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The past 10 years have seen more recognition and acceptance of the right of service users to participate in developing social care, especially given the new responsibilities that key government legislative and policy initiatives have placed on organisations to consult service users. As a result, service users are increasingly asked to take part in the planning, provision and evaluation of services. This has created interest in what works in participation and why. Therefore, this assignment will look at issues around service user participation, in particular, i will define the terms ‘participation’, and ‘service user’, look at the history of participation, analyse Arnsteins ladder and its uses for participation, good practice and barriers to participation, which shall include theory and research, to finish i shall discuss what is the implication of participation to social work practice.
Service user participation has emerged more so in the last 30 years as a key feature in social work policy, practice, research and education. The emphasis on democracy in the UK over the past century has implied that members of society have a right to participate in civil life, and this emphasis on participation has gradually been extended to public services (Taylor et al 2004). Service user participation has been a central theme in the modernisation agenda when shaping and developing services, it has also been highlighted within recent legislation to involve service users in every aspect of care planning, delivery and review, also in the involvement of service users and carers in the reform of social work education (Warren, 2009).
Service user involvement has been influenced by a number of social policy theories including consumerism, citizenship, human rights based theories and social justice approaches, all have helped to form a framework for current practice in service user involvement (Abel et al, 2007). However this area is a highly complex and contested area with little research into how participation actually works in practice, although there are many published works on how participation should be achieved but not how the outcome of participation has been achieved.
This is because the defining the terms ‘participation’ and ‘service user’ can be difficult to define because of language used and are subjective, for example, one individual may describe themselves as something different to another.
What is a service user?
Beresford (2005, p471) states that ‘Service user’ has tended to develop as a generic term to describe people who receive, have received or are eligible for health and social care services, particularly on a longer term basis’. Beresford (2000, P489) also ‘highlights the term ‘service user’ as problematic because it views people primarily in terms of their use of services, which may not be how they would define themselves’. A service user Tyler (2006) states that ‘Being termed a ‘service user’ is meaningless to anyone if it does not consider the person behind the label. Although I am proud of whom I am, what I have achieved and enjoy being me, it is important that people see the ‘bigger picture’ of who I am’. The label service user applies to us all, we all use services, some individuals more than others which allow them to share their individual thoughts and experiences to benefit others.
Shaping our lives (2003) give their own definition and describes this as ‘the term service user can be used to restrict their identity as if all they are is a passive recipient of health and welfare services’… they go to say that ‘this make it seem that the most important thing about them is that they use or have used services and ignores other things that make a person who they are’. This definition indicates that individuals are people first and thier commonality of using services and their shared experiences can help to make improvements to services. However, each individual’s views are different to each other’s depending on their experiences and therefore are not a homogenous group.
What is Participation?
The oxford dictionary (2010) defines participation as the act of taking part in something. However, (Braye 2000, p9) states that ‘the language of participation is complex; the same term means different things to different people, and the same concept may be known as a number of terms’, such as partnership, involvement, and working together and collaboration. Karen Healey (2000) has, for instance, claimed that there is no universal definition of user participation or user involvement. The concept must always be placed in a context. User involvement is thus construed and perceived differently in different contexts.
Public, social and individual. Involve understanding participation.
Participation can include involving the service user in the assessment of their needs; ensuring that their wishes and feelings are taken into account, also in the planning of services required, an example of this can be seen in direct payment and individual budgets, and also in the reviewing of care plans and within meetings where decisions are to be made, this is specifically true in children’s services. The UN Convention (1989) on the right of the child states ‘Child participation is the right of the every child’, and article twelve states ‘Children have the right to be heard and considered in decisions affecting them’ (unicef, 2009). In this context partnership does not just refer to working with other professionals and agencies but also working alongside service users and carers as equal partners. Thompson (2000) highlights, social work intervention involves the exercise of power, which if used negatively can reinforce the disadvantages that service users experience. Used positively however power can help to enhance the working relationship, the outcomes, and empower the service user.
Finally, participation in strategic planning and service development, research and in the design and implementation of legislation, for example, our health, our care, our say (Department of Health (2005).
Warren (2009, p6) states that ‘participation, partnership, involvement, and working together are often used to encapsulate a wide range of different ideas and activities. These terms may sometimes be used interchangeably or can have different meanings for different people, there being no universally accepted definition’. This also states that this is a postmodernist view and that language shapes our views of reality. If it is true that there is no agreement in how to define participation and it is subjective, relative and is socially constructed, then participation could be seen as a process rather than an outcome of intervention which then informs of the reason why there is little research into participation and assessing outcomes. For example, if the research is assessed in quantitative, numeric forms, such as asking how many individuals have turned up to a meeting and got involved, it does not take into account that presence does not mean participation, participation can be done in so many other ways.
For years now Arnstein’s ladder (1969) has informed the practice of participation, and has been a key document in this area. Arnsteins ladder consists of 8 rungs arranged in a ladder pattern with each rung corresponding to the extent of citizens’ power in determining the end product; therefore, it focuses on the redistribution of power in citizen participation in a hierarchal society. (Arnstein, 1969)
The aim to participation is to achieve a genuine partnership between the service user and agency and although the ladder is a useful tool to determine if the outcomes are being achieved and that the agency is not participating in the rungs of tokenism or non participation (Dungey et al, 2007). However, the following view of participation suggest that Arnsteins ladder has for a long time now gone uncontested and when looking at participation we should take a critical stance on Arnsteins ladders and seek out other methods in order to be better informed.
