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Social Work Education
The International Journal
ISSN: 0261-5479 (Print) 1470-1227 (Online) Journal homepage: http://www.tandfonline.com/loi/cswe20
Learning from service users’ involvement: a
research about changing stigmatizing attitudes in
social work students
Elena Cabiati & Maria Luisa Raineri
To cite this article: Elena Cabiati & Maria Luisa Raineri (2016) Learning from service users’
involvement: a research about changing stigmatizing attitudes in social work students, Social Work
Education, 35:8, 982-996, DOI: 10.1080/02615479.2016.1178225
To link to this article: http://dx.doi.org/10.1080/02615479.2016.1178225
Published online: 03 May 2016.
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Social Work Education, 2016
VOL. 35, NO. 8, 982–996
http://dx.doi.org/10.1080/02615479.2016.1178225
© 2016 Informa UK Limited, trading as Taylor & Francis Group
Learning from service users’involvement: a research about
changing stigmatizing attitudes in social work students
Elena Cabiati and Maria Luisa Raineri
Department of Sociology, Catholic University of Milan, Milan, Italy
ABSTRACT
Stigmatizing attitudes can create barriers to forming partnership with
service users and to developing people’s empowerment. So, social
work education must help students overcome their stigmatizing
attitudes. A useful strategy for bringing about changes is service users’
and carers’involvement in social work education, providing students
with direct exposure to stigmatized people in roles that emphasize
their humanity and strengths, rather than their deficits. The present
study assessed the impact of a one-day meeting with service users and
carers members of self-help and mutual-aid groups on freshman social
work students. Students completed an adapted version of Attitudes
to Mental Illness Questionnaire before and after the meeting, and
answered several qualitative questions. Data comparisons suggest
that after face-to-face contact with service users and carers, social
work students showed reduced stigmatizing attitudes. Implications
for further research and social work education are discussed.
Social work and stigmatizing attitudes
Stigma is particularly important in social work because most if not all people social workers
work with will be subject to some form of stigmatization. ‘Simply being a client of a
social worker is often enough to attract stigma’ (Thompson & Thompson, 2008, p. 216).
Furthermore, social work has an important tradition and role in supporting vulnerable
populations and in fighting discrimination and stigma (Banks, 2008; Barnes, 2006; Burke &
Parker, 2007; Cree, 2013; Dominelli, 2002, 2008; Fook, 2012; Thompson, 2006). Nevertheless,
social workers often share the negative view of social problems that is so widespread among
general population. Stigmatizing attitudes are not only present in society at large but also
in helping professions, including psychiatry, psychology and social work (Nordt, Rössler, &
Lauber, 2006; Scheyett & Kim, 2004; Trevithick, 2005). Promoting users’ empowerment and
partnership is pivotal to social work practice, but stigmatizing attitudes can create barriers
to forming partnership and to empowering people. Therefore, it is vital that social work
education helps students to overcome their stigmatizing attitudes (Zellmann, Madden, &
KEYWORDS
Service users’and carers’
involvement; stigmatizing
attitudes; relational social
work; AIMQ
CONTACT  Maria Luisa Raineri  marialuisa.raineri@unicatt.it
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Social Work Education   983
Aguiniga, 2014) as means to develop a ‘critical understanding of how socio-structural inadequacies,
discrimination, oppression, and social, political and economic injustices impact
human functioning and development at all levels, including the global’ (Sewpaul & Jones,
2005, p. 220).
Various ways to decrease stigmatizing attitudes in general population (e.g. Corrigan &
Penn, 2015; Galletly & Burton, 2011; Heijnders & Van Der Meij, 2006; Lebel, 2008; Weiss,
Ramakrishna, & Somma, 2006) and among professionals (e.g. Galletly & Burton, 2011)
are described in literature. As direct contacts and personal relationships with those stigmatized
seem particularly useful to reduce stigma (Corrigan & Penn, 2015; Covarrubias &
Han, 2011) an important strategy for bringing about changes in professionals’ perceptions
of stigmatized people has been to involve the latter in education and training, providing
students and practitioners with direct exposure to stigmatized people in roles that emphasize
their humanity and strengths, rather than their deficits (Scheyett & Kim, 2004; Shor
& Sykes, 2002).
