Worker competence and partnerships with people with learning disabilities: a model for analysis

by Karen Kniveton

Abstract

This paper introduces a teaching resource, in the form of a 'toolkit' Kniveton and Etchells (2004), which examines interactions between people with learning disabilities and those working with them in terms of partnership and empowerment. A model that is the basis of the toolkit is presented, as is an example of its use. The terms partnership and empowerment are then explored, especially as they apply to the UK situation, and interviews with users of the toolkit are described, in order to inform this discussion. Finally the issues raised are examined in the light of the supposed tension between SRV and 'empowerment.'

Introduction

This presentation results from work undertaken in conjunction with my colleague Jean Etchells. Together we have developed a toolkit, Kniveton and Etchells (2004) that enables students to analyse their direct interactions with people with learning disabilities and to develop partnerships that are mutually empowering. The students who use the toolkit are training to be dually qualified social workers and nurses in the area of learning disabilities and they use the toolkit on their final practice learning experience with people with learning disabilities who are using health and/or social care services. The author of this paper has recently undertaken an evaluation of the toolkit by interviewing students and practice teachers who have made use of the toolkit in their practice.

The toolkit places emphasis on the competence of the student, as opposed to the more usual emphasis that is placed on the competence of the person with a learning disability or, even more usually, the lack of competence of the person with a learning disability.

It is recognised that people with learning disabilities often need others to support them and that the degree of support varies. This support may come from family, friends, workers, advocates or other people with learning disabilities. The toolkit uses the term partner to describe these individuals because the term seems to capture the value being placed on the relationship. Hereafter the term partner will be used, which for present purposes is descriptive of the student but could equally apply to a worker or anyone else supporting a person with a learning disability.

The Etcheton model-- partnership analysed

The toolkit contains a model, shown below which is based upon the premise that it is the partners responsibility to reflect on their actions and skills, and to gain insights into which actions have a positive effect on achieving a successful partnership and which actions have a negative effect. This approach is necessary to counter balance the more usual focus on the (lack of) competence of the person who has been labelled as having a learning disability and who is often therefore denied opportunities to develop by the actions of their partner.

The model describes eight potential situations along a continuum of power, from the development of individual awareness and action to political awareness and action. The toolkit presents each situation stated in the model. The situation is described and the partner is encouraged to address reflective questions, to undertake activities and to seek further resources to support their development.

An example from the toolkit

Situation three, one of the examples in the toolkit, shown below in two succeeding pages in this paper but ones which appear on opposite sides of a page in the hardcopy version of the toolkit, describes a situation where the person with a learning disability is able to express their feelings, or needs or wants or rights but their expressions are not always understood by their partners or others. Using the example, partners are encouraged to reflect on their ability to understand what the person may be expressing and to find ways of communicating that develop mutual understanding. For example, giving inaccessible, inaccurate or misleading information would be disempowering for the person with a learning disability and could be considered as an abuse of the partner's power. Whilst "working with the person by communicating in ways they understand" would help them both become more powerful and would be an example of mutual empowerment.

Mutual Empowerment-- the underlying philosophy

Underpinning the guidance in the toolkit is the philosophical concept of mutual empowerment. This is a term developed from the now common term empowerment, which has become de rigueur in the UK causing one commentator to state that

"The rhetoric of empowerment drops on ours heads at every turn like confetti" (Humphries 1996 p.1)

Certainly discourse on empowerment dominates in the social work field and the term is now enshrined in much legislation and in particular in health and social care legislation. For example the 1990s saw the introduction of two pieces of key legislation for social work practitioners; the Children Act (1990) and The NHS and Community Care Act (1990). Both pieces of legalisation are relevant to people with learning disabilities with the latter being particularly so as it is used by health and social care practitioners who undertake assessment and care management activities with people with learning disabilities. This legalisation in effect brought about a major change for services in the UK with the intention of shifting the balance of power in favour of service users

"The rationale for this re-organisation is the empowerment of users and carers"

and

"A change in attitude and approach by managers at every level is required that amounts to a new organisational culture" Department of Health (2001)

This is a situation where a person expresses their feelings, or needs, or wants, or rights although their expressions may not always be understood by you or others. The person with a learning disability will be expressing their feelings, wants, needs or rights in the way they behave. You will need to remember not to make a negative judgement about this behaviour. It is possible that some people may express their feelings, needs, want or rights in ways that attract negative labels, e.g. 'challenging behaviour', 'attention seeking behaviour. Having observed the person's behaviour the challenge to you as a partner is to understand the expression and this may take time. There may be a temptation for you to respond to your observation of the behaviour and/or to the negative label. It is important for you to remember that failure to understand could lead to you focusing on modifying the person's behaviour rather than understanding what feelings, needs, wants or rights they are expressing.

In the process of working towards mutual understanding it is crucial that you pay attention to giving and receiving feedback in meaningful and accessible ways. This might be through touch, gesture, signing, pictures, video or other visual means as well as, or instead of, speech.

