Social Work Education
The International Journal
ISSN: 0261-5479 (Print) 1470-1227 (Online) Journal homepage: http://www.tandfonline.com/loi/cswe20
Mend the gap - strategies for user involvement in social work education
Ole Petter Askheim, Peter Beresford & Cecilia Heule
To cite this article: Ole Petter Askheim, Peter Beresford & Cecilia Heule (2017) Mend the gap -strategies for user involvement in social work education, Social Work Education, 36:2, 128-140, DPI: 10.1080/02615479.2016.1248930
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Date: 08 August 2017, At: 07:32
SOCIAL WORK EDUCATION, 2017 VOL 36, NO. 2,128-140
http://dx.doi.org/! 0.1080/02615479.2016.1248930 ÜI "\ Taylor & Francis Croup
ij Routledge
Taylor &. Francis Crou
Mend the gap - strategies for user involvement in social work education
Ole Petter Askheim3, Peter Beresfordbc and Cecilia Heuled
department of Health and Social Work, Lillehammer University College, Lillehammer, Norway; department of Health and Human Sciences, University of Essex, Colchester, UK; department of Clinical Sciences, Brunei University London, London, UK;dSchool of Social Work, Lund University, Lund, Sweden
ABSTRACT
A major strand in social work's history has been its paternalistic character, partly due to a philanthropic tradition, but also to the tendency to import an individualist expert model into social work practice. As a result, gaps have arisen between expert and experiential knowledge. In this article, so called'gap mending strategies'developed by the international network PowerUs are discussed. PowerUs consists of teachers and researchers from schools of social work and representatives from service user organizations in nine European countries.The gaps as the network identifies them are presented and we share some processes within our practices that mend or maintain gaps between service users and professionals. Two main strategies will be explored in more detail—a strategy that has been developed in the UK of mainstreaming service user participation in all stages of social work education, and a strategy that has been developed in Scandinavia of developing joint courses for social work students and students from service user organizations. A main conclusion is that alliances between educational institutions and service user organizations will be important to get a fuller understanding of what gaps we are facing and how they best could be mended.
KEYWORDS
User involvement; social work education; gap mending strategies; European experiences
Introduction
Service user involvement is an objective of increasing importance in social policy generally, as well as in the education of social workers specifically The concept is fundamental in the international definition of social work adopted by the International Association of Schools of Social Work, IASSW and the International Federation of Social Workers (IFSW)1:
The social work professions core mandates include promoting social change, social development, social cohesion, and the empowerment and liberation of people./.../ The uniqueness of social work research and theories is that they are applied and emancipatory. Much of social work research and theory is co-constructed with service users in an interactive, dialogic process and therefore informed by specific practice environments.
In a European Framework for Quality Assurance of the Social Professions developed by the IFSW, the involvement of service users in the running and development of social services
CONTACT Ole Petter Askheim Q ole-petter.askheim@hil.no © 2016 Informa UK Limited, trading as Taylor & Francis Group
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is identified as a key element in the social work role (Anghel & Ramon, 2009; Beresford, 2016). However, despite the good intentions, the achievement of the goal of increased user involvement and empowerment as a result of social work appears to remain distant. A major strand in social work's history has been its paternalistic character, partly due to a philanthropic tradition, but also to the tendency to import an individualist medicalized expert model into social work practice. As a result service users are mainly conceived of as persons with deficiencies and problems. The attitudes are transferred to the students of social work. Students mainly learn about user involvement and empowerment through theory and mainly meet service users as clients during their placement periods or when service users give isolated lectures. The cooperation with the practice field' is mainly limited to contact with the professionals (Beresford et al., 2006; Borjeson, Denvall, Heule, & Kristiansen, 2008).
In this article, so called gap-mending strategies' developed by the international network PowerUs to reduce the gaps between the declared aims and the experienced realities are discussed. PowerUs consists of teachers and researchers from schools of social work and representatives from service user organizations in nine European countries (www.powerus.se). Firstly, the gaps as the network identifies them will be presented and we will then share some processes within our practices that mend or maintain gaps between service users and professionals. Two main strategies will be explored in more detail—a strategy that has been developed in the UK of mainstreaming service user (and carer) participation in all stages of social work education, and a strategy that has been developed in Scandinavia of developing joint courses for social work students and students from service user organizations. We will finally discuss to what degree the gap-mending strategies represent approaches to renew social work in a radical transformative way.
