@pixiegirle will be hosting next week’s #OTalk on service user involvement. There are a few sections she’d still like to add to, but here’s her introductory blog post to get you thinking!
Service User* Involvement
*The term Service User in this context, refers primarily to people who utilise mental health services. However, it must be acknowledged that many individuals prefer to use alternative terminology, including, but not limited to, ‘patient’, ‘consumer’, ‘survivor’, ‘the public’ or person. (Welsh Government 2008).
The involvement movement has increased in momentum since the 1970’s (SCIE 2014). Indeed, Patient and Public Involvement (PPI), Citizen Engagement and Participation, Co-production and Service User and Carer Involvement are phrases we hear on a daily basis as Occupational Therapists. Yet, despite its prevalence in successive policies, strategies and best practice guidelines, there is ‘no single template for involvement’ (JRF 2003). Indeed, professionals, service users and carers will often find different forms of involvement personally meaningful, leading to an array of definitions of what it means to be involved, and indeed how best to facilitate involvement.
It is important to note that this blog is written from the perspective of being both an Occupational Therapist and an Involvement Activist, and written primarily for fellow Occupational Therapists to enable them to reflect upon their practice and professional development. Initially, key concepts prevalent to the involvement movement will be discussed, followed by a discussion upon Occupational Therapy and Involvement. Whilst this blog will draw primarily upon involvement in mental health, many of the principles and practices are applicable to other areas of practice.
Branfield et al (2006) emphasise that Involvement must be broadly defined to ensure it remains inclusive. Significantly, people with lived experience have highlighted these broad features:-
- Making experiences, views and ideas known
- Being able to get together to work collectively for change and mutual support (Branfield et al 2006)
It is also widely advocated that Involvement should occur during the design, planning, delivery and evaluation of services, in addition to education and research (WG 2008).
The notion of power is prevalent throughout the literature on Involvement. As I am unable to provide an account of the implications of power as articulate as Branfield et al (2006), I include a lengthy quote:
‘’Issues have been seen and understood from other more powerful perspectives, like those of politicians, policy makers and professionals. This heritage has also affected understandings of participation and user involvement.
Often user involvement has been framed in terms of seeking to involve service users in the service system’s activities, ways of thinking, goals and structures. The most common calls have been to ‘join our committee’, ‘send in your views to our consultation’, ‘fill in our questionnaire’ and the like. That is still what most service user involvement is like. But from the beginnings of the emergence of new movements of service users, 30 and more years ago, first disabled people and then other groups of service users, began to develop a different understanding of what user involvement and participation might mean. They didn’t necessarily want to get involved in existing organisations and services. They wanted to develop their own.’’ (p ix)
The Involvement Continuum
As highlighted eloquently by Branfield et al (2006), who leads or controls the overall involvement activity and process has a strong influence upon how meaningful Involvement may be for people engaged in the Involvement activity or opportunity. The Ladder of Involvement presents this concept, however I have drawn upon the notion of a continuum, adapted from Nolan et al (2007). A continuum acknowledges that involvement must be broadly defined and will depend upon individual preferences.
The Involvement Continuum (Adapted from Hickey and Kipping (1998) and Nolan et al (2007)
|Not Involvement||Profession led involvement||Partnership / co-production||Service User led involvement|
|Tokenistic Involvement where:-
||Service User led involvement, organisations and initiatives:-
Occupational Therapy and Involvement
Generic vs Core Skills
Involvement is not unique to Occupational Therapy, and is something that all organisations or professionals who work in health and social care should do. Indeed, many organisations will have policies outlining the manner in which the organisation will involve the people who utilise its services. Whilst Involvement could be perceived as drawing upon Occupational Therapists’ generic skills, Occupational Therapists are in an excellent position to be able to enable involvement at all levels of service delivery given their philosophical underpinnings and core skills. Indeed, many of the values espoused by Involvement, mirror the values of Occupational Therapy, including:-
- Valuing people and their lived experience
- Enabling and empowering people to do things for themselves independently
- Facilitating engagement and participation in personally meaningful ways
- Taking strength based approaches
- Notions of justice and equality
Furthermore, our core skills, including Activity Analysis, Grading Activities and Environmental Assessment can help facilitate involvement.