Service users’and caregivers’involvement in social work education
Diffusion
In the last three decades, in the UK, service users’ and carers’ involvement in social work has
become firmly embedded in important aspects of social work education (Branfield, 2009;
Edwards, 2003; Taylor, Braye, & Cheng, 2009). In recent years, service users’ involvement
in university programmes has been started in other European countries—as Denmark,
Germany, Norway, Sweden, in Northern Ireland (Agnew & Duffy, 2010), Croatia (Skokandić
& Urbanc, 2009) and in Eastern European countries (Zavirsek & Videmsek, 2009). As far
as we know, in the Italian social work education system, only two experiences can be found
that were carried out by the Catholic University of Milan and by the University of Eastern
Piedmont (Allegri, 2015), respectively.
Rationale
The involvement of service users and carers in social work education is thought of as promoting
the more collaborative ways of working that contemporary social work theory and
practice emphasize (Waterson & Morris, 2005), and as providing a balanced education
capable of building a good professional practice in students, especially when service users
are involved right from the beginning (Baldwin & Sadd, 2006; Tyler, 2006; Waterson &
Morris, 2005). The central idea is that social workers must regard service users and carers
as partners in dealing with their life difficulties. So, social workers should not regard them
merely as recipients of interventions, but as people from whom to learn, both in professional
practice and education.
Service users’ everyday experiences are fundamental to equipping would-be social workers
with key elements of knowledge and expertise and to improving services (Anghel &
Ramon, 2009; Beresford, 2000). The exposition to service user perspectives also aims to
help social work students, and freshmen especially, relate theory and practice (Cooper &
Spencer-Dawe, 2006; Irvine, Molyneux, & Gillman, 2015).
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984    E. Cabiati and M. L. Raineri
Power sharing
In order to achieve an effective participation and to avoid the risks of a tokenistic approach,
general issues about how users’ role could be presented and how programmes could be
adjusted to promote effective changes in social work practice should be addressed (Askheim,
2012).
There is the risk that users could be seen as ‘case studies’ instead of partners, increasing
the emphasis on the distance between ‘us’ (professionals) and ‘them’ (the users) (Beresford
& Croft, 2008; Wilson & Beresford, 2000). Conversely, only if service users and carers feel
respected for what they can offer, they are more able to share their perspectives (Anghel
& Ramon, 2009, p. 187). When groups or organizations of users are involved, they are in
a better position to effectively challenging conventional images of service users (Beresford
& Boxall, 2012).
Involvement domains and methods
Service users and carers have collaborated with social work courses in different ways: as personal
testimonies, educators, co-teachers, recruiters of students (Askheim, 2012). They have
contributed by telling their stories and real-life experiences, as well as by producing written
materials (Reynolds & Read, 1999) and videos (Smith, 2013). Gee, Ager, and Haddow
(2009) analysed what learning students had gained after spending 24 h with service users
and family carers. Quinney and Fowler (2013) described a participatory initiative carried
out through online discussion groups run by users and carers.
Judkins and Lahurd (1999) underlined the importance of involving service users and
carers in curriculum development and design, and not only as personal testimonies—they
should be regarded as partners in developing educational programmes (Molyneux & Irvine,
2004). To this purpose, they may take part to a wide range of tasks, as students’ selection,
development of teaching approaches and materials, programme planning, teaching and
learning activities, feedback and assessment, quality monitoring and evaluation (Health &
Care Professions Council, 2014).
Though, service users and carers have been actively involved in assessing the readiness
of freshmen students in social work for their first period of practice learning (Duffy, Das,
& Davidson, 2013) and in assessing students’ achievement both in practice learning and
in institution-based learning (Gee et al., 2009), more compelling evidence about the effectiveness
of service users in such roles is needed (Skoura-Kirk et al., 2013). According to
Gregor and Smith (2009), prior to involving ‘service users as educators’, their potential role
and contribution, as well as their training needs, should be considered.
Recruitment and training
Involving service users and carers can mean working with individuals or working with
groups and networks of service users and carers, with voluntary organizations (Health &
Care Professions Council, 2014), with community organizations (Gupta & Blewett, 2008),
with local activity centres (Askheim, 2012). This outreach work always takes time and
requires careful preparation. It is essential to explain the initiative to the different individuals
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Social Work Education   985
or organizations targeted, and to learn what they may offer, whom else they are involved
with and what their engagement conditions are (Levin, 2004).