Tritter and McCallum (2006, p156) state that ‘despite its importance in shaping thinking, this model continues to be applied uncritically’, and argues that ‘for Arnstein, the sole measure of participation is power to make decisions and seizing this control is the true aim of citizen engagement’. Thus, ‘the different rungs on the ladder relate directly to the degree to which citizens have attained decision making power with complete citizen control being defined as the highest point’ (Tritter and McCallum 2006, p157). However, the engagement of user participation is complex and individuals will formulate their own meanings and action that reflect in their own views of what participation is and how they want to involve themselves. For example, a service user can participate and effect decisions without actually having to have the power to make a decision, and therefore, Arnsteins ladder is constrained by a specific conceptualisation of activism, such as hierarchies of power and that participation should be processes that are empowering and enabling at four levels: system, organisation, community, and individual (Tritter and McCallum, 2006). Collins et al (2006) also agrees with this and suggests that Arnstein’s ladder, with its focus on power, is insufficient for making sense of participation at a conceptual or practice level. Warren (2009, p50) states ‘that different levels of participation of may be appropriate for different individuals and groups of service users and carers at different times and contexts’. Therefore, the ladder does not recognise the diverseness of services users who may seek different level of involvement in relation to different issues and at different times, it only recognises the hierarchy of power which assumes that service users have a goal and a measure of this is not achieving full power and little opportunity to evaluate the individual or groups involvement.
Thompson (2000) discusses that power can be a complex issue that operates on different levels. Quinney (2009, p33) states that ‘shared power is a non hierarchal structure where power is shared but responsibility and accountability needs to be clear. Power sharing can be difficult to negotiate and is complicated by power being located and experienced at the personal, professional, and societal level’.
When service providers seek to involve service users, they often do so in order to gain feedback so that they can make changes and improvements to their services. What this principle asserts is that approaches to involvement should also be designed so that service users are personally empowered by the experience. In other words, there should be a two-way, rather than a one-way benefit. A good example of where things can go wrong in terms of involvement is when service users feel that their views have not been listened to or taken seriously, which can have the effect of making people feel disempowered rather than empowered. Adams et al (2002) states that In order to achieve meaningful communication, the social worker needs to be able to build a relationship with trust; the essence of partnership is sharing. ‘It is marked by respect for one another, role divisions, and rights to information, accountability, competence and value accorded to individual input. Each partner is seen as having something to contribute, power is shared, decisions are made jointly and roles are not only respected but are also backed by legal and moral rights’ (Tunnard, 1991).
In an overview of research from SCIE, Carr (2004) suggests that people are being involved and participating, however, this research shows that it is unclear to what level and impact that individuals have on outcome, which suggests that better monitoring and evaluation need to be addressed with service user which integrates mapping and feedback in the whole participation process. Crawford et al (2002) point out that ‘the ultimate goal of service user participation should be the promotion of health, quality of life, or overall user satisfaction with services. However, these outcomes are often difficult to measure, they can take a substantial amount of time to become evident, and the link with the participation of services users and carers can be difficult to prove’. Overall, the evidence base is generally weak in the area of evaluation of user and carer participation. Few papers examine the outcomes of user participation for the various stakeholders and the actual outcome measures are poorly conceptualised (Carroll et al, 2007).
The issues involved with researching service user participation are complex and opinions are often polarized as it is in its infancy, with many practical, ethical, moral, methodological, and philosophical question unanswered (Grant et al, 2007).
No set model of how to participate……
Although there are explicit requirements to assess how commissioners and providers are involving their users, however there are fewer centrally set targets to asses this.
Truman and Raine (2002) claim that there has been a long tradition within the voluntary sector of centring the planning and delivery of services on the needs of users. However, how this is managed can lead to tokenism, for example, a service may call themselves user led, but in fact when the information from service users is interpreted by workers/ managers this interpretation can be lost in language; A service may involve service users in planning meetings but when implemented in practice the workers can use their own interpretation of this. Tokenism occurs when an organisation feels satisfied that it has ticked the boxes, yet the reality is experienced very differently by service users and carers.
Heikkilä and Julkunen (2003) state that user particiaption and user involvement have two very different meanings and that involvement is suggestive that service user activity has an impact on the service process in some way, whereas, participation suggests that service user are participation in a activity only as informants.
INVOLVE WEBSITE PUBS – 3 model social individual and societal. Put this and what its about as a intro to particaption. Look at all three and analyse.
Barriers to participation
As i have already discussed above power is the biggest barrier to participation, there are many more barriers which need to be discussed. Barriers are historical, financial, physical and attitudinal.
Kenyon Et al, (2002) define access as ‘the processes by which people are prevented from participating in the economic, political and social life of the community because of reduced accessibility to opportunities, services and social networks, due in whole or in part to insufficient mobility in a society and environment built around the assumption of high mobility.’
The reviews indicate that organisational culture and structure also needs to respond and change in order to accommodate new partnerships and new ways of working with people who have often been oppressed and marginalised. There are things
to learn about innovative and collective approaches to participation and change from user-controlled organisations such as centres for independent/inclusive living and self advocacy schemes. Organisations require policies and procedures (formulated with service users) that engender positive political commitment and minimise resistance to user led change. User-led research could usefully reveal more about the role of professional allies in promoting change.
Healey (2000) highlights the need for us to recognise the productivity of power, and argues that by focussing on power as only being oppressive ignores the positive dimensions of power.
to be sensitive to the issues of power and imbalances – to recognise the power imbalances
Healey (2005) discusses the practice principles and how the social worker should adopt a positive and optimistic attitude towards service users, working in partnership with them so solutions to problems are developed collaboratively.
Tokenism occurs when an organisation feels satisfied that it has ticked the boxes, yet the reality is experienced very differently by service users and carers.
It is also essential to note that user involvement takes place on different levels (Truman & Raine 2002) ,
1) at a national and local level;
2) in the planning, organising and managing services; and
3) in organising individual care
Barriers to participation
Implications for sw empowerment, info sharing ect
Policy and legislation
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