If you react positively to how a person is expressing their feelings, needs, wants or rights you are both likely to develop new skills. To achieve a successful partnership you will need to find ways of communicating that help develop mutual understanding.

Whether communication and mutual understanding of this expression, situation 4, is achieved is dependent on your actions or skills as a partner. Your actions may have a positive or negative effect on achieving a successful partnership.

Check the arrows opposite; which actions apply to you? Complete the blank arrows overleaf with your specific actions.

The second page of example three from the toolkit is shown below

Look at the coloured arrows overleaf and write specific examples of your actions in the corresponding blank arrows below.

Humphries (1996) in a critique of empowerment suggests that the dominance of empowerment has occurred because of two particular phenomena. Firstly, the push towards equal opportunities policies in the UK and USA in the 1970s and 1980s and secondly, the rise of social movements based on identity politics. Her critique leads her to conclude that

"One thing is certain, the current culture of empowerment embodies containment and collusion, a depoliticising of action for change, and must be viewed with scepticism as a path to transformation (p.14).

Interviews about the toolkit

My colleague and I, as teachers of students who will work in services for people with learning disabilities, were familiar with much of the literature on 'empowerment' and the related arguments (see for example Adams 1990, Beresford and Croft 1993, Jack 1995). The view that empowerment cannot be understood separately from an understanding of power and oppression was something with which we agreed (see Mullender and Ward 1991). However, the further view, that empowerment involves the giving and taking of power we viewed as controversial. This view seems to be related to the belief; expressed by some writers (see for example Baistow 1994), that empowerment is both liberatory and regulative and appeals to the powerful and the powerless. This can mean that there is an assumed consensus about what the term means, when in fact it has a very different meaning for those involved (Braye and Preston-Shoot 1995). Within the field of health and social care in the UK it is the liberatory aspects that appear to be emphasised and student social workers and student nurses often talk about "empowering" people. For example in assignments students will state that "I worked to empower the service user". This seems to be based upon two beliefs. Firstly, that power can and should be given away and secondly, that the concept is inherently liberatory. However, it seems clear that despite the inculcation of empowerment as a theoretical concept in social work education for more than a decade, there is little evidence of change. The power balance between professionals and people with learning disabilities appears to be unchanged and people with learning disabilities are not experiencing liberation by workers or by any other means. It could be that this is evidence of "containment and collusion" embodied in the current culture of empowerment as referred to by Humphries (1996 p.14). Indeed, in evaluating the toolkit evidence has been gathered that supports the belief, expressed in the model, that the actions of workers can and do prevent people with learning disabilities from becoming more powerful, but in a climate where there is an illusion of empowerment. For example, one student interviewee explained that the learning disability agency they were placed with had a written philosophy statement that embraced the principles expressed in the White Paper Valuing People: A New Strategy for Learning Disability for the 21st Century (rights, inclusion, choice and independence) but that the principles were not evident in the agencies practices.

"... at the placement everybody talked about empowerment and whatever but in reality it was far from anything to do with empowerment"

This was supported by a practice teacher interviewee who said that

"the majority of agencies have a perfectly acceptable mission statement... but very little is being done about staff attitudes and values... there is a gap between what they say they do and what they actually do."

It could be that by connecting empowerment and social role valorisation (SRV), as the toolkit attempts to do, the culture of "containment and collusion" could be overcome, at least in the direct partnerships with people with learning disabilities.

The historical development of empowerment described by Dalrymple and Burke (1995) appears significant in that they quote Solomon's work, Black Empowerment, which may well be an example of identity politics but one that in the 1970s linked empowerment and "valued social roles". Solomon defines empowerment as

" a process whereby persons who belong to a stigmatised social category throughout their lives can be assisted to develop increased skills in the exercise of interpersonal influence and the performance of valued social roles" (Solomon 1976 cited in Dalrymple and Burke 1995).

The fact that there was a need to produce the White Paper Valuing People can be cited as evidence of the continued exclusion and disempowerment of people with learning disabilities and the lack of valued social roles. It is this situation that raises the question,

"What is needed to enable partners to analyse their direct interactions with people with learning disabilities and to move towards mutually empowering partnerships that result in people with learning disabilities becoming full citizens with valued social roles?"

The model and the toolkit attempt to address this question and its use enables both parties to become more powerful. Becoming more powerful means that both parties in the partnership gain and have recognised new knowledge, new skills, new abilities and new attitudes. One aim of the toolkit is to urge partners to reflect on and to fully consider how they communicate with people with learning disabilities and to enter their world, rather than as is usual expecting the learning disabled person to enter theirs. It seems from the evaluation that this is one of the strengths of the toolkit. For example the student interviewees all referred to developing heightened awareness of how they communicate with people with learning disabilities and of how they may influence the outcomes in decision making

"I feel that consciously I have got quite a strong commitment towards anti-oppressive practice but unconsciously is my commitment to achieving what I want to achieve more powerful?... it is something I need to keep asking myself now am I doing this for me or am I doing this for that person?"

