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

Chapter 1 Background to the project

Introduction

1.1 The idea for this project came out of research (Altrum Risk Research Team 2011, Mackay et al 2011) that was undertaken in the first few years after the Adult Support and Protection (Scotland) Act 2007 [hereafter referred to as the ASPA] was implemented. This found that whilst there was lot of good work being undertaken to support and protect adults at risk, there were occasions where there was a difference between the perception of the practitioners who undertook work and service users who experienced it. Differences centred on how well the service user understood what was happening, and the extent to which they had a meaningful voice in the process. This project was supported by the Scottish Government to build on this research to explore how we might improve service users' involvement in adult support and protection [hereafter ASP] work by bringing together service users and practitioners to co-productively develop tools or approaches. This chapter provides background information on adult support and protection and sets out the aims and methods of the project.

Adult support and protection work

1.2 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 ASPA underline that an adult at risk of harm should be supported to express their own views and should be supported to participate as fully as possible in any decision-making processes. They also emphasis any action should benefit the person. Some people may have varying degrees of intellectual and/ or communication impairments and the onus is on the local authority practitioners to find ways to enable them to be involved as far as possible. Involvement depends on people understanding what the ASPA is all about, expressing their views, having those views taken into account and agreeing to any pursued action by local authorities unless there are exceptional circumstances.

1.3 ASP work is therefore about seeking to help people work through risks they may be facing in their lives. This often means helping a person sort through difficult feelings in stressful circumstances. It may mean rethinking important relationships or making decisions that will have a long term impact on their lives. It may involve the person working with several different services together, which can be confusing. Finding good solutions to risk needs to involve the adult at risk, use their strengths and ideas, and should keep their interests central. All these things can be summed up as participation.

Previous research

1.4 The aims and methodology for this project arose from two recent projects, based at the School of Applied Social Science, University of Stirling. The first project, led by Kathryn Mackay, was a collaborative practitioner research study which interviewed practitioners and services users in three Scottish local authorities to explore the experiences of assessment and intervention under the new law (Mackay et al 2011). The second project, which Beth Cross helped facilitate, was a participatory project with service users that explored understandings of risk and developed tools to improve service users' involvement in adult support and protection work (Altrum Risk Research Team 2011).

1.5 This research highlighted the following factors that supported or limited service users' participation:

• The nature of the interaction between the practitioner and the person
• The person's confidence and levels of anxiety
• Opportunities and access to resources to help the person process information and understand ASP work, whether they have a communication disability or not
• Time and encouragement given to the person to express their views
• The way ASP work was structured by the agency e.g. how inquiries were undertaken, how they approached case conferences

1.6 Wider research into adult abuse from across the UK and internationally supports these findings, emphasising the centrality of the service user/practitioner relationship in supporting adults at risk of harm throughout the process (Bergeron 2006; Dixon et al 2010). Positive open relationships help to develop shared understanding and problem solving but also reduce the power imbalance that exists between worker and service user. Whilst sometimes crisis situations mean that workers have to act before such relationships are developed or where contact might only be a matter of an initial inquiry, the onus is still on the practitioner to ensure that the adult understands what is happening, why it is happening and has the opportunity to give their views and ask questions.

1.7 It is also important to note that there have been various small projects within Scottish local authorities since 2008 that aimed to evaluate people's experiences so far, to produce clear, easy information about ASP in written and DVD formats, and to raise awareness of adult abuse and harm through public events. The first step for this project was to synthesise learning from these various projects into a briefing paper that informed the work of this project.

Participative and co-production approaches

1.8 The projects undertaken by Beth Cross and Kathryn Mackay demonstrated that local authorities, individual practitioners and service users were interested in working together to improve participation within ASP processes. However, neither project worked with both practitioners and service users together. A meeting between these two research projects demonstrated how practitioners and service users could share what were clearly different views of the ASP journey. It highlighted the potential value of a project where service users and practitioners worked together as team members and indicated the results might powerfully model good participatory practice. However, such an approach had been rarely carried out within statutory local authorities. Siting a project within locality teams might also demonstrate how this method could be used, thus taking a bottom-up as opposed to top-down approach to changing local policy and practice.