Relationships and roles in social work education and practice
Policy documents have prioritised service user participation in recent years (Beresford, 2011; Eriksson, 2015). Beresford and Croft (2003) identify two different traditions of service user participation, with different goals and philosophical roots. The first, they call consumerist/ managerialist, and comes from management strategies. It sees service users as customers that can help develop more effective services. Its approach emerged under neo-liberalism and was put in place in service systems. Here the concern has been to include the views and ideas of people as public service users, in the same way that they have been in market research in the provision of mainstream commercial goods and services. The aim is to provide market intelligence rather than to bring about any transfer of control or increased say in decision-making. The other model is called a democratic/citizenship one. Its goal is delivery from different kinds of exclusions and oppression and the redistribution of power. The democratic/citizenship model emphasizes the importance of active service user participation in all aspects of support and services (Cameron, 2014; Priestly, 1999).
Many social scientists agree that specific methods are of less importance than the relationships that are developed in social work practice (Hasenfeldt, 1992; Parton, 2000; Trevithick, 2003). However what roles the service users should take in relation to social workers differs greatly between different social work models. The professionalization of social work practice has led to an increasingly common view of the social worker as an expert in other people's problems. Social work has sought to develop its own body of knowledge, with social workers seen as having specific expert professional knowledge to validate their activities. The
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tendency is reinforced since the social workers generally are employed in organizations characterized by certain ways of defining and understanding the problem. The institutions have a certain repertoire of measures and benefits at their disposition, which influences how practitioners identify the problems and the persons seeking help. The Danish researchers Jarvinen and Mik-Meyer (2003), p. 15) describe the development in social work as the standardisation of human problems'. Consequently, categories and roles are constructed, and individuals reduced to cases. The tendency has gained further strength as manageralism and New Public Management (NPM) ideas have gained ground (Beresford, 2009; Lavalette (ed.), 2011; Rogowski, 2010). The users are reduced to passive consumers. At the same time, strong elements of control in the NPM model to secure the efficiency and cost-effectiveness of the services express lack of confidence to both the users and the producers of the services.
Research has also shown that social workers often share negative views of social problems that are widespread among the wider population. Stigmatizing attitudes are not only present in society at large, but also among helping professionals and students in areas as psychiatry, psychology and social work (Mittal et al., 2014; Nordt, Rossler, & Lauber, 2006; Svensson et al., 2014; Trevithick, 2012). A consequence of all this can be that the experiences and contributions of people with direct experience as social work service users are devalued or ignored. Reports from service users also show that they often feel humiliated and oppressed as a result of their contact with people who are employed to help them (Johansson, 2006; Oliver, Sapey, & Thomas, 2012; Ronning, 2005).
In contrast to this paradigm stands a model based on reciprocal relationships and co-production of knowledge, which reflects the referred goals of social work expressed by the IFSW and the IASSW. The participatory model suggests that social workers should see vulnerable and disadvantaged groups as their allies in mutual efforts to change and better society. To include service users in developing society and its services is a political matter, as well as a matter of human rights. Additionally, empirical studies from different service user groups show that service users' satisfaction with the services, and also their recovery processes and positive solutions of their problems, are strongly associated with a positive reciprocal relation between the users and the services, with the basis in the users' own values and preferences (e.g. Davidson, Andres-Hyman, Fry, & Kirk, 2008; McCormack & McCane, 2010).
Mending the gaps
The gap-mending concept can be characterized as a reflective tool that helps teachers and researchers to consider what, in their practices increases, maintains or mends gaps between policies, services and professionals—as well as service users. Gaps always exist in a context. Gaps can develop and be maintained because of prejudices based on social work's categorization of people, because of language barriers, because of institutional hierarchies and the roles we have created for people within them. They can also exist because of lack of knowledge. Contextual knowledge is therefore essential in gap-mending reflections, as well as a good understanding of existing gaps.
An essential component of the gap-mending concept is co-production. Co-production is defined as a particular form of partnership between people who use social care services and the people and agencies who provide them (Hunter & Ritchie, 2007, p. 9). Bowers and Wilkins (2012, p. 100) declare that as a concept co-production is renowned for its excessive flexibility in terms of the ways in which it has been defined and interpreted'.
