service user involvement presentation homeless agency may 2006

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Exploring Complexity & Power

Service User Involvement in the Homeless Sector

A Presentation to a Working Group of the Homeless Agency - DublinLiz Lennon May [email protected]

Thank you for the invitation to speak with you today. I was asked to share with you my experience of service user participation over 23 years of my working life.

Here’s a little background.

I started my working life on contract to the Dept of Sport & Recreation in West Australia. In those days (the early 80’s) there had been very little academic work done on community development and participative processes. We got to trial and develop many techniques in the field that are standard practice today. The majority of my work involved consulting with all sorts of groups – from the obvious sporting organisations to arts, disability and women’s groups. We developed whole of community plans with communities and involved everyone from children to older people to footballers! And we went out in the field (literally in some cases) to do it. I helped set up learning centres run by women in country towns; ran dreaming sessions for people with disabilities; gathered hundreds of young people from all over the southwest to speak out; ran week long life and living programmes for people over 60 (who had more energy than I did) – to name a few activities.

My next job involved being a community development officer for many communities covering 600,000sq kilometres. Working with pretty much every age, race and gender group I facilitated with people the development of health programmes; arts research; young women’s speak outs; setting up women in business courses; working with aboriginal women; government departments linking of programmes; and even a process conference to reorganise the wildflower industry in WA. I drove down very dusty roads to meet and listen to people.

Then I moved to Perth as a part time education officer for Learning Centre Link. This organisation was the umbrella group for over 70 learning centres in WA – predominantly set up and run by women. I travelled all over the outback working with the women who ran and managed the spaces.

In 1993 I moved to Ireland and have been here for nearly 13 years. In that time I have had the privilege to do action research and evaluation in a range of sectors and communities. In 1994 I developed the first all of community gatherings in Kilkenny, Clondalkin, Wexford, and Portlaoise as part of a bigger process to develop the first Partnership plans. We also paid and trained local people as researchers. I was part of a team that did extensive research for the National Travellers Research. I had the most amazing time meeting and listening to over 300 travellers on their sites and places of learning. I’ve trained long term unemployed people to be action researchers in their local communities. My work has encompassed many sectors including Arts, Disability, Rural & Community Development, and Homelessness.

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Exploring Complexity & Power – Service User Participation in the Homeless Sector

As you can see, the majority of my work has involved connecting, consulting and listening to all sorts of people – many who have been labelled powerless.

So – what have I learnt in my work with all these people?

That a respect for people has to underpin my work Everyone is different and can bring learning and insight to the table People are experts in their own experience Everyone has the capacity to contribute in a meaningful way – our job is to

create many ways for people to feel safe enough to do it That your job role should not define you nor should you use it as a barrier to

connecting with others That relationship building is one of the key factors in any successful process I

have been involved in – and it’s often the one that people don’t spend enough time on

That a good plan is really a construct to make us all feel we have some direction and control in this complex world. Plans create a framework within which we can move, experiment and trial new ideas and ways of being together

Tangible and visible results (no matter how small) enthuse and remotivate people

To acknowledge my own fears when I go to meet a new group of people that have been labelled in some way

To acknowledge my own internal stereotypes and judgements that arise when I meet someone that is different than me

To really listen to what people are trying to say To understand that if someone doesn’t understand me it’s not because they

are stupid – it’s because I’m not communicating clearly enough Every contact is a human encounter – regardless of the formal roles or labels I’m not afraid to challenge and refuse to dumb down to people that are

perceived as powerless When I have trained people to be action researchers I manage the

autonomy/direction dichotomy – more on that later My encounters with people always opens up new ideas, directions and

perspectives that I can integrate into my own practice That I don’t have to know everything to actually make things happen –

perfection is an aspiration not a reality That acknowledging my own power within and working with people to

engage their own power is my life’s work

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Try not to make promises you can’t keep

We don’t always know what’s best for other people

There can be a real tension between what people want to be involved in and what the public sector wants to engage them in

In many ways we are talking about citizen and civil rights

So what has this all to do with your ongoing discussions on service user involvement?

Heaps.

All my work has been based on working with people to create powerful, just and celebratory places to work and live.

All our work and your discussions are about involving the very people that all our services, policies and practices are meant to serve.

The next part of my presentation will explore: Power Service user involvement continuum The Autonomy/Direction Dilemma Constraints & opportunities regarding service user involvement Suggestions & options for the sector as the next steps forward

Let me start by exploring three key terms that we all use but rarely define because we assume we all have the same understanding – never assume, always clarify.

Service user involvement, service user participation & empowerment

Service user involvement and service user participation are often used interchangeably. In participation theory they are seen as two distinct terms that refer to different levels of power access to a process.

Service user participation refers to people taking part in some activity or acting as informants in a consultation process.

Service user involvement usually refers to the users activity having some form of impact on the service process. Involvement is higher along the power-sharing continuum than participation.

Participation will not guarantee any changes – Involvement will.

Empowerment is not the natural result of participation or involvement. This term is misused and misunderstood. In fact many user activists would claim that participation in consultations has disempowered people as they see little change occurring as a result of their time and effort. People know when a process will be empowering and when it is tokenistic.