1.9 Beth Cross and Kathryn Mackay used the opportunity of delivering research dissemination workshops under the auspices of the Institute for Research and Innovation in Social Services, to bring together service users co-facilitating the workshops with practitioners attending the workshops in the spring of 2012. These workshops provided further insight into the potential of co-production processes and laid the groundwork for this research project. In addition the workshops also highlighted how specialist teams were more likely to be familiar with participative ways of working with service users than local authority teams. Particular challenges to participative ways of working were also highlighted, the principle one being the adoption of an overly legalistic or procedural approach by local authorities. Whilst there are times when local authorities have to act in emergencies, undertake court applications, and basically take control, most on-going ASP work is about working with the adult to minimise the potential of future harm.

1.10 In addition, it was also recognised that advocacy workers play a key role in supporting some service users through ASP work but that their perspective was missing from the research so far.

Overview of the project

Project Aims

1.11 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 adults 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

b) Building on this knowledge in the current project

c) Establishing small co-production locality teams of service users and practitioners to work together on an aspect of ASP work they wanted to improve and develop a tool or approach to address issues they identified

1.12 It was acknowledged that there would not be time within the life of this project to test out and evaluate any tools that were developed, but means might be found to do so at a later date. However, value lay in capturing and synthesising the learning around developing the tools themselves and from using a co-production model to develop policy and practice at the frontline of ASP work.

1.13 The potential benefits of this project were:

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

1.14 The strategy was to establish a national network of four teams within local authority areas to work on their own chosen issue and find ways in which it might be tackled through developing 'tools' and/or approaches. 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 (chapter two summarises this paper). Stage two focussed on the teams working on their chosen issue and coming together in two national workshops to share their work and support each other's work. This project 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.

Co-production locality teams

1.15 Local authorities with whom Beth Cross or Kathryn Mackay already had links were invited to take part. Several more than actually took part expressed an interest but were unable to proceed due to pressures of work. One local authority started but then withdrew for similar reasons. Dundee City, East Ayrshire, Perth and Kinross Councils have been involved in the project throughout. North Lanarkshire Council and The Advocacy Project joined later.

1.16 Each team was a partnership between:

• Local authority social work service practitioners
• Local advocacy worker
• Service user(s)

1.17 The project drew upon the draft ethical UK guidelines and principles for community-based participatory research (CBPR) that were being developed by the Centre for Social Justice and Community Action at Durham University (2012) to guide its work. The core principles are:

• Mutual respect
• Equality and inclusion
• Democratic participation
• Active learning
• Making a difference
• Collective action
• Personal and professional integrity

Supporting the teams individually

1.18 Kathryn Mackay and Beth Cross offered individual support to teams. Each team was visited at the start and then later on. The researchers were available by phone or email. However the teams all seemed to work well on their own though they appreciated the deadlines of meetings and workshops to push their work forward, as well as the debate and discussion of outsiders' views when they met with the researchers.

1.19 Claire Lightowler from the Institute for Research and Innovation in Social Services offered expertise on local project work and dissemination. She also set up a project blog on the IRISS website. This was populated by the briefing paper and full write ups of the two national workshops (see http://blogs.iriss.org.uk/asp/f). The blog did receive hits and one valuable connection with The Advocacy Project was made through this route (see section 3.26 for details).

Supporting the teams together

1.20 The two national workshop days when the teams came together were an important aspect of the project. Their aims were to support, exchange, debate and share learning. The first in January was designed to launch and stimulate ideas for the second stage where teams started to undertake their own projects. Heavy snow on the day prevented many from coming but there was a representative from each team. Those who were there engaged in a number of activities and discussions. These included sessions by Scottish Consortium for Learning Disability (SCLD) on how they developed co-production processes within their work and by Lois Cameron, from Talking Mats, who shared insights from a project working with disabled people on developing information using symbols to explain what ASP was about (Cameron and Place 2011). A member of the forum theatre group, The Good Life, spoke about service user led work on the issues of ASP and improvised with Lois Cameron a brief scene that demonstrated the usefulness of this technique for addressing issues and dynamics that may otherwise be difficult to broach or work through.

1.21 The second workshop in June had much better attendance and became a forum of lively debate where the teams shared their own work, gave and received feedback. It also helped to identify the learning each team had accumulated along their journey together. Further information about the workshops is contained in chapter 4.

Summary

1.22 The ASPA legal principles underline the expectation that adults at risk of harm should be supported to express their views and participate as fully as possible in decision-making. This project built on previous work that highlighted factors which supported and limited service users' involvement in ASP and also demonstrated the value of participatory research methodologies. The aim of this project was to improve service user participation through establishing locality co-production teams who then selected an aspect of ASP work and then developed a tool or approach to improve service involvement. Learning about the challenges of improving service user participation and how the co-production model worked in practice at the frontline line in ASP work were also key elements of this project.