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Needham and Carr (2009) distinguish between three levels of coproduction: at the lowest level, co-production is simply used as a description of how all services rely on some productive input from the users. This approach simply restates existing approaches to public services as co-productive, and fails to acknowledge the potential for more effective use of productive capacities among service users or for creating social capital. At an intermediate position, Needham and Carr describe co-production as a tool of recognition for the people who use services and their carers, acknowledging their input, valuing and harnessing the power of existing informal support networks and creating better channels for people to shape services. This level of co-production offers a way to acknowledge and support the contributions of service stakeholders, although without necessarily changing fundamental delivery systems. There is therefore a danger that it can be a device to legitimize existing approaches, helping people who use services better to understand the strains that providers face, rather than changing organizational cultures and improving service provision. At its most effective, Needham and Carr describe co-production as an approach, which involve a transformation of the services. The transformative level of co-production requires a relocation of power and control, through the development of new user-led mechanisms of planning, delivery management and governance. It involves new structures of delivery to entrench co-production, rather than simply ad hoc opportunities for collaboration and brings service users and practitioners together in new ways.
It is important that these different levels of co-production are remembered and acknowledged when we talk about co-producing methods in social work, and that existing power mechanisms have to be challenged. When we speak of gap-mending strategies, it is essential to emphasize that it is co-production at a transformative level we have in mind. Beresford (2011, p. 109) reminds us of this when he describes social work as co-production: 'What it means is that understanding and construction of social work practice comes to be seen as a joint activity between service user and worker, in which the former can play an active part in structuring and shaping in accordance with their rights and needs'.
An important ingredient in transformative co-production is the concept of empowerment. The concept of empowerment originates from the literature on marginalized people and the process through which marginalized people can mobilize and raise awareness, in order to draw on their own abilities and resources to solve their own problems. Empowerment has been important as an organizing concept for the disabled people's and service users' movements. Vital sources of inspiration have been the Black civil rights movement in the USA in the 1950s (Solomon, 1976) and not least, Paulo Freire's book 'Pedagogy of the Oppressed' (1970). Two related aspects of empowerment are personal and political empowerment. This acknowledges the importance of both personal and political change and their inter-relation. Thus, service users highlight personal empowerment—meaning the need for change within us—if we are to be actively and meaningfully involved in making change. Otherwise we may only serve as a stage army. Such personal empowerment is likely to include gaining confidence, knowledge and skills. But political empowerment is also of importance—and this is understood as the need for making change at wider structural and political levels. This model of empowerment places an emphasis on the need to address both of these elements if people are to be truly rather than tokenistically involved in making change. Disabled people and service users have seen developing their self-organization through their own 'user led organisations' (ULOs) as the major method of doing this. Such organizations can support people's personal empowerment as a first step to them becoming actively collectively
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involved to achieve change. This can be gained through the greater strength that comes from developing collective ideas and agendas and working together to achieve them in their own organizational space (Campbell & Oliver, 1996; Jacks, 1995; Oliver & Barnes, 2012; Shera & Wells, 1999). A gap-mending practice should be empowering for service users as well as professionals and they should help empowering each other.
The PowerUs network
The concept of gap-mending was developed by the PowerUs network,2 which started in 2011 through an EU-funded project consisting of social work teachers and service users from three countries—Sweden, Norway and the UK. The purpose of the network was to share good experiences of service user participation in social work education and research. Participants of the original network had developed different strategies aiming to reduce the distance between social workers and service users and to enhance the experiences of the service users. In Scandinavia (Lund (Sweden) and Lillehammer (Norway), this had been done by creating university courses that included both students from the social work programme, as well as students recruited from different service user organizations. In the UK, the development had taken a different turn. Service users had, in collaboration with researchers and teachers of social work, succeeded responding to a new requirement of mainstreaming service user participation in all aspects and stages of planning and execution of social work professional education.
In five years, the PowerUs network has grown to include new participants from countries like Denmark, Germany, Switzerland, The Netherlands, France and Belgium. The requirement to join the network is an active practice of collaboration between service users and academics in developing methods that the network has come to call 'gap-mending' methods. Theoretical approval of service user participation is thus not enough. There is a growing European interest in methods developed within the network, which was demonstrated at the international conference organized by the European Association of Schools of Social Work (EASSW) in Milan 2015, in which PowerUs was a partner. The conference was introduced with a film produced by PowerUs.3 The EASSW has expressed a desire to disseminate the values and methods of PowerUs to its 300 member schools. In some European countries, service user involvement in social work education has become a requirement, however, there are still many European countries where the inclusion of users of social services is still considered as a 'taboo' issue and it has been ignored.
