Chapter 26 – Vicki Anderson (D2SOP3)
Domain 2 Standard of Proficiency 3
Recognising service users as active participants in their health and social care and be able to support service users in communicating their health or social care needs, choices and concerns.
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KEY TERMS Active participation Human rights-based approach Everyday practices and relationship-building Environment – emotional, cultural and structural |
Social care is… the profession that has the most potential for impact on the lives of people in crisis. That is why it is so important to make that impact a positive one. |
TASK 1
Describe a time when people did not seek or take on board your input in a decision that impacted your life. How did that make you feel?
At first glance, this proficiency appears to be straightforward: simply ask for service users’ input and take their views on board. In asking for input, we need to consider and make allowances for communication difficulties, disabilities, language and cultural barriers. However, such a simplistic interpretation is problematic and lies at risk of ‘tick box’ practice. Does offering a choice of three activities from which to choose satisfy the requirement? Will hiring a translator suffice? Such gestures may contribute little to supporting active participation unless they are built on strong foundations that embed specific values and approaches into all aspects of the service delivery. In the absence of a human rights-based approach that respects service users as autonomous individuals with rights of self-determination, measures such as these will fall short of ensuring active and meaningful participation or decision-making on the part of the service user. These foundational approaches and values must be at the base of all service delivery, including planning, consultation, relationship-building, practice culture and everyday interactions. To effectively support active participation, consideration must be given to the power balance in staff-service user relationships. We as practitioners must fully adopt non-judgemental attitudes and relinquish control over actions and outcomes. In asking for service user input we must not only listen but must also create an emotional, cultural and structural environment where individuals are free to communicate their needs and feel safe to raise concerns.
Active Participation, Self-determination and a Human Rights-Based Approach
The concept of active participation marries well with a human rights-based approach to service delivery. Both a human rights- based approach (HRBA) and the concept of active participation focus on the inherent dignity of the human being. The individual is placed at centre stage of all decisions affecting them and, most important, they play a key role in service planning and delivery
(Quin et al. 2002).
Supportive Environments
Respecting individual service users, their rights, choices and opinions must be an aspect of the organisational culture running from the top levels of management to every person involved in the service. The relevant values must be adopted throughout the service and reflected in policy and practice as well as in planning. Only where these values are intrinsic in the service will the correct environment be provided for the service user to effectively communicate their preferences and to actively engage. Evidence of these inherent values should be visible in the visions and mission statements of the organisation, in its strategic focus and, crucially, in its planning and organisational processes. Good practice in this regard is seen where service users are recognised as key stakeholders, where they are an integral part of the review and planning process and thorough consultation is carried out in seeking their opinions and feedback. Facilitating this practice requires a division of power unusual in governance structures. While customer consultation is common in most non-care services, attributing decision-making power to customers is not. What is required is that the traditional model of top-down service delivery is flipped to allow for a bottom-up approach. Adopting this partnership approach for strategic design is a difficult process and requires that all involved are dedicated to the values at the heart of the change. Power division must be structurally embedded, with clarification of roles and processes to support continued active and meaningful engagement. Clear lines of communication for feedback, review and raising concerns or complaints must be in place. Service users must know the ways in which they can get their message across and feel comfortable and confident to do so. All service staff must actively seek out opinions, views and feedback from everyone in the service. Representatives of service users should be active in planning and review teams.
TASK 2
Consider different environments that you encounter. Which of those environments encourages you to speak up for yourself and communicate your choices? What about that environment helps that to happen?
For these efforts to be successful, respect for active participation must also be a cornerstone of the organisational culture. Reflection in organisational visions and missions will support this, as will the modelling of good practice by management. However, further efforts must be made to ensure that appropriate values are adopted among staff teams through training, education and supervision. These aspects of practice culture should be protected through continuous review and reflection. In the absence of these cultural and structural supports, the individual social care worker will be challenged in incorporating them fully into practice and the service users will not feel the full benefit. Being proficient in supporting active participation is therefore not only associated with service user interaction, it also requires the social care worker to be able to identify the absence of necessary structural aspects and to advocate for change.
Everyday Practice and Emotional Culture
Recognition of service users as active participants in their health and social care is not only relevant in direct planning situations, it must also be an aspect of everyday practice and inherent in all interactions and communications with the individual. In fact, when facilitating active participation and consultation, these practice domains are not mutually exclusive. This proficiency requires professionals to support service users to engage in planning processes, to contribute meaningfully to determining their care plans, their goals and, as much as possible, the frameworks of their health and social care. Efforts in this regard will be minimally effective in large planning operations if they are absent from smaller-scale planning and communication. The necessary recognition and respect must be at the base of the service user-social care worker relationship and must be present in the seemingly meaningless interactions of everyday practice. To be effective, this p roficiency must not only relate to the determining life goals, it has to be present in deciding on the plan for the day or in deciding what’s for dinner. Furthermore, these smaller decisions must be respected, the rights of the service user to make these decisions must be respected and this respect must be communicated consistently. The reasons for this are threefold.