Participation, involvement and empowerment involve different degrees of power sharing.

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Informing and consulting people is an indirect form of participation

Creating decision-making partnerships and processes for change is direct involvement

While work has been done on creating processes for more service user involvement, there has been very little research on whether that involvement has created real and sustained change

Consultation is not empowerment

Let’s have a look at a power and participation model that will help inform future decisions regarding the nature, scale and scope of any work the sector decides to do on service user involvement.

Sherry Arnstein developed the ladder of participation in 1969. I’ve turned it on its side so we can view it as a continuum.

manipulation

The further along the continuum the more power sharing between service users and service providers.

Manipulation & Therapy were seen by Arnstein as methods to cure and educate people with less perceived power

Informing & Consultation were viewed as first steps in citizen participation but became tokenism if there was no real feedback or change

Placation involved co-opting individuals onto committees and decision making structures but the power holders still decided the legitimacy of advice they received from citizens

Partnership saw power redistributed through negotiation and planning/decision making was shared

Delegated Power had citizens having the majority of seats with the delegated power to make decisions

Citizen Control involved citizens having power to develop and manage processes

This continuum is a useful tool when deciding the nature of service user involvement. I’m assuming that the sector is interested in evolving a process that will include aspects of informing, consultation and partnership – at the least.

Before I move to a deeper analysis of service user involvement I want to outline one more power model that will aid your deliberations.

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Manipulation Therapy Informing Consultation Placation Partnership Delegated Power

Citizen Control

Service users can be involved within organisations and the sector as:

Peer workers

To select workers

Be part of performance appraisal

Feedback on service

Input, develop & deliver training

Sit on boards

Help with induction

Develop own care plan

Develop information

Input on resource allocation

Help develop and deliver prevention programs

Be action researchers

In my experience, power within must be developed in order for any involvement or empowerment strategies to succeed – and I don’t just mean for service users. I believe that underdeveloped power within is very real for many service providers and is often visible through a range of behaviours including defensiveness, always going by the rules, objectifying and even demonising their clients/customers, psychosocial distancing, a refusal to explore new ways of working, and a fundamental belief that people can’t change.

For many service users the belief in themselves as powerful has been eroded by a range of life experiences – and unfortunately some of this erosion has been at the hands of the very people who should be serving them. If you come to a space where hope is too painful then your willingness to participate or become involved will be very low. The sense of power within has diminished and any faith in the systems will or skill to listen and support them has disappeared.

In any of this work we must be very careful that we are not creating a false rhetoric regarding service user involvement and at worst reinforcing already existing structures and power relationships.

I know this group is focusing on service users as key stakeholders for new involvement initiatives. I believe that they are not the only stakeholders that require new opportunities and ways of having input and involvement in critical decision making and planning in the sector. I sense that frontline workers and lower level managers need more ways to share their experience and ideas. They rarely get to share and input on a sector wide basis.

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Power Over Power To Power With Power Within

Relationship of dominance

Having decision making authority

Organising with a common purpose

Self-confidence, awareness & assertiveness

People are the experts in their own experience

People can contribute in a meaningful way – our job is to create as many ways as possible.

There is no one answer or structure for service user involvement

While service users as legitimate stakeholders is (relatively) unquestioned – service user credibility is open to question. User contributions in some areas would be more welcome than others.

While there appears to be strong support for the principle of service user involvement I feel that there is less agreement and understanding regarding how to put the theory into practice.

I want to outline what I see as the very real constraints to service user involvement from both a user and provider perspective

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Service Users

Us vs. Them syndrome Lack of faith in the system

to change Fear of how professionals

may use information about them when they start power sharing

No sense of power within Little experience of

committees and many of the formal structures and language barriers

More focused on concrete and immediate personal needs

Went to consultations and never got feedback and didn’t see any change –very frustrating

Don’t feel they are given real choice and control – so why bother

No resources to be involved

Focus on individual needs more than strategic change

Current structures may not be appropriate for involvement – seen as boring and time consuming

Service Providers

Us vs. Them syndrome Professional protectionism Organisational resistance and

culture Notions regarding expertise and

competence – theirs and users Use of language and jargon No sense of power within No sense of power within the

organisation Professional perspective seen as

the dominant and only position Don’t know how to go about

involving service users No resources to involve users Don’t understand impact and

issues regarding power, choice and control

Focus more on strategy than individual needs

Won’t acknowledge power imbalances

Dogma that surrounds what people believe is the ‘way’ for decision-making – meetings, formal committees etc.

Have neither the skill nor the will

Clashing process timelines Priorities & pressures from other

stakeholders

From entry to exit of services there are issues of choice, power and control

Who has the power to decide the nature, level and direction of the service a homeless person will receive?

How open are professionals (and the organisations they work in) to being questioned about their practices, policies and routines?

A little further on I’ll turn those constraints into opportunities and guidelines for involvement.

I want to digress slightly and talk about the Autonomy/Direction Dilemma.