The Swedish experiences
There is no legislation in Sweden that regulates service user influence in municipal social services or in the education of social work. However, the National Board of Health and Welfare has published several publications to provide the municipality's advice and guidance to develop service user participation in their activities. This has not resulted in a considerable change in the practice. When it comes to social work educations in Sweden, the importance of service users' perspectives was pointed out 2009 in an evaluation made by the Swedish National Agency for Higher Education (Hogskoleverket, 2009). Although the schools of social work in Sweden have courses about service users, it is very rare to involve them as partners in planning or development of the curriculum.
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In 2005, teachers at Lund University launched a new pedagogical concept, including a group of service users in a 75 ects (European Credit Transfer and Accumulation System) credit course that had normally been an elective course for social work students in their last semester. Since then, 18 such Mobilization courses have been undertaken, with approximately 400 social work students and a little over 200 service users involved. The service users study along side with the social work students and achieve university credits. The teachers have been inspired by many social theorists and pedagogues throughout the years, among them Freire (1970), Levinas (1998), the work of Joan Tronto (2009) as well as the writings of the recovery-movement (Deegan, 1988; Topor, 2001; Wilken, 2010).
One important goal of the experimental course was to shift a focus that there often is, on the needs, or the problems of the individual, to the need for reciprocal relationships and a strengthened community in society. This can be seen as a paradigm shift, as the organization of social work in Sweden is mainly structured around the categorization of individuals according to their problems. The change can also be understood as an attempt to shift social work activity from regulation to inclusion.
An important lesson learned in the early years was to deconstruct categories that are dominant in social work practice and that tend to cause tension between the two student groups. Not until methods that required a more personal input from the students were developed did the teachers experience a breakthrough in their aim of creating community and solidarity between the student groups. One method of developing this reciprocity is by initial personal presentations, where every student gets 15 min in front of the others to talk about who they are, and what matters to them in social work practice. For social work students, an important boundary is crossed as they share both doubts and weaknesses with each other and with the other student group. This works as an icebreaker and makes it possible for the students from service user organizations to face the social work students outside their prejudices, built on earlier experiences.
Social work students experience empowerment, as they can draw from earlier life experiences, including hardships, and become more personal in their future practice, with a better ability to resist bureaucratic demands of conformity. It is unlikely that they would choose to be so generous in showing themselves from a vulnerable side, were it not for the presence of the students from service user organizations. In the reflections from the social work students, they share that they normally experience university courses as being more competitive and encouraging them to show sides of themselves that could leave them vulnerable or disadvantage them in that competition. Service user students also say that they are relieved to be able to talk freely and on equal terms about the need for a changed social work practice. Many of them have earlier thought of university studies as something unapproachable. Some continue to study, in some cases, to become social workers.
The vision of the course has been to reconstruct a better and more inclusive practice. The students spend most of the time developing project ideas that are often both innovative and close to the needs expressed earlier in the course through the presentations of the participants. A difficulty is, though, that although these projects have great importance and value, they are often not compatible with the rigidity of the social service organization in Sweden. However, some of the projects have been realized, and some new service user organizations have been launched with the help of the platform and network that is created by the mobilization course. We have also seen further empowerment within the local service user movement, as many of their members have been challenged and further equipped through
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university studies. Students network with each other on social media and in public lectures that are held in the School of Social Work in Lund, also with students that have taken the course in other semesters than themselves.
For the teachers the platform of the mobilization course have been an ideal structure for testing research hypothesis in practice, and with the help of students-developing new knowledge about community principles and mechanisms (Angelin, 2015; Heule & Kristiansen, 2011, 2013, in press, Kristiansen & Heule, 2016).
Reflections from Norway
In the Norwegian Act of Social Services, it is stated that the services as far as possible should be designed in cooperation with the service users.4 The curriculum for social work education declares that the services users' needs should be at the centre of the work and that the social workers should show respect for the service users' knowledge and choices.5 Still, there are weak traditions for involving service users in the social work and social education courses in Norway. Traditionally people with user experiences are used in single lectures; otherwise the students mainly meet them as clients in their practice placements.