Everyday actions: it must be recognised that life is not made up solely of long-term and large-scale planning; life is determined by the small everyday actions and interactions that each of us has. If service users are not participating in decisions daily, they are not sufficiently active. Unlike many other professions, the impact of social care work is not reserved for scheduled appointments or meetings, it is carried out through everyday activities and interactions that from the outside may appear insignificant.
Have an Impact: it must be appreciated that the purpose of this proficiency is not solely that a professional has the relevant recognition of the service user, it is that that recognition is felt and observed by the relevant person or persons. It is important that the recognition on the part of the social care worker has the necessary impact on the life and experience of the individual service user. As stated above, the relevant respect for and recognition of the service users’ right to participate cannot be portrayed in a half-hearted manner, it cannot be faked. If transmission of this proficiency is reserved only for a formal planning environment, it will not hold sufficient weight. It can only be meaningful where it is communicated to the service user in small, everyday interactions. These interactions are the site for professional relationship-building, where the parameters of trust and respect are built, and where the majority of the social care work is carried out. It is through the small daily interactions, the shared meals, chats over tea or seemingly meaningless trips to the community that the emotional environment of the service is established. It is vital that this emotional environment is one that respects each service user and supports them to express themselves and to communicate freely without fear of rebuke or judgement. Honest communication about needs and wants, and particularly concerns, requires a sense of emotional security, which takes time to establish. For this reason, showing recognition of the service user as an active participant in their health and social care must be ingrained in all areas of practice and service delivery.
Supports Service User to Communicate. The third aspect of this argument links into the second section of the proficiency, directly addressing communication. The proficiency requires that the social care worker supports the service user to communicate their needs, choices and concerns. Communication can be a challenge in several social care sectors. This may be due to inhibited communication skills, disabilities, language or cultural difficulties, among others. In these circumstances, communications are strengthened through informal everyday interactions. Both the ability to communicate and the confidence in communication are improved where the social care worker takes the time and effort to listen and to effectively support communication. Time and energy must be invested in maximising lines of communication through small, casual and everyday interactions. Only then can social care workers sufficiently support communication for active and meaningful participation.
In summary, despite the apparent simplicity, practice in line with this proficiency is reliant on understanding, appreciation and adoption of a range of inherent values, not only by the social care worker but by the service as a whole. Being proficient in this regard requires more of the social care worker than simply asking questions and using communication supports. It is the responsibility of the social care worker to understand their role and that of the service in either changing or reinforcing the systematic oppression that their service users experience and that so many have fought to change. This proficiency requires the adoption of an intrinsically human rights-based approach that recognises the value of a person, that respects their right to self- determination and places them at the centre of all decision-making. These values must be incorporated into everyday activities, they must be communicated to the service user in all interactions and must be a cornerstone of the practice culture. It is the job of the social care worker to create the appropriate emotional environment through everyday practice that supports the service user to feel safe and respected in communicating their opinions, choices and concerns. Furthermore, it is the role of the social care worker to recognise the importance of surrounding cultural and structural environments in influencing the ability of service users to actively participate in their health and social care. Where these environments are inadequate, it is the job of the social care worker to advocate for change in the best interest of their service user.
Tips for Practice Educators
Developing the necessary skills and knowledge for this proficiency requires different layers of learning for the student. While they will have knowledge of the proficiency and will have considered practical application before they come to the placement, a true appreciation of the meaning of active participation and an adoption of the relevant values into practice requires real life experience. What active participation means will be different across various social care settings, as well as between different individuals. It is paramount that the student has the opportunity to witness real life examples of this proficiency in action, to observe the adoption of the underlying values and assumptions and, most important, to see the limitations and barriers to application.
My advice to practice educators would be start early; talk to the students about this proficiency from the beginning of their placement, as reaching the adequate level of understanding may take time. Begin with supporting them to develop a baseline understanding of how they see service users being supported to make and communicate their choices day to day. This could be as simple as choosing activities or choosing the clothes that they wear. Encourage the students to identify these things and ask them what structures they see that support or limit these types of choice.
Once you are satisfied with their understanding of the everyday practice, move to supporting them to develop a more critical awareness. Perhaps, when they know the service users a bit more, ask the student what they think active participation means to the different individuals. It may be suitable in your setting to have them look at one or two service users as case study examples. Focusing on individual circumstances will facilitate the students to critically explore the concept of active participation and how they as practitioners can support it to happen, even where limitations are in place. Whether restrictions to active participation be circumstantial or resource-based, it will benefit the student to see how limitations can be minimised through professional practice that seeks to support the service users to communicate their choices and that respects their choices. Don’t be afraid to challenge the student, ask them some difficult and thought-provoking questions to guide them towards a deeper level of understanding and appreciation. It is important that you use your own insight into the concept and your experience of its application in your setting for these discussions.
References
Charlton, J. (2000) Nothing About Us Without Us: Disability Oppression and Empowerment. California: University of California Press.
Quinn, G., Degener, T., Bruce, A., Burke, C., Quinlivan, S., Castellino, J., Kenna, P. and Kilkelly, U. (2002) Human Rights and Disability: The Current Use and Future Potential of United Nations Human Rights Instruments in the Context of Disability. United Nations Press. Available at: <http://www2.ohchr.org/ english/issues/disability/study.htm>.