In my experience as both a project manager and action evaluator I have come to really understand something that is critical to the success of any partnership process.

I believe that in our real wish to encourage involvement and empowerment we often set up a process/project that increases rather than decreases people’s struggles.

I have been involved and evaluated countless service user projects and there are two mistakes that are commonly made:

Don’t spend enough time building relationships and trust between all stakeholders

We try and move service users too quickly to empowerment

I remember an old man in a fantastic cross generational arts project in North Sligo yelling at me one day in a group reflection session ‘ you’re the teacher why don’t you earn your money and make some decisions instead of asking us all the time’.

Fantastic learning – what I learnt that day is that many people who have not had the experience of power sharing in decision making want to feel safe and see some direction at certain phases of a project. In the project I am currently evaluating the support team said they constantly struggled with the issue of who made what decisions – and in hindsight they increased the burden of expectation and responsibility on the service users by giving too much autonomy at an early stage. This was completely reinforced in my discussions with the service users. They felt that too much decision-making power was given to them in the beginning and they would have preferred a bit more direction from the support team as they built up their confidence.

The following page shows a diagram I developed last week to show the team how I saw the process and how it could be improved in the future. They were delighted to be able to name a process and struggle that had impacted on all of them.

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We need to ask service users who have been involved in service user processes what their experience was like.

Many professionals really think that they know best. They do not believe in the validity of user experience or their competence to make decisions.

We (professionals) are not the living embodiment of how to live life in an ordered and rational way.

Real relationship building between all stakeholders will aid the whole direction/autonomy dilemma. I don’t believe that we always spend enough time on building trusting relationships between stakeholders – people move to task too quickly – to the detriment of group process and development.

Another issue regarding relationship building between users and providers is that there is a personal knowledge imbalance between the 2 groups. It was pointed out to me by a service user in an action research project that when she was invited to represent service users on a homeless forum that some of the professionals had an in-depth knowledge of her life, traumas and feelings – and she only really knew their names and work titles. Over time and as her own power within grew she felt less threatened by this. Nevertheless it is important to note this imbalance.

The service user also told me that as she got to know the workers on the project support team her sense of US vs. THEM diminished – and it became WE.

Relationships develop in both formal and informal environments and I believe we need to create more informal and social opportunities to engage – to see the human behind the title or label. The formality of committee meetings can be intimidating and a real downer to expressing your views. Using a range of communication processes including small group discussions and creative activities could liven up even the formal environment.

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Start Middle End Of a Project/Process

Direction

Negotiation

Autonomy

People feel a sense of safety when there is some framework and direction at the start of a process. Shared and autonomous decision making then evolves as relationships and confidence build.

The Direction/Autonomy Dilemma copyright Liz Lennon 2006

This is like learning the trapeze without a net. Handing over full decision-making power can create a burden of responsibility and expectation that hurts people.

The whole issue of service user representativeness on decision-making structures is a red herring.

We do not expect professionals from organisations to represent the views, opinions & experiences of all their peers.

What is needed for everyone involved are clearer ways to communicate and inform peers and be informed by them.

Let’s have a look now at some guidelines for service user involvement:

Be clear about the purpose of engagement. Refer to the participation continuum. Are you informing, consulting, involving, partnering?

Ask service users how they want to be involved. Be prepared to be challenged – try and be open to looking at new ways of

engaging and working together. Be honest about your own organisations cultural and professional attitudes

that may constrain service user involvement. Find Champions for Involvement in your organisations and sector. Develop what I call Education for Participation processes that involve

both service users and service providers. Realise that the higher up the participation continuum you go, the more

time, resources and skills you’ll all need. Take the time – formally and informally – to build trusting relationships. Realise that different stakeholders will have different needs and priorities.

That’s where negotiation and communication come in. Be very aware of your own stereotypes, judgements and resistance to

power sharing. Be committed to getting the resources need to develop real involvement

processes and projects. This includes paying service users to participate – money is an acknowledgement of power and status.

Build in service user involvement processes as an integral part of the sector and not just one off events or projects.

Build in the necessary supports for users and providers. People may need counselling and supervision.

Build in reflection points to review progress. Be as clear as possible about decision making power – discuss the

direction/autonomy dilemma. Give people the space to express their concerns, reservations, fears and

excitement about the process. Any user forums must be linked into other decision making fora

Where to next? Map existing organisations and sector policy and practices Ask service users what form of involvement would appeal to them and what

stops them from being involved Ask organisations what constrains the development of service user

involvement Develop sectoral strategy and action plan for service user involvement at all

levels of the participation model linked to the current sectoral and organisational baseline established in the mapping process

Develop Education for Participation processes Develop practical guides to good practice Resource the strategy

Thanks for listening.

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Ask service users how they want to be involved.

If you’re newly homeless then your priority is do deal with immediate needs. You will want clear information and a quality service. You may want to be involved in developing your own care plan and be involved in case management conferences that makes decisions about your future.

As time goes on people will want to be involved in different ways.

Our challenge is to create as many avenues to accessing real involvement – and include service users in developing them

service user involvement presentation homeless agency may 2006

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