Inspired by the mobilization course in Lund the course 'Empowerment: meeting face to face creates new insights' (5 ECTS-points) since 2009 has been organized at Lillehammer University College as a joint course for undergraduate/bachelor students in social work and social education together with students with experiences as users of welfare services (Askheim, 2012). About 120 internal and 70 external students have since taken part in the course.
The title of the course, 'Empowerment: Meeting face to face gives insights', declares the goal: to create new insights for both groups. The intention is to give the participants new knowledge about the possible implications of marginalization and powerlessness and how they could be challenged when service user knowledge and professional 'expertise' are regarded as equally valid approaches to these problems. More specifically the goals are to give the students insight into:
• How power and powerlessness are created in the relationship between service users and professionals
• What empowerment can involve at different levels (individual/systemic level)
• How service user competence and professional competence can complement each other
• How empowerment can be realized in practice
Most of the external students have experiences connected to mental-health problems and are recruited through their service user organization or a user-led regional centre Another main group has service user experiences relating to drug misuse. Additionally some students have service user experiences relating to physical impairments, sensory impairments, as well as problems that are more mixed.
During the course, the students work intensely together four days every week during a three-week period. One day each week is reserved for individual studies. The course starts with a seminar located outside the college. On this seminar the students work together through experience based and creative methods derived from art and expressive therapy (Levine & Levine, 1999). These are methods well suited for promoting community, building
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trust and creating a safe learning environment. The second part consists of lectures that aim to illuminate the concept of empowerment. Discussion groups composed of students with different backgrounds then follow and the students then meet in plenary sessions. Finally, the students conduct a group project, which the groups present in plenary. The presentation takes place in a variety of ways, as role-plays, video productions, and as oral and written presentations. This presentation is a final exam.
The immediate evaluations of the courses are very positive. Both internal and external students say that they have come to new understandings about each other and about the use of theoretical concepts in practice (Askheim, 2012; Askheim, Altmann, & Hasvold, 2014). At the same time the relationship challenges established attitudes and roles. The course makes both parties reflect upon their roles and attitudes. The 'us-and-them distinction between the parties dwindles.
A crucial criterion of whether such a course is successful or not, is nonetheless if the course has a lasting effect, if it adds values to programs, and enhances and changes professional practice, as well as improving service users' outcomes. A comprehensive literature review of projects with service user involvement in social work education concludes that there is no sufficient empirical evidence that service user involvement improves outcomes for students, nor that it has an effect on social work practice or on outcomes for future service users (Robinson & Webber, 2013). The conclusion further that in order to get meaningful service user involvement it is urgent to define specifically what the overarching aims should be. They refer to Beresford (2005) who defines meaningful involvement as evidence of change or improvements.
To investigate further whether our course seems to have a more lasting effect, we did a follow-up study with a selection of former students in 2014 (Altmann & Hasvold, 2015). What the students express four to five years after the complementation of the course correspond strongly with their immediate feedbacks. What the former students emphasized as valuable by the end of the course was repeated and elaborated. Former internal students felt that participating in the course had changed their attitudes and perceptions of the social worker's as well as of the service user's role, and as a consequence their practice. The external students described increased awareness about suppression mechanisms, self-worth and status as equal participants, and how this had affected how they today act in the role as service user.
Two of five former external students said that participation in the course has been a crucial factor for them to start further education. Having good experiences as students on the Face-to-Face course, and having their competences recognized, seems to be of great significance. This suggests that each of them has gained a greater degree of control of their own future.
The differences between Robinson and Webber's (2013) and our findings, can be related to the fact that their data were mainly based on service user's participation in admission interviews for studies, service users' assessment of students' assignments, and service user lectures. These are measures well suited to clarify and recognize a service user perspective, but differ from our course where internal and external students are learning together. Our study is based on the gap-mending pedagogy that reflects a partnership between the student and the service user This cooperative learning seems to have brought change or improvements in the way as Beresford (2005) refers to as meaningful service user involvement.