Service users and carers may need support and training, particularly when they take part
in student selection processes or assessment tasks (Brown & Young, 2008). Help with reading,
understanding and/or producing written may be necessary too (Gupta & Blewett, 2008).
Preliminary meetings among service users and carers enable them ‘to present the views
of the group, rather than just their own experiences, which can be emotionally difficult for
them and dismissed as unrepresentative by those receiving the training’ (Baldwin & Sadd,
2006; Gupta & Blewett, 2008, p. 468; Irvine et al., 2015).
Outcome
Most authors argue that service users’ and carers’ involvement in social work education
is extremely valuable to all parties (Brown & Young, 2008; Morgan & Jones, 2009; Irvine
et al., 2015).
Irvine et al. (2015) show that many students come to realize how keeping the service users’
perspectives at the core of practice is paramount in order to actualize social work values.
Thanks to service users’ and carers’ testimonies, awareness of the importance of human
experience within the social and health service system has grown (McCusker, MacIntyre,
Stewart, & Jackson, 2012). A student quoted by Smith (2013) said that he had learnt by
service users the importance of being aware of how social workers’ behaviour and attitude
impact upon them.
Students acknowledged the importance of interacting with service users and carers away
from their usual environments and roles (Benbow, Taylor, Mustafa, & Morgan, 2011). The
‘us-and-them’ distinction between the parties dwindled (Askheim, 2012). Significantly for
the purposes of the present article, it has been shown that the stigma associated with certain
service user groups, particularly in relation to mental health, decreases. This occurs
to varying degrees, depending on students’ previous experience (Smith, 2013). One of the
most important results of the project carried out in Northern Ireland by Coulter, Campbell,
Duffy, and Reilly (2013) was showing how this kind of initiatives appeared to increase students’
awareness and capacity in a divided society. After talking with victims of violence
and discrimination, students appeared more equipped to meet the requirements of such a
society (Judkins & Lahurd, 1999).
Furthermore, learning by and with service users and carers develops communication
skills (Skilton, 2011) and emphasizes the value of listening (Branfield, 2009).
There are indications that service users involved in social work education improve
their confidence and self-esteem, arising from a sense of making meaningful contribution
(Benbow et al., 2011; McCusker et al., 2012). The significant literature review by Robinson
and Webber (2013) underlined that little effort has been made to ascertain if the participation
of service users in social work education actually improves outcomes for students. After
analysing 29 international studies, they showed that none of them addressed the effects on
social work practices and only two measured change in social students’ attitudes or in their
perception of service users and carers.
The study presented in this article attempts to fill a small part of this gap by investigating
the effects of a meeting between freshman students in social work and service users and
carers in terms of reduction of stigma.
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986    E. Cabiati and M. L. Raineri
A full-day meeting: students and EBE together
Setting
In Italy there aren’t specific policies to promote service users’ involvement in social work
education programmes, and not even in social services planning and delivery.
Nevertheless, service users’ and carers’ participation is closely linked to the social work
approach taught at the Catholic University in Milan, i.e. Relation Social Work. Relational
Social Work (Folgheraiter, 2004, 2007, 2015; Folgheraiter & Raineri, 2012) stems from
relational sociology (Donati, 2010) and focuses on relationships as the basis for change. The
central idea in Relational Social Work is that change emerges from a reciprocal aid, both
among people in difficult circumstances, family members, friends, neighbours and between
that network and the social worker. The practitioner helps the network to develop reflexivity
and improve it in enhancing welfare, and—in turn—the network helps the practitioner to
better understand how s/he can help it (Folgheraiter & Raineri, 2012).
In Relational Social Work, service users are considered as ‘experts by experience’
(McLaughlin, 2009; Preston-Shoot, 2007; Saleebey, 1996), because they have experience
of using care services, and especially because they are experts about their lives, and about
their difficulties.
