To what extent do experiences of using services or caring for someone influence the perspectives - PowerPoint Presentation

To what extent do experiences of using services or caring for someone influence the perspectives and practice of social work students at Queen’s University Belfast? Damien KavanaghSchool of Sociology, Social Policy and Social WorkQueen’s University BelfastN. Ireland

About me A Dad and PartnerMental health experiences within myself and my familyMental Health Social WorkerPre-employment checks and disclosure – ‘Risk?’Background in (passion for) mental health peer advocacyGraduate student (MRes)I am nervous

Aims of enquiry To identify and explore the levels of health and social care service use, and caring responsibilities, among social work students at Queen’s University Belfast. Investigate the prevalence of client and carer self-identification among a population of social work students.Investigate the level of self-identification and disclosure among social work students.

Aims of enquiry Identify whether and to what extent the social work students perceive clients and carers as ‘other’ than themselves.Consider whether a relationship exists between the policy, practice and identity issues involved.This study also sought to explore whether future social workers presume that the people they will work with and support are vulnerable or oppressed.

Northern Ireland Context1.7 million population Legacy of the conflict Sectarianism Increasing diversity Integrated service - issues Community and Voluntary Sector

Unionism / Loyalism

Nationalism / Republicanism

‘ Belfastism’

Terminology and language Challenges in defining categories (McLaughlin, 2009).Service user: someone who has used or uses services in Health and Social Care.Caregiver: someone who has or has had an on-going emotional or practical interest in the wellbeing of a service user.

Social contextSociety emerging post-conflict. Disability issues were not the main concern.Conflict issues were and are not the main concern for many disabled citizens and caregivers.Social Work part of an integrated Health and Social Care setting.

Legislative context The Special Educational Needs and Disability Order (SENDO) 1 September 2005. Extended Disability Discrimination Act 1995 to ensure equal opportunities in Higher Education. Section 75 of the Northern Ireland Act 1998 (aka Good Friday Agreement). Duty on public bodies to promote equality of opportunity.

Disclosure Disclosure is the responsibility of the student, as a personal decision.Unclear how students may be facilitated in addressing barriers to self-disclosure within context of personal choice.Notion of ‘process’ in a fluid ecological context, as opposed to single event.

Identity Fluid discourses, subjectively significant experiences and categorisation (Chapell et al, 2003; Goffman, 1958)Individual agency and power imbalances (Clark, 2006) Opportunities for identity redefinition (Foucault, 1994)‘Otherness’ and professional socialisation, denying personal experiences ( Clouder , 2001)

Identity Evidence-informed practice and objectivity in context of humanity and subjectivity (Wiles, 2011)Disability as a medical, personal tragedy (Oliver and Sapey, 2006)Fear of disclosure and unfitness to practise (Wray et al, 2005)

Citizen involvement Citizen leadership increasingly central to social work education (Farrow and Fillingham, 2011) research (Rose, 2008; Kavanagh et al, 2012), policy and practice (Duffy, 2008).Service users and caregivers involved in design and delivery of curriculum and regulation of workforce.Helps reduce distance between experience and interpretation (Beresford, 2007). Potential for over-involvement (Rose, 2008).

Social work as an entityMulti-disciplinary, integrated nature of health and social care and marginalisation of social work (Judd and Sheffield, 2010). Regulatory requirements, heightened accountability as ‘surveillance’ of workers (McLaughlin, 2010).Target and performance driven philosophy (Heffernan, 2006).

Higher EducationStructural and institutional norms which differ from students’ culture and values ( Reay et al, 2010).Internships compound this with organisational norms (Hughes et al, 2007).Diversity of and micro-political nature of internship settings exacerbate issue (Dutton and Worsley, 2009).

MethodologySample Phase one: Initial purposive sample across BSW (Bachelor of Social Work) undergraduate program (n=122).Phase two: Convenience sample of a priori criteria – those who self-identify as service user, caregiver or both.

Methodology Data collectionMixed method – Phase one survey (using Personal Response System)Phase two semi-structured interviews.Interview and survey schedule.Informed consent.Analysis Subjective experiences warranted inductive approach.SPSS and thematic framework.

Results and analysis Gender Frequency Percentage Male 15 13.5 Female 96 86.5 Total 111 100 Table1: Frequency of survey participants by gender

Disabled students Disability Frequency Percentage None 101 91.0 Physical impairment 1 0.9 Hearing impairment 2 1.8 Sensory impairment 1 0.9 Learning Disability 6 5.4 Total 111 100 Table 2: Frequency table of cohort by disability, as disclosed.

As a future social worker do you regard service users as different from you? Frequency Percentage Yes 51 47.2 No 57 52.8 Valid Total 108 100 Table 3: Frequency table of cohort’s views regarding service users.

Please indicate if you have ever used or are using services beyond Primary Care. Frequency Valid Percent Yes 60 55 No 49 45 Valid Total 109 100 Table 4 : Breakdown of service use beyond primary care.

Self-identification and otherness Used/using services beyond primary care View service users as different Total Yes No Yes 25 32 57 No 23 25 48 Total 48 57 105

InterviewsAvailable sample = 20 Actual sample = 6 social work students

Future practitioner profiles ‘Rita’ : Initial child protection social work assessment in respect of her own children. Past and current experiences as a carer for her father, who lives with physical support needs. ‘Stephanie’: Prior use of cancer services. P resent experiences as a consequence of having used these services, in terms of the physical and emotional effects of treatment . ‘Rose ’: A caregiver for her brother, who lives with an intellectual disability.