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The British model
The UK is probably the country where the importance of user involvement in social work has been most clearly recognized officially and where it has the longest history. The new degree in social work, which was introduced in England and Wales in 2003, has made these countries the only ones in Europe where educational institutions are obliged to involve service users actively in the implementation, practice and evaluation of social work programmes at all levels (Department of Health, 2002). The Department of Health in addition provided special grants from central funding in order to support higher education institutes (HEIs) to develop and resource strategies to involve service users and carers (Levin, 2004). Government guidance does not prescribe the exact form of inclusion and participation to be pursued.
However, the British model can be summed up historically as primarily focusing on involving service users and carers (it has always involved both) in the process of social work education, in order to add their perspectives and input to the learning and knowledge provided for the students taking part (Branfield, 2009; Branfield, Beresford, & Levin, 2007). Projects documenting user involvement show that people with service user experiences are involved as lecturers and consultants in the development of programmes and curriculum, in the process of recruiting and assessing students and in the evaluation and quality assurance of the programmes (Anghel & Ramon, 2009; Baldwin & Sadd, 2006; Gupta & Blewett, 2008; Humphreys, 2005; Levin, 2004). Some courses have developed relationships with local 'user controlled organisations' (ULOs) to take forward this task; others have set up their own groups to work with the students. Students value the input of service users in their training because they provide a unique and valuable perspective, and people who rely on various services find their involvement in professional education to be worthwhile and beneficial (Beresford, 2014; Evaluation of Social Work Degree Qualification in England Team, 2008).
The involvement of service users in the design and delivery of the social work programmes does not necessarily imply that they take an active part as students. However, in some English projects, people with user experiences have been specially recruited as students and have obtained academic credits (Barnes, Carpenter, & Dickingson, 2006; Taylor & Le Riche, 2006) Increasingly when students are recruited to social work courses, there also seems to be recognition that their own lived experience—as both service users and carers—is something to be valued rather than viewed as a deficit.
More recently two developments have taken place which have had an impact on user involvement in UK social work education. First, building on the activities and experience gained by PowerUs, courses based on the Scandinavian model have also begun to emerge in Britain. Both London South Bank University and New College, Durham, have developed such courses. What has been especially interesting about the Durham course is that it has broken new ground, involving as students' mothers whose involvement with the social work service has related to child care and child protection issues (Casey, 2016). Secondly, there has been an increasing political and policy interest in England in so-called 'elite' social work graduate courses, including Frontline, Step Up To Social Work and Think Ahead. All have been concerned with 'improving the quality' of candidates for social work, but have tended to interpret this in terms of perceived improvements in their academic ability interpreted in terms of their qualifications and the status of their undergraduate universities. This has raised concerns that this devalues lived experience and limits diversity and reflects a desire
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to tailor social work training to a neoliberal agenda and to restrict undergraduate routes to qualification (SWAN, 2014).
Concluding remarks
There is increasing urgency to develop systematic and effective user involvement in social work and social work education. Without it, social works values and goals are likely to be subverted because of the paternalistic traditions of social work and the dominating political climate in the contexts where social work is to be practised.
As the title indicates, the gap-mending concept has been developed as a reflective tool for mending the gaps between the declared goals of social work as, for example, stated in IASSW and IFSW-definition and between policies, services, professionals-and service users. The aim is to renew social work in a transformative way, consistent with its declared goals. The experiences from the gap-mending approaches referred to in this article and the growing interest in different countries is promising. How the gap-mending strategies more concretely should be developed is likely to vary and will have to take into account national and local considerations. Alliances and networks between educational institutions and service user organizations as well as across national borders will be important to disseminate the values and methods and learn from each other, inspire each other and discuss with each other to get a fuller understanding of what gaps we are facing and how they could best be mended. The growth of the PowerUs network and the growing cooperation between PowerUs and the EASSW is a promising start for such a development. The EASSW conference in Paris in June 2017 will be an important event to reinforce the gap-mending principle further and to spread it to new partners within Europe.
Notes
1. http://www.eassw.org/global-social-work/2/gdsw-a-global-definition-of-social-work-.html.
2. www.powerus.se.
3. https://www.youtube.com/watch?v=QExM_aA2Mus seen 2016-01-15.
4. https://lovdata.no/dokument/NL/lov/2009-12-18-131#KAPITTEL_1.
5. https://www.regjeringen.no/globalassets/upload/kilde/kd/pla/2006/0002/ddd/pdfv/269389-rammeplan_for_sosionomutdanning_05.pdf.
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