Involvement as an Occupation
As an ‘occupation’, Involvement must be personally meaningful and personally defined. Like any other occupation or activity, involvement has many forms and depends upon the complex interaction between the individual, their occupation and the environment. Consequently, any involvement activity must be meaningful for the individual involved, which may depend on previous experience or roles, in addition to the individual’s skills and knowledge and preference on the involvement continuum. It will require preparation to ensure involvement offers the appropriate context to make meaning and provide opportunities for mastery.
The University of the West of England has created an Algorithm of Involvement which can be utilised to aid anyone interested in planning involvement in the future.
Area of practice and Professional Development
It is fundamental that the environment and context is considered when involving people. Whilst, Branfield et al (2006) emphasise the growing momentum of user-controlled involvement, as Occupational Therapists, we work primarily within exiting organisations and cultures. Drawing upon COTs Post Qualifying Framework, examples and resources are presented in accordance with Occupational Therapists’ four areas of professional development – Clinical Practice, Management, Education and Research. I have also supplemented this with examples and resources that pertain to user-led or controlled organisations and involvement activities as our environment should not detract or restrict the growth and success of these activities and organisations.
Involvement is a concept, widely advocated in mental health. However, Irrespective of what area of practice we find ourselves in, by the very nature of our profession and in accordance with our Code of Ethics and Professional Standards, Occupational Therapists (COT 2010) should be:
‘’committed to client-centred practice and the involvement of the service user as a partner in all stages of the therapeutic process.’’ (pv)
Our area of practice will ultimately influence the type and method of Involvement. Dependent upon where the Involvement activity lies on the Involvement Continuum, examples include: Working in partnership to develop care plans, enabling and supporting people to set their own therapeutic goals, Peer Workers (who deliver services), delivering training.
Involvement can occur at any level of service provision, from therapeutic intervention to working strategically at Board level. Whilst meaningful Involvement during therapy is of prime importance to Occupational Therapists, the literature on Involvement places great emphasis upon Involvement in activities related to the design, planning, delivery and evaluation of services. Indeed, Involvement should extend beyond the therapeutic process to activities traditionally associated with senior management, including recruitment and strategic and board level activities.
Dependent upon where the Involvement activity lies on the Involvement Continuum, examples include: Recruitment and Interviewing, developing strategies, staff appraisal, evaluating a service using service users as interviewers, consultation, completing an evaluation questionnaire, commissioning services in partnership with professionals.
COT (2007) advocates the involvement of services users in education:
‘’Involvement of service users in programme design, delivery and evaluation helps to ensure the relevance of curricula and is one of the criteria in the COT standards for education (2004b) against which occupational therapy programmes are measured for accreditation. Higher education institutions (HEIs) must continue to review the effectiveness of service user involvement in their programmes.’’ (p15)
Dependent upon where the Involvement activity lies on the Involvement Continuum, examples include: Service user lecturers, Sharing stories or personal experiences as case studies, being involved in the design of a course, evaluating content of course.
There is a growing involvement movement within the research community. Indeed, INVOLVE (England) and Involving People (Wales) support and advocate for the role of service users within all research activities. A number of research teams now have people with lived experience working in an array of capacities within the team. SURE, the Service User Research Enterprise based at Kings College London is co-directed by Professor Diana Rose, the world’s first Professor of User-led Research. Information on SURE can be accessed here.
Dependent upon where the Involvement activity lies on the Involvement Continuum, examples include: Service User Researcher’s, Membership of an expert reference group, Research teams, consisting primarily of service users, independent service user researchers who collaborate with academics on a consultancy basis.
5. Service User led organisations and initiatives
To be updated….
Questions to think about for #OTalk:
- What does ‘service user’ Involvement mean to you?
- What Involvement opportunities do you, your service or your organisation provide?
- What difficulties / barriers have you faced when trying to involve service users?
- What has helped you to involve service users?
- How can we make Involvement more meaningful for the people who use our services?
- Putting Involvement in to practice: Ideas / Plans for the future!
To be updated…