Involving service users and carers in social work education
Thinking about the meaning and level of involvement
Participants in the SCIE project have emphasised that programme providers and their partners need to be very clear from the start about the principles, aims and intended outcomes of service user and carer involvement. There is a link between decisions in this area and budgetary considerations. On the one hand, the budget available may put limits on the amount, type and extent of participation and preparation for it. On the other hand, the level of involvement sought may affect the size of the budget that is needed.
There is a long-standing debate about the meaning of 'partnership’, 'participation’, 'involvement’ and 'working together’ (16-19). These terms are often used interchangeably, are ambiguous and may have different meanings for different people. The challenge is how to put into practice the ideas underpinning these terms.
Taylor (20) offers a framework for the discussion of service user participation in social work education. She suggests that our thinking should cover: culture and values; roles and responsibilities; and the 'value added’ to professional education by the partnership. She emphasises the importance of negotiating and agreeing the nature of the partnership with service users.
In relation to roles, Manthorpe (21) identifies three models for incorporating the experience of carers into social work training: personal testimony; carers as co-trainers; and the use of the programme participants’ experience of providing and receiving care. Although a distinction should be made between carers and service users, this model may also apply to service users’ contributions. In a recent paper, Beresford5 makes a case for the direct transmission of people’s 'experiential knowledge’ in research and training, using ways that empower them. He offers for discussion the theory that: "The greater the distance between direct experience and its interpretation, then the more likely resulting knowledge is to be inaccurate, unreliable and distorted”.
Barnes and colleagues (22) trace the evolution of participation from a 'consumerist’ to an'empowerment’ approach and, most recently, a 'stakeholding’ and 'partnership’ approach. They "consider partnership a more realistic approach because it acknowledges differentials in power without demanding equality”. However, they point out that "empowerment may be an outcome of partnership with service users even if it is not the primary aim”.
Some service user organisations such as the Wiltshire and Swindon Users’ Network prefer to define themselves as allies rather than as partners, arguing that the term 'allies’ more accurately reflects their relationship with the programme providers. Given these issues, it will be necessary to discuss and clarify the approach on each programme. Empowerment may be the value underpinning the training and the outcome of work with service users and carers (16-18). Also, it may be a condition of engagement laid down by potential service user and carer partners (23,24).
The providers of social work education have stated that they have to be 'clear from the start about the levels of participation' that they hope to achieve in the first instance. These may change over time, as experience builds up, and when more funding becomes available. A clear, shared understanding on all sides about the aims, and scope of the partnership should facilitate working together. This includes the influence and power that service users, carers and other stakeholders will have in decision making, for example, in the student selection process.
Partners may want to use a rating scale to assess the degree or level of service user and carer involvement in the degree programme overall and in various elements of it. The ladder of citizen participation created by Arnstein (25), with its eight steps ascending from citizen manipulation at the bottom to citizen control at the top, has strongly influenced the development of tools for evaluating service user involvement.
These scales usually cover a continuum of involvement ranging from 'none’ at one end to 'full involvement’ and 'integration’ at the other. The scale developed by Goss and Miller (19) to evaluate user- and carer-centred community care has been adapted and applied to service user involvement in nursing, social work and mental health education (26-9).
The latest version of this scale is included in the National continuous quality improvement tool for mental health education published by the Northern Centre for Mental Health (29). This very useful tool aims to help the Workforce Development Confederations in their commissioning of postqualification mental health education programmes but surely has wider applicability, including to the social work degree.
The tool must be used in conjunction with the accompanying guidance notes. Sections 2 and 3 cover mental health service user and carer involvement in programme planning, delivery and evaluation. Following the completion of open-ended questions and discussions, groups of service users and carers use a five-point scale to award a score for involvement. This is then weighted and contributes to one overall percentage score for the programme. Different scores are attached to the five levels, ranging from 'no involvement’ to 'partnership’.
Partnership is achieved when "educationalists and users work together systematically, strategically, with full support, reimbursement structures and with education and training opportunities available. Users are involved at all stages of the planning, delivery and management processes. Decisions are made jointly. Users are involved in the assessment of students in the practice area. Users are working as lecturers”.
While such scales aid thinking about the level of involvement, they do not fully cover the equally important issue of the quality of this involvement. Separate mechanisms will be required to set quality standards and work towards achieving them.