Coherently with the Relational paradigm, the involvement of service users or ex-service
users and carers as teachers is an important part of social work education programme at
the Catholic University. During the 3 years of bachelor’s degree and even in the 2 years of
master’s degree, the students take part in various activities realized with the contribution of
carers and services users. First-year students work together with service users and carers in
the activity described below. During the following training years there are two workshops
each of 30 h, where service users and carers with different life problems are invited to share
their experience with the students, and to discuss with them how social work interventions
could be improved. In the third year of bachelor’s degree and in the second year of master’s
degree, groups of service users and carers, students and other stakeholders work in partnership
to develop small community social work projects. Service users and carers take part
in the annual social work students’ congress in which conventional practice placements
and off the beaten track placements (Doel, 2009) are presented. Finally, service users and
carers are involved in almost all lessons, workshops and other events opened to external
professionals too (students supervisors, social and health practitioners, etc.).
The meetings
The present study looked at a learning experience that is part of a Social Work Orientation
Workshop (Cabiati, 2016) addressed to freshman students and aimed at providing them with
an opportunity to know a life story and change their views of social problems and service
users. For 8 years, this annual ‘Social Work Orientation Workshop’ has been a component
of professionalizing modules about Social Work Skills, Values, Approaches and Contexts.
Every academic year, the University organizes a full-day meeting between students and
‘Experts by experience’ (EBE), who are service user members of self-help and mutual aid
groups). The programme of the day is divided in two parts: in the morning, each student
talks individually with a service user for two hours. It is not a professional interview but a
simple conversation aimed at knowing each other and exchanging life experiences. After
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Social Work Education   987
the lunch time, shared together in the university canteen, all the participants (students and
service users) meet together in 5 groups with about 15 EBEs and 15 students, to express
thoughts and feelings about the experience. Every group was facilitated by one of EBEs.
The EBEs who participate in the meetings can be experts in various different problems
that can change every academic year depending on the self-help/mutual-aid groups in which
EBEs took part. In the year when the present research was carried out (2014), the students
met EBEs with experience in the following problems: mental health; drugs addiction; alcohol
addiction; unemployment; disability; difficult partner divorce; parents of children in child
protection; gambling addiction.
EBE recruitment
EBEs were recruited through self-help and mutual-aid groups organizations, the so-called
‘umbrella’ organizations that gather a number of self-help and mutual-aid groups for the
same type of problem, or many groups with different targets.
Firstly, the initiative was presented to some key persons who were group facilitators and
who had already contacts with the teachers of social work course. Then, the University sent
a letter to each self-help and mutual-aid group, inviting all those who were interested in
participating and suggesting to extend the invitation to other potentially interested groups.
The only necessary condition to participate was to be member of a self-help and mutual-aid
group for a year at least.
In 2014, a total of 80 self-selected members of mutual-aid groups took part in the fullday
meeting. This number can be seen as a significant success, since—according Levin
(2004)—the number of individuals actively involved in social work education initiatives
usually ranges from 4 to 20, with an average of 8–10.
According to Relational Social Work, service users and carers are ‘experts by experience’
because they are experts in their lives, in coping one or more life problems, in taking
care of a relative or a friend, in managing the relationship with services and practitioners.
The recruitment through self-help and mutual-aid groups’ organizations was chosen taking
into account both the range of benefits arising from working in groups (highlighted
above) and particularly what happens in this kind of groups. Self-help and mutual-aid
groups produce strengths-driven processes promoting psychological insight and social skills
(Steinberg, 2010). Self-help and mutual-aid groups imply an ongoing reflection on personal
experiences, starting from the others’, in a peer-to-peer logic. In this way, individuals
can develop narrations and points of view enhanced by the other members’ perspectives.
When someone participates in a self-help and mutual-aid group for a period of time, s/he
will not only elaborate his/her experience individually but s/he will also enrich it with the
coping experiences of the other members. When motivated people who have lived similar
experiences talk and listen to each other, they can develop a higher standing life knowledge
that expresses the shared experience and is less contingent on individual circumstances.
In a self-help and mutual-aid group, the knowledge of individual members upgrades, just
because it becomes shared knowledge (Raineri, 2011).Thus, the student who meets an EBE
listens to his/her life story, but in the dialogue between them the experiences of other people
expert in coping with a particular difficulty also emerge. In this way, the student does not
listen only to the individual voice of an expert but listens to his/her experience revisited in
the light of experiences of others.
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988    E. Cabiati and M. L. Raineri
Due to all these reasons, the experience in self-help and mutual-aid groups was considered
as an excellent basis of competence for the EBEs involved in social work education.
