A Project To Support More Effective Involvement Of Service Users in Adult Support and Protection Activity

Executive Summary

What is adult support and protection work?

Local authorities have legal duties to inquire and investigate situations where an adult may be at risk of harm. They also have to consider whether they need to take action to support and protect the adult in question. The principles in the Adult Support and Protection (Scotland) Act 2007 state that an adult at risk of harm should be supported to express their own views and to participate as fully as possible in decision- making processes. This depends on people understanding the context of why a practitioner is making contact: what is adult support and protection (ASP) and how might it be relevant to them? Thereafter, much of ASP work is about helping people to work through risks they may be facing and what they may wish to do about them.

Project aims and methods

The overall aim of this short- term scoping project was to explore how social work service practitioners might be better equipped to understand the perspectives of people who may be at risk of harm and to identify ways to improve service user participation in investigations, decision-making and meetings. This was to be achieved by:

a) Synthesising existing research and practice experience about what supports and limits service user involvement in ASP work and building on this knowledge in the current project

b) Establishing small co-production locality teams of service users and practitioners to work together on an aspect of ASP work they wanted to improve by developing a tool or approach to address the issue

It was acknowledged that there would not be time, within the life of the project, to test out and evaluate any tools that were developed.

The potential benefits were:

• Raised awareness by welfare practitioners of how to improve understanding and participation, and confidence in trying out new methods of engaging with services users
• Diversification of the tools or approaches to more appropriately match people's needs and strengths
• Demonstration of the effectiveness of this co-production approach in tackling practice issues and improving the experience and participation of service users in ASP processes

A national network of four teams within local authority areas (Dundee City, East Ayrshire, North Lanarkshire and Perth and Kinross) was established. The locality teams were made up of service users, social work practitioners and managers, and advocacy workers. The project ran from November 2012 to June 2013 and had two stages. Stage one (November to January) consisted of identifying and setting up the teams and producing a briefing paper on the research and development work undertaken to date in Scotland about ASP work. Stage two focussed on the teams working on their chosen issue, coming together in two national workshops to share and support each other's' work. This report pulls together all the learning about improving service user involvement in ASP work gained during the project, presents the tools developed and highlights the lessons learned about the co-production approach itself. There are plans to test out and evaluate the tools. This would provide practitioners with more detail about the outcomes the tools might achieve.

How is adult support and protection working in practice?

Research, local evaluations and workshops highlighted that service users and carers have had mixed experiences of ASP. Some have been good, but some adults felt more could have been done to help them understand what ASP was about and to help them have more say along the way. This was confirmed by the locality teams who identified the following factors:

• There has been more of a focus on procedures than the service user perspective to date
• There appears to be an underlying presumption if you have told someone something then they will retain that information but emotions and stress can get in the way
• The service user gets very little written information along the way
• Time is needed to encourage and establish open dialogue
• There is an overreliance on traditional interview methods
• Practitioner knowledge of how a given person best participates is not easily accessible to others
• Case conferences need attention in terms of preparing people for them (if they wish to attend), getting their views heard and in terms of the person receiving feedback after the meeting

Tools developed

All the tools aimed to increase the voice of the service user and encourage more meaningful dialogue. Two teams developed new tools: a visit summary sheet to be written with the service user at the time of the visit and a 'STOP! Make sure you include me' tool to record how best to communicate with and involve someone. The other two teams wanted to try out and adapt pre-existing tools which service users could complete around risk-taking and support (Altrum Risk Research Team 2011). One team also explored how to integrate the visual tools with council IT systems. These tools should not be viewed as checklists, or purely pieces of paper, but are devices within a defined process to help service users to have more say and to help practitioners think more deeply about what supporting participation means.

Learning from the project

A key factor that facilitated learning for all locality teams was bringing together different participants outside of one-to-one case work where each other's experiences and perspectives could be shared. There was a need to view ASP work from the perspective of service users because to date the focus has been on getting local authority policy and procedures right. This meant critically reviewing the processes and paperwork councils had generated around ASP work and which the script that practitioners worked from. In contrast the project locality teams sought to develop shared scripts between practitioners and service users.

Learning from developing the tools

As a result the teams identified important ways of working that enable collaboration between practitioners and service users:

• Expect to consider a range of options before picking one
• Choose a discrete aspect of ASP work and be realistic
• Devise tools that are simple to use
• Change is achieved through the process of using the tool
• Provide guidance and support about how they are to be used
• Use symbols and pictures that are commonly understood
• Remember that paperwork is for service users too
• Think about transferability of formats; converting a paper-based tool to an electronic format can be complex
• Organisational change takes time: share the vision and its potential with practitioners as well as management

Learning from doing co-production

In the process teams also identified a number of important points about co-production as a service development approach:

• Flexibility is required about how service users wish to work on projects: no one model fits, find out how they want to get involved
• Relationships take time to build and for everyone to feel comfortable about working in a different way with each other
• A 'nothing's off limits' approach helps to build trust and openness
• Acknowledge you can't fix it all and find a realistic starting point
• Co-production working develops practitioners' skills and knowledge that can then be used more widely
• Deadlines provide a useful framework for pacing work
• Humour is key: being able to laugh and relax together
• This local model of policy and practice development does take time as it is more of a journey of joint discovery but it sets the seeds for change in situ, and creates alliances and ways of working that can be built upon

Conclusions

This project has demonstrated the value of a co-production approach to explore how service user involvement in ASP work might be improved. It has produced new tools and adapted existing ones (see Chapter Three and Appendix 2) which are ready to pilot and can then hopefully be put to use. There is a real appetite amongst local authorities to do this type of developmental work but for some work pressures prevented them from taking part. Whilst practitioners and managers are aware of the need to improve service user participation they do need to step back from day to day work to fully appreciate the barriers.

In particular the project demonstrated:

• Co-production with service users and advocacy workers has helped local authority staff to see their work through each other's eyes and experiences
• Small locality teams proved a good model because relationships could be developed in ways that are not possible within more formal working parties
• Service users will participate in different ways, it's about choice and what suits them best
• The teams demonstrated what might be described as a re-balancing of power between the practitioners and service users and as such model best practice.
• Bottom-up ideas and potential solutions are worth cultivating
• This type of work takes time and may require creative adaptation to respond to changes in circumstances that impact on service users' participation
• Having a national network was effective in promoting learning between the teams and was a catalyst for moving the work forward

Improving ASP Participation Project Team members: Bobby Brown, Jenny Bruce, Maureen Conway, Beth Cross, Neil Dunn, Fiona Gaffney, Michelle Howorth, Susan Hynd, Claire Lightowler, Kaye MacGregor, Kathryn Mackay, Senga McCulloch, Lee McLauchlan, Rhona Maxwell, Brian Rapley, Rose Sinclair and Helen Winter.

For more information please contact:

Kathryn Mackay, Lecturer in Social Work, University of Stirling, School of Applied Social Science, Colin Bell Building, Stirling, FK9 4LA

Telephone: 01786 467714 E-mail: k.j.mackay@stir.ac.uk
or
Dr. Beth Cross, Lecturer in Youth and Community Work, University of the West of Scotland, Hamilton, ML3 0JB
Telephone: 07889 122619 E-mail: beth.cross@uws.ac.uk