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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 Kavanagh School of Sociology, Social Policy and Social Work Queen’s University Belfast N. Ireland. About me.

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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 Kavanagh

School of Sociology, Social Policy and Social Work

Queen’s University Belfast

N. Ireland


About me
About me for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

  • A Dad and Partner

  • Mental health experiences within myself and my family

  • Mental Health Social Worker

  • Pre-employment checks and disclosure – ‘Risk?’

  • Background in (passion for) mental health peer advocacy

  • Graduate student (MRes)

  • I am nervous


Aims of enquiry
Aims of enquiry for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

  • 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 enquiry1
Aims of enquiry for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

  • 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 context
Northern Ireland Context for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

  • 1.7 million population

  • Legacy of the conflict

  • Sectarianism

  • Increasing diversity

  • Integrated service - issues

  • Community and Voluntary Sector


Unionism / for someone influence the perspectives and practice of social work students at Queen’s University Belfast?Loyalism


Nationalism / Republicanism for someone influence the perspectives and practice of social work students at Queen’s University Belfast?


for someone influence the perspectives and practice of social work students at Queen’s University Belfast?Belfastism’


Terminology and language
Terminology and language for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

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 context
Social context for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

  • Society 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
Legislative context for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

  • 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 for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

  • 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
Identity for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

  • 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)


Identity1
Identity for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

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 involvement for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

  • 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 entity
Social work as an entity for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

  • Multi-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 education
Higher Education for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

  • Structural 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).


Methodology
Methodology for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

Sample

  • 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.


Methodology1
Methodology for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

Data collection

  • Mixed 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
Results and analysis for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

Table1: Frequency of survey participants by gender


Disabled students
Disabled students for someone influence the perspectives and practice of social work students at Queen’s University Belfast?

Table 2: Frequency table of cohort by disability, as disclosed.


As a future social worker do you regard service users as different from you
As a future social worker do you regard service users as different from you?

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
Please indicate if you have ever used or are using services beyond Primary Care.

Table 4 : Breakdown of service use beyond primary care.


Self identification and otherness
Self-identification and otherness beyond Primary Care.


Interviews
Interviews beyond Primary Care.

  • Available sample = 20

  • Actual sample = 6 social work students


Future practitioner profiles
Future practitioner profiles beyond Primary Care.

  • ‘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. Present 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 profiles1
Future practitioner profiles beyond Primary Care.

  • ‘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.


Questions
Questions beyond Primary Care.

  • Influence 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
Labelling, otherness and sameness beyond Primary Care.

“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
Self-labelling beyond Primary Care.

“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
Sameness beyond Primary Care.

“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
Language beyond Primary Care.

“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
Balance and Fluidity beyond Primary Care.

“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’


Disclosure1
Disclosure beyond Primary Care.

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’


Disclosure2
Disclosure beyond Primary Care.

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’


Disclosure3
Disclosure beyond Primary Care.

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’


Disclosure4
Disclosure beyond Primary Care.

Ownership 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
Other emergent themes beyond Primary Care.

  • 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
Limitations beyond Primary Care.

  • 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
Conclusions beyond Primary Care.

  • 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).


Conclusions1
Conclusions beyond Primary Care.

  • 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’.



References
References beyond Primary Care.

Beresford, P. and Croft, S. (2004) Service Users and Practitioners Reunited: The Key Component for Social Work Reform, British Journal of Social Work 34 (1): 53-68.

Beresford, P. (2007) The Changing Roles and Tasks of Social Work from Service Users’ Perspectives: A literature informed discussion paper, London: Shaping Our Lives/General Social Care Council.

Beresford, P. (2008) ‘We don’t see her as a social worker’: a service user case study of the importance of the social worker’s relationship and humanity. British Journal of Social Work, 38(7): 1388-1407.

Chappell, C., Rhodes, C., Solomon, N., Tennant. M. and Yates, L. (2003) Reconstructingthe Lifelong Learner: pedagogy and identity in individual, organisational and socialchange, London: RoutledgeFalmer.

Clark, C. (2006) Moral character in social work,British Journal of Social Work, 36(1):75-89.

Cooper, A. (2008) Social work [electronic resource] : an introduction to contemporary practice, Harlow: Pearson Longman.


References1
References beyond Primary Care.

  • Cooper, H. (2006) Involving service users in interprofessional education narrowing the gap between theory and practice, Journal of Interprofessional Care, 20(6):603-17

  • Clouder, D.L. (2001) Becoming Professional: An Exploration of the Social Construction of Identity, Warwick: University of Warwick.

  • Duffy, J. (2008) Looking out from the middle: user involvement in health and social care - www.scie.org.uk/publications/reports/rep18.asp - accessed 1st March 2013.

  • Dutton. A. and Worsley, A. (2009) ‘Doves and hawks: practice educators’ attitudestowardsinterprofessional learning’, Learning in Health and Social Care, 8(3): 45-153.

  • Farrow, K. and Fillingham, J. (2011) ‘Promises and Pitfalls: Involving Service Users and Carers in Social Work Manager Education’, Social Work Education, 30: 1-13.

  • Foucault, M. (1994) ‘The subject and power’, in J.D. Faubion, (ed) Power: Essentialworks of Foucault 1954 – 1984, volume 3, London, Penguin Books.

  • Goffman, E. (1959) ‘Presentation of Self in Everyday Life’, New York: Doubleday.


References2
References beyond Primary Care.

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.


References3
References beyond Primary Care.

Rose, D., Fleischman, P. and Wykes, T. (2008) 'What are mental health service users' priorities for research in the UK?', Journal of Mental Health,17(5): 520-530.

Reay, D., Crozier, G., and Clayton, J. (2010) ‘‘Fitting in’ or ‘standing out’: working-classstudents in UK higher education’, British Educational Research Journal, 36 (1):107-124.

Sakamoto, I. & Pitner, R. (2005) Use of Critical Consciousness in Anti-Oppressive Social Work Practice: Disentangling Power Dynamics at Personal and Structural Levels, British Journal of Social Work,35: 435-452.

Webb, S. A. (2006) Social Work in a Risk Society: Social and Political Perspectives, Palgrave Macmillan: Basingstoke.

Webber, M. and Robinson, K. (2011) ‘The meaningful involvement of service users andcarers in advanced-level post-qualifying social work education: A qualitative study’,British Journal of Social Work, 10: 1093

Wiles, F. (2011). Professional registration and the discursive construction of social work students’ identities. EdD thesis, The Open University.

Wray, J., Fell, B., Stanley, N., Manthorpe, J., and Coyne, E. (2005), Final Report of ThePEdDS Project: disabled social work students and placements, University of Hull,

[Online] http://www2.hull.ac.uk/fhsc/pdf/PEDDS%20final%20report.pdf (accessed 10.05.13).


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