In fact, thanks to their participation in those groups, the EBEs are experts in sharing and
communicating their life experience. This expertise needs an adequate amount of time—at
least one year—to be elaborated. So, the EBEs were required to participate to a self-help and
mutual-aid group for at least a year before taking part in the meeting.
Other minor issues about the EBEs participation were discussed with the key persons
who were group facilitators and with the course’s teachers.
Research method
The research hypothesis was that face-to-face contact with people coping with life difficulties
would produce educational effects in the students, particularly by reducing the level
of prejudice towards service users who are experiencing life problems. The research aimed
at exploring how this educational experience affected participants and at finding out, by
means of a survey, if students’ attitudes showed any change.
Students were administered an adapted version of the ‘Attitudes to Mental Illness
Questionnaire’ (AMIQ—Cunningham, Sobell, & Chow, 1993; Luty, Fakuda, Umoh, &
Gallagher, 2006), previously translated into Italian, both in the two weeks preceding the
meeting (pre-test) and in the two weeks following it (post-test). The second administration
included some additional qualitative questions.
The 5-item AMIQ has good psychometric properties and can be used in most situations
(Luty et al., 2006). Respondents read short vignettes describing an imaginary service user
and answer five questions for each vignette. Respondents are asked to rate how likely some
consequent events are to occur on a 5-point Likert scale (from −2 = most likely, to + 2 = most
unlikely). The scores for the five questions are then added up, giving a total score that can
range between −10 and +10. Low scores indicate negative attitudes.
The data collected by means of the questionnaire were analysed through a statistical programme
to look for differences between pre- and post- results. Differences were calculated
by subtracting each student’s pre-test score from his/her post-test score.
The full-day meeting was part of the common academic activity, so all freshman students
were expected to attend it. Prior to the meeting, students were told that they would take
part to an initiative aimed at gaining a better understanding of the life and difficulties of
people who turn to social services.
Through an email the survey was sent to the students by an external researcher. The
online questionnaire came with a note giving assurance about anonymity and explaining
that the research intended to gather information about some opinions and attitudes of the
students. Students have never known the survey and its aims before. Responding to the
questionnaire was discretionary and the teachers didn’t participate in the research project.
Students responded online anonymously. Each student was asked to insert an alphanumeric
code that would allow us to make the pre-/post-comparison. Non-obligatory participation,
anonymity and lack of awareness of the specific AMIQ aims were a way to limit the influence
by role expectations.
The study was conducted with the freshman students of the Catholic University (Milan,
Italy) in 2014. A total of 100 students participated. Most of them (90%) were female and
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Social Work Education   989
Italian. The mean age was 20 years. 45% of them came from technical college and 55%
from high schools.
Findings
The hypothesis of the present research, i.e. that after face-to-face contact with EBEs students’
attitudes towards service users would improve, was supported by the findings of pre-test/
post-test analyses. The data obtained through the first and second administration of the
AMIQ are shown in Table 1.
Post-test mean scores differ from pre-test mean scores for all the vignettes, with the
only exception of the disability vignette. The mean AMIQ scores improved from −0.45
prior to the meeting with EBEs to +0.25 after that meeting, with a mean difference
of +0.70.
Through a second analysis, participants were divided into percentiles on the basis
of their total score at the pre-test. Three groups were identified: with a high, medium
and low level of prejudice. It is apparent that the increase in mean scores is due to
improvement by students with lower scores (i.e. students in the sample who initially
had a high level of prejudice).
As Table 2 shows, change scores for this group of students are up to 2.71 for the vignette
about schizophrenia, and up to 1.37 in total.
Qualitative data collected by asking some questions during the second administration
of the AMIQ revealed that participants appreciated the experience of meeting the EBEs,
following which they were able to identify some key concepts for social work practice.
Students’ answers confirmed that they had improved their personal attitudes towards
service users:
Table 1. Pre-test and post-test scores.