Future practitioner profiles ‘Barbara’: Child and Adolescent Mental Health Services in respect of her son. Lived experiences of a parent who lives with alcohol addiction.‘Anna’: Someone living with epilepsy in addition to experiences as a child and adult with a parent who lives with alcohol addiction.‘Ursula’: Experienced sexual abuse as a child, and on-going mental health needs who made use of counselling services in relation to these experiences. Experiences of living in and leaving local authority care.

QuestionsInfluence on how they perceive themselves. Influence of how others perceive them.How their experiences have influenced their approaches to social work.Their readiness to disclose their experiences in a public setting.

Labelling, otherness and sameness “Now that I’m a social worker I don’t want to give too much away.... I view my illness and how it shaped my life differently.... I remember the first day .... thinking, ‘What are people going to think about someone on crutches? I need to get off crutches before I go on placement’. ... I was always conscious that it was about me feeling different from other people, and that all came from being sick .”‘Stephanie’

Self-labelling“I made the realisation that I’m a carer and not just a family member. I could see people around me answering differently.... my life experiences are different from everyone else’s.... It’s more than being a sister; I don’t know any of my friends who would be mothering their 16 year old brother.”‘Rose’

Sameness “I think it’s important to think through past experiences and be aware of the potential impact on people. I’m no different from anyone else.... Our lives are basically the same as the people we are going to be offering support to. We’ve just been a bit luckier with the circumstances, and I think that’s the only difference.”‘Barbara’

Language“It’s all about the words that you use. People are in contact with social services for a reason, but it’s always ‘service user vulnerable’, not ‘service user strong’. It’s about the pathology of service user status and experiences, people need to practice thinking about people in a different light, as experts on themselves.”‘Ursula’

Balance and Fluidity“I have grown as a person ... I am a professional and I bring my life experiences. I will not deny these; they’ll not be put in a box. .... I now know the other side of the relationship.... I always check how I think about things; it’s about personal and professional safety.”‘Ursula’

Disclosure Reinforcing good practice.“My family and my Gateway experience was a more positive experience and I would be more willing to share this. I wouldn’t be though if it had been a bad experience.”‘Rita’

Disclosure Social justice and advocacy.“Yes, when I have to stand up for them when someone makes a remark....I felt hurt and insulted, but now that I’m on the social work course I’m trying to handle situations better.... I don’t want him (brother) to be an object or subject to be talked about .”‘Rose’

Disclosure Access to accommodations, institutional and personal.“I did, mostly for support materials and to increase my accessibility. The previous University didn’t ask and I didn’t tell them. I had friends from school with me who supported me.”‘Anna’

DisclosureOwnership and protection of experiences “I said a couple of sentences but didn’t say too much detail about it. I think that if you bring your life experience and once you put it out there someone else owns your personal information.”‘Ursula’

Other emergent themes Experience-informed practice, linking experience to interpretation.Positivity and expertise.Balanced approach to negotiating multiple identities within a context of fluidity and professionalization.Institutions facilitating service users and caregivers on the program to contribute to learning.Fitness to practise.

Limitations My lived experiences and potential bias. Regular reflections in supervision assisted.Possibility of desirable responses from interviewees. Limited sampling frame in context of academic timetable. The good grace of students and teaching staff facilitated this. Challenges in migrating data from the Personal Response System to SPSS. Survey - level of non-response for each question. Interview sample limited from the point of view of gender, as no males were recruited for interview.

Conclusions Subjective interpretations of user and carer self-identification exist. Who owns disclosure?The extent to which this cohort of students perceive service users and carers as ‘other’ than themselves is also significant. Variances in perceptions of experiences, ranging from presumed vulnerability to presumed strength, hope and opportunity (Sakamoto and Pitner , 2005).   Sensitivities to the concept of holding blurred and fluid identities as human beings, as opposed to binary relationships between lived experiences and professional work practice ( Chapell et al, 2003).

Conclusions Disclosure underpinned by a critical tension between individual agency and professional socialisation (Clark, 2006).Pertinent questions about social work education and practice as a potentially and paradoxically oppressive forum for practitioners with lived experiences, and whether or not meaningful supports exist for these people (Webber and Robinson, 2011).Further research explicitly in relation to the concept of ‘otherness’.

A final word on Northern Ireland .....

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References Hughes, J., Jewson., N., and Unwin, L. (2007) Communities of Practice: CriticalPerspectives, London, Routledge.Judd, R.G., and Sheffield, S. (2010) Hospital Social Work: Contemporary Roles and Professional Activities, Social Work in Health Care, 49(10): 856-871 Kavanagh , D., Daly, M., Harper, M. and Campbell, J. (2012) ‘Mental health service users and carers as researchers: reflections on a qualitative study of citizens' experiences of compulsory mental health laws in Northern Ireland,’ in Goodson, L. and Phillimore , J. (2012) Community Research for Participation: From Theory to Method , Bristol: Policy Press. Manthorpe , J., Rappaport , J. and Stanley, N. (2009) Expertise and Experience: People with Experiences of Using Services and Carers' Views of the Mental Capacity Act 2005 , British Journal of Social Work, 39(5): 884-900 . McLaughlin, H. (2009) ‘What’s in a Name: ‘Client’, ‘Patient’, ‘Customer’, ‘Consumer’, ‘Expert by Experience’, ‘Service User’—What’s Next?’ British Journal of Social Work , 39: 1101–1117. Oliver, M. & Sapey , B. (2006) Social Work with Disabled People , Basingstoke: Palgrave Macmillan Robinson, K. and Webber, M. (2013) Models and Effectiveness of Service User and Carer Involvement in Social Work Education: A Literature Review, British Journal of Social Work , 43: 925-944.

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