This interviewee also said that using the toolkit had helped them to consider how they communicate

"I now think it is about me moving into the person with a learning disabilities form of communication...I have learnt to be very patient and wait for the person with a learning disability to respond rather than fill in the gaps"

The same interviewee referred to giving the "right" information to help people become actively and meaningfully involved in decision making.

Teaching students to analyse their direct interactions with service users, which is the stated aim of the toolkit, is supportive of the position expressed by Thompson (2000)

"Power relations are generally reflected in interpersonal interactions and can be reinforced or challenged by such interactions...Power is not just an abstract concept but exists at a very practical, concrete level in our day to day interactions. It is important then, that social workers are aware of, and sensitive to the power issues involved in interpersonal interactions so that they can contribute to empowerment, rather than reinforce a sense of powerlessness". (p.58)

It was our experience that power, and therefore empowerment, were largely viewed by students as abstract concepts and that there was a gap between their college based learning and their practice based learning. The valuation produced some evidence to support this

"you are given all the theories at college but until you are actually sitting down and reflecting you don't truly understand what is going on"

"What I found useful about the model was ...there are some practical suggestions for developing empowerment in practice and I found that quite useful...and also the identification of some of the things that are quite oppressive and actually analysing those and thinking am I doing anything that is oppressive? And what else can I do to actually improve that way I am interacting with people".

The theory practice gap was also reflected in a comment by one of the practice teacher interviewees who stated that

"I think we need to prepare students in some way for the fact that social work values are not as clearly practised as they ought to be".

Conclusion-- the toolkit and SRV

The toolkit aims to bridge the theory practice gap and to make empowerment a meaningful concept expressed by a process of positive change. The model and the toolkit attempts to triangulate empowerment, partnership and advocacy with the aim of developing a successful partnership where both parties become more powerful as they learn together and where neither party takes or gives power as in the scales of justice approach. This triangulation assists in representing power as a relational concept. In this respect a connection between SRV and the toolkit can be claimed in that partners, as they develop; as they enter the world of the person with a learning disability and learn new skills, and develop new attitudes, seek to bring about positive change. Thus Wolfensberger's view of SRV is supported

"SRV relies largely on educational and persuasive strategies that change people's mind content about certain classes of other people by changing their perceptions, expectations and attitudes (2002 p.252)

One interviewee when discussing how using the toolkit had affected their values said

"Yes...it has pinpointed that fact that people do have a right to their own say and they are able, if you give them the right information in the right way".

Interviewees did say that there were other factors that were significant in their development and that alongside the toolkit they placed other teaching resources, for example awareness raising videos, and practice developments, for example person centred planning. What the evaluation highlighted is that developing partners skills, abilities and attitudes happens subtly in response to a range of factors and that it is difficult to say which learning experience is most significant for any individual. All those interviewed did, however, welcome the toolkit as a way of developing partnerships and facilitating mutual empowerment.

References

Adams R. (1990) Self-Help, Social Work and Empowerment, London, Macmillan

Baistow K. (1994) Liberation and Regulation? Some Paradoxes of Empowerment, in Critical Social Policy, Issue 42, Vol. 14, No. 3, pp34-46

Beresford P. and Croft S. (1993) Citizen involvement: A practical guide for change, London, Macmillan

Braye S. and Preston-Shoot M. (1995) Empowering Practice in Social Care, Buckingham, Open University Press

Dalrymple J. and Burke B. (1995) Anti-Oppressive Practice Social care and the Law, Berkshire, Open University Press

Department of Health (1991) Care Management and Assessment: Practitioners Guide, London, HMSO

Department of Health (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century, Cm 5086

Humphries B. (1996) Contradictions in the Culture of Empowerment, in B. Humphries ed. Critical Perspectives on Empowerment, Birmingham, Venture Press

Jack R. (1995) Empowerment in Community Care, London, Chapman Hall

Kniveton, K. and Etchells, J. (2004) Learning for successful partnerships: A toolkit for analysing power in direct interactions with people with learning disabilities, Salford, School of Community, Health Sciences and Social Care, Salford University.

Mullender A. and Ward D. (1993) Empowerment and oppression: an indissoluble paring for contemporary social work, in J. Walmsley, J. Reynolds, P. Shakespeare and R. Woolfe eds. Health, Welfare and Practice: Reflecting Roles and Relationships, London, Sage

Thompson N. (2000) Understanding Social Work, London, Macmillan

Wolfensberger W. (2002) Social Role Valorization and, or Versus, "Empowerment", in Mental Retardation, Vol. 40, No. 3 pp252-258

Submitted by

E-mail: Karen Kniveton, Salford Social Work Research Centre, University of Salford, UK

International Journal of Disability, Community & Rehabilitation
Volume 3, No. 1 SRV Edition
www.ijdcr.ca
ISSN 1703--3381