Vignette Pre-test mean (SD) Post-test mean (SD) Change score
John (cocaine) −1.51 (2.84) −.68 (3.15) +.83
Tom (depression) +.52 (2.74) +.84 (2.69) +.32
Stefano (alcohol) +.05 (3.63) +.96 (3.42) +.91
Robert (law problems) −5.43 (2.53) −4.39 (2.82) +1.04
Michael (schizofrenia) −1.39 (3.29) −.17 (3.35) +1.22
Claude (disability) +5.22 (2.75) +5.17 (2.61) −.05
Paul (birth parent of a child in foster care) +.4 (3.93) +1.07 (4.09) +.67
Luke (gambling addiction) −1.42 (2.75) −.81 (3.53) +.61
Total −.45 +.25 +.70
Table 2. Pre-test and post-test scores for students who initially had a high level of prejudice.
Vignette Pre-test mean (SD) Post-test mean (SD) Change score
John (cocaine) −3.14 (2.39) −2.32 (2.52) +.82
Tom (depression) −.82 (2.77) +.36 (2.51) +1.18
Stefano (alcohol) −2.46 (3.40) −.61 (3.63) +1.85
Robert (law problems) −6.96 (1.68) −5.39 (2.48) +1.57
Michael (schizofrenia) −3.89 (2.85) −1.18 (3.18) +2.71
Claude (disability) +3.96 (3.34) +4.46 (2.60) −.50
Paul (birth parent of a child in foster care) −1.68 (3.67) −.68 (3.36) +1.00
Luke (gambling addiction) −3.43 (2.50) −2.11 (3.24) +1.32
Total −2.30 −.93 +1.37
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990    E. Cabiati and M. L. Raineri
I have learnt more about drug addictions, revising my wrong ideas
I found out that these people have a problem, but are not a problem.
The answers to the qualitative questions suggested that students’ stigmatizing views of
service users as bad or lacking people were questioned after meeting them:
Prior to the meeting I was worried, but now I have to say that service users are strong and
brave people.
When I will become a social worker it will be important for me to treat each service user as
a unique person, giving him/her the chance to change and avoiding to focus on past events.
Service users are people who take on the challenge of starting a new life. They are people from
whom we can and we have to learn.
This change in the image of service users requires to be further elaborated in a critical perspective,
following the idea that each user, just as each person, could have both strengths
and vulnerabilities. However, for a young student at the first step of the education way this
change of perspective could represent a promising starting point. For future practitioners
engaged in human relationships, these statements are meaningful, because being able to
suspend one’s own conjectures and judgements, and to set aside one’s own feelings and free
associations in order to recognize the otherness will be essential for them (Sevenhuijsen,
1998).
Furthermore, students underlined that they needed to improve their personal reflexive
abilities:
I learned that prior to expecting other people to change I have to question myself.
To become a good social worker I need to work deeply on myself, coping with my worries,
understanding my limits and my resources.
Analysing these answers appeared from the same students the danger to run into a stigmatizing
attitude and at the same time the wish to avoid it. This idea represents an important
issue for the young would-be social workers. The experience opens the way to get to the
core of the matter during the educational pathway.
Finally, to the question ‘Was the meeting a positive, negative or neutral experience for
you?’, none of the students answered ‘negative’, two students answered ‘neutral’ and most
of them expressed enthusiasm and satisfaction.
Discussion
Overall, the findings of the present study are encouraging. Data suggest that meeting faceto-face
with people who are expert in coping with their own life difficulties had positive
effects on social work students. Change scores show a reduction of stigma for almost all
the vignettes presented in the AMIQ.
The only exception showing no improvement was the situation of a man with disability
(Claude). It is possible that the students who talked with people with disability or their
relatives during the meeting had already a good understanding of the everyday difficulties
of living with a disability, so their attitudes did not change significantly.
Interestingly, stigmatizing attitudes seem to have decreased not only with reference to
the problems of which the EBEs had a personal experience (and about which, then, they
talked with the students during the meeting) but also with reference to the situation of
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Social Work Education   991
Robert (offender), that had no correspondence to any of the self-help and mutual-aid groups
involved.
Despite the pre-/post-improvement, Robert was by far the most stigmatized character
in the opinions expressed by our sample of students. Therefore, particular attention will
have to be paid in addressing prejudice towards offending people and, if possible, it may be
useful to involve in future meetings also EBEs who have experienced this kind of difficulty.
For the students of our sample, the full-day meeting with the EBEs was one of the first
opportunities to interact with service users. Qualitative findings of the present study suggest
that this encounter has some characteristics of a relational and dialogical practice culture.
