equitable relationship with users workers need to address 'imbalances in power'. This may not mean equal power in all situations but to move away from the structures and practices, which seek, to place all decision making power in the hands of the professional. The user in this case scenario was empowered by being encouraged to talk about his concerns and the things that he enjoys doing by being invited to talk about his experience.
Reflective practice helps us to acknowledge the importance links between theory and practice and to appreciate the dangers of treating the two elements as if they were separate domains. Reflection in practice facilitates the analysis and understanding of a situation and more importantly, of one's own actions and reactions in the work place. It encourages and provides a mechanism for adjusting the theories and trying different approaches.
However, reflection in practice goes beyond theory and testing of theory in practice. As Osterman and Kottlamp (1993:19) states 'reflective practice is viewed as a means by which practitioners can develop a greater level of self awareness about the nature and impact of their performance, an awareness that creates opportunities for professional growth and development'. The holistic model of reflective practice is concerned not only with outcome of practice, but also with the cognitive process, which develops the outcomes. Reflecting involves skills of combining experience, knowledge, theory and feelings. Gould (1996:1) describes reflective practice as 'an understanding of professional knowledge as primarily developed through practice and the systematic analysis of experience'.
The optimum conditions for reflection is in supervision this gives opportunity to reflect on the way that work has been done with individuals and to consider different ways of working, feedback from users, report writing when going to court or just writing up about a visit, conversations with peers and at care plan reviews of which the users are invited to attend.
There are many models of reflection, but how we learn effects how we reflect. Reflective practice consists of having experiences, thinking about concepts related to the experience, trying out new experiences and being aware that it is about being willing to try new things. So reflective practice is about integrating different elements of the work, policies, theories and accountability. It is about analysing what we do and helps us to understand why certain decisions are made and how practice can be improved.
User involvement is as fundamental to the service user as providing services. On pages one and two the essay develops an example of service user participation, which takes a variety of forms and at different levels on Arnsteins eight rugs. Effective partnership requires workers to have relevant skills and attitudes as well as an enabling supportive working environment. User involvement is underpinned by understandings of how power operates in Social Worker and Service user relationships especially when social workers have responsibility to provide services. However, these responsibilities do not mean that social workers cannot work in partnership with those who require their services. (2,103)
Reference list
Arnstein, S. (1969) 'Ladder of Citizen Participation.' Journal of the American institute of planners. 35, 4 (216-224).
Beresford, B. (1997) Personal accounts:' involving disabled children in research'. London: Social Policy research unit / the stationary office.
Coulshead, V. and Orme, J. (2006) Social Work Practice fourth Edition: Basingstoke: Palgrave.
Department of Health (1995b) the challenge of partnership in child protection London: HMSO.
Dominelli, L. (1997) anti racist social work. Basingstoke: Macmillian.
General Social Care Council (2002) Codes of Practice for Social Workers. London: General Social Care Council
Gould, N. (1996) Introduction: 'Social Work education and the crisis of the professions' 'in' Gould and Taylor (1996). Aldershot: Arena.
Liebech, H and Pollard, E. (1997)' Oxford English Dictionary', Oxford: Clarendon press.
McDonald, A. (1999) Understanding community care a guide for social workers .Basingstoke: Macmillan
Osterman. K. and Kottlamp, R. (1993) 'Reflective practice', Newbury Park, CA: Corwin Press.
O'Sullivan, T. (1999) Decision making in Social Work.'Basingstoke: Macmillian
Payne, M. (1997) Modern Social work theory 2nd edition. Basingstoke: Macmillan.
Shier, (2001) Pathways to participation, openings, opportunities and obligations: Children and society vol 15: 107 -117
Smith, F. and Lyon, T. (2002) The Children Act 1989 2nd edition personal guide, Surrey: Children Act Enterprises.
Thoburn, J., Lewis, A and Shemmings, D. (1995) Paternalism or partnership? 'Family involvement in the child protection process'. London: HMSO