It is a brief intervention that may have a significant impact on students. The students of our
sample pointed out how this kind of experience could help them recognize users’ value,
respect their identities and facilitate empowerment and participatory approaches.
Limits
The most obvious limitation of the present study is the lack of a comparison group. Therefore,
it cannot be claimed that the decrease in students’ stigma was entirely or mainly due to the
meeting with the EBEs, though it may be reasonably assumed.
Moreover, it was not assessed if and how long the changes in students’ attitudes last. In
their framework for evaluation of educational programmes, Robinson and Webber (2013)
have highlighted eight levels of evaluation, based on: learners’ perceptions (1a), service users’
or carers’ perceptions (1b), staff perceptions (1c), modification in learners’ attitudes and
perceptions (2a), acquisition of knowledge and skills by learners (2b), changes in learners
behaviour (3a), changes in organizational practices (3b), benefits to users and carers 84).
The research presented placed at the level 2a (modification in students attitudes and perceptions).
With reference to level 3a, at the present it’s not possible to prove if the effects
of this experience persist in the students. In the same way, from this study there are no
elements to prove that this experience could influence their behaviour in future social work
practices. Future studies would be needed to scrutinize if an experience like this could
produce long-term effects.
It would be both interesting and important, for future research, to gather EBEs’ opinions
and perceptions about their engagement. The vast and enthusiastic participation by service
users and carers that has been observed over the years suggests that this activity benefits
EBEs too.
AIMQ was used earlier in social and clinical studies (Galletly & Burton, 2011; Luty,
Kumar, & Stagias, 2010; Luty, Maducolil, & Mendes, 2011; Luty et al., 2006; Onesirosan,
Ohiole, & Osemudiamen, 2012) from which the problem of role expectation has never
mentioned. However, it’s not possible to exclude that this could be occurred. Furthermore,
it’s important to note that the positive effects generated thanks to the experience with EBEs
are general, not only related to the single problem encountered. The design of the study had
not allowed to identify the factors associated with positive changes in students’ attitudes. In
this sense, the change may have occurred due to the nature of shared experience, rather than
the core views held regarding the subject matter. The change could be strongly connected
to the nature and the structure of the experience that aimed to create a social climate in
which experiences and expertise were reciprocally exchanged. For all these limits, this has
been an exploratory study without statistical claims.
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992    E. Cabiati and M. L. Raineri
Conclusions
Participants to the meeting expressed satisfaction and appreciation about this initiative.
Besides, data suggest that the full-day meeting was effective in reducing stigmatizing attitudes
and mistrust towards people who have personal and social problems.
Stigmatizing attitudes towards people with mental illness, drug addiction or offenders is
commonly reported among professionals. It is widely recognized that in order to become
effective and morally upright social workers, it is essential to develop some abilities related
to human, relational and personal skills (Banks, 2008; Barnes, 2006; Braye & Preston-Shoot,
1995; Schön, 1983; Thompson, 2002; Trevithick, 2005; Wilkes, 1985). Promoting face-toface
contact with experts by experience may be an effective strategy to reduce dangerous
feelings of anger, mistrust and discrimination.
To think of people who are living life problems as ‘experts by experience’ it is necessary
to recognize their power, their abilities and their feelings, irrespective of the resolution of
problems. Furthermore, for social work professionals, the obligatory way to ‘create’ power
is to take a step back and relinquish some of their own power (Folgheraiter & Raineri,
2012). Social work education has the responsibility of encouraging students’ awareness
about the need to establish fully collaborative relationships with service users, co-creating
help interventions. The reciprocity of help—letting the user be an equal and help the social
worker—is not an empty slogan or a luxury. It is a radical turning point (Folgheraiter, 2012)
because, if this reciprocity is absent, the help withers and dies (Beresford & Croft, 2008).
This study confirms that social work education can be enhanced through the participation
of service users as ‘experts by experience’. Given that in a true helping relationship both
human agents aid each other (Pettersen & Hem, 2011) and that both experts and interested
parties should work together in a synergic search for a common good (Folgheraiter
& Raineri, 2012), learning from service users is for would-be social workers a valuable
educational opportunity at the first steps on their path.
Disclosure statement
No potential conflict of interest was reported by the authors.
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