Service Users as Collaborators in Social Work Practice, Research, and Education
Relational social work research centre, Department of Sociology
Catholic University of Milan, Italy
Relational social work research centre, Department of Sociology
Catholic University of Milan, Italy
Abstract. The idea that social work needs to be concerned with thinking and acting in a more collaborative way with the people in need is common around the world. At the international level, codes of ethics and social work principles inspire practitioners, researchers, and educators in bridging the gap between themselves and people in trouble, commonly known as service users. Beyond a common agreement around such principle, to realize collaborative relationships in practice is a challenge that requires prudence, coherence, and methodology. The Relational social work method supports the practical development of participation, collaboration, and reciprocity. Through concepts and examples, this article aims to describe how service users can assume the role of collaborators in social practice, research, and education.
Keywords: Relational social work method; service users participation; Experts by experience; life expertise.
Received: 4/6/2019. Accepted: 25/08/2018
Copyright © 2019 Elena Cabiati, Chiara Panciroli. Published by Vilnius University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Nowadays, thinking about the future of social work, practitioners, social work educators, and researchers must reflect on the quality of the relationships that they have established with the people, families, groups, and communities in trouble.
First of all, this paper reflects on the concept of service users. Traditionally, service users are depicted as people in need, who require aid from professionals and the welfare system in general. It is common sense that social workers (at the case – those at the group and community levels) meet vulnerable people who need (consciously or not) their help and interventions to change their own attitudes or lifestyles for the better. After the encounter with people in trouble, social workers, in collaboration with other professionals, work to diagnose the issues and to find solutions. Professionals have the responsibilities and competences to do it – they know how to tackle such issues as alcohol addiction, violence, abuse and neglect, or poverty.
For this purpose, it is important that service users collaborate with social workers in order to receive advice and treatment.
This is the idea of social work that we could define as “professionals-led social work.” It is a popular concept of social work. From an ethical and methodological perspective, however, it is problematic in that it does not support people’ agency and neglects the right to self-determination, putting the social worker in a state of solitude as a “solver.” Are social workers change agents or agents of others’ changes? It is difficult to work carrying the responsibility for the change of others on one’s shoulders.
In this paper, another concept of social work, a Relational Concept, will be explored. Relational Social Work suggests engaging service users not as recipients of help but as co-producers of helping interventions (Donati 1998; 2010). Each person involved in a helping process can leave the traditional role of a user or a client (the typical role of those who are assisted or manipulated) to assume that of helper (Folgheraiter 2004; 2017). It is a strong and unconventional idea that requires prudence and methodological consciousness.
The focus of Relational Social Work is not on professionals or service users. It is not a professionals-led social work and not even a service users-led social work. Carl Rogers (1980) and Tom Kitwood (1998) said that “the person comes first”1; this means that the person counts more than their issue.
Relational social work expands this idea by saying that relationships are the most important aspect of the social work process. Human relationships here are considered as the basis for change; thus, it is a relationships-led social work. The focus is on the relationship between service users, professionals, and all people that express care toward a family or a situation; it is a matter of formal and informal roles, but above all, it is a matter of care.
The relationship between those who help and those who need help must be dynamic. The same can be said for those who teach and learn, for those who do research, and those who are the “subjects of the researches.” In the following paragraph, these concepts will be explored in the reality of social work practice, research, and education.
Service Users as Collaborators in Social Work Practice
People in trouble not only have a say in the helping processes (such is the minimum) but may also become collaborators. To imagine service users as collaborators of the social workers, it is important to point out two main ideas:
1. People may change but they cannot ever be changed (Prochaska et al. 1992). A social worker is not allowed to manipulate people so that their lives comply with what the social worker wishes (Seikkula & Arnkil 2003). Social problems may often have solutions, but they can never be solved by someone. No professional can unilaterally eliminate problems in other people’s lives just because they know what needs to be done.
2. Human help emerges from relations and not from technical treatments (Folgheraiter 2004; 2017). Technical treatments can be important in the helping process but they are not the source of wellbeing or change. If a situation goes for the better, it is because people in these networks help themselves and others toward the better (ibid.).
In the helping processes, the relationship between users and professionals must be a relationship of reciprocity (Folgheraiter 2004; 2017). It is clear that social workers and service users have different roles as well as different competences, skills, and life experiences. However, during the helping process, they must consider that they need help from each other. In a painful situation, professionals could express the objective meaning of the problem. This meaning may derive from their knowledge of procedures and regulations or from their previous experiences as social workers. The people involved, on the other hand, could express the subjective meaning of the problem: feelings, views, and knowledge of those who are directly affected by the problem. Often, social workers do not give enough attention to the meanings that people attribute to their desired change and fail to put themselves in another’s shoes (Sevenhuijsen 2014).
These two parts alone might not be sufficient to solve a particular issue. Professionals, thanks only to their knowledge, cannot solve problems as they do not know how those problems are experienced and perceived by people involved; moreover, they do not know the desires and aspirations of these people. On the other hand, those affected by a problem, if they cannot solve the problem only thanks to the activation of their own network of relationships, often need professional support to help not only with their knowledge of the system but also thanks to the counseling skills. Counseling skills support people in trouble in making decisions for their life.
The success of a helping process depends on a mixture of professional expertise and experiential expertise.
While respecting different roles and functions, we say that social workers and families can help each other. If a social worker guides the methodological process, people directly involved can fill its contents because only they know the true meaning of their condition of life. The technical knowledge of professionals without the experiential knowledge of those directly involved produces interventions that are not centered on the relationship. In these cases, the interventions are very often impossible, perhaps built with efforts and resources but not adaptive to the life of families, and cause frustration for professionals. It is important that practitioners make all the efforts to avoid planning helping interventions without those who will have to realize the results of that planning in practice, in their lives.
Another point concerns the importance of asking for help. Social workers must be able to ask for help, not only to give help. Generally speaking, social workers are more comfortable imagining themselves as people who give help and not somebody who may receive it. Even social workers need care and help to withstand the professional load. They are at ease in giving help (it is part of their personal motivation), but they are less at ease in asking for it.
For example, thinking about a painful situation of a family with children involved, some social workers’ interventions can be either led by thinking, “what help must I provide to these parents or these children,” or otherwise – based on the following questions: “How we can cooperate to cope with this situation? What are my collaborators? From whom I could receive help?” Social workers are not help dispensers.
Service users can be collaborators in decision-making, assessing interventions, planning a foster care project, supporting the reunification of a family, and planning care assistance. All these professional tasks can have an impact on their personal life.
Service Users as Co-Researchers
The participation of service users and carers is not only limited to the helping project that directly involves them but can also extend to a higher level: in the planning of services, defining social policies, and even in the production of knowledge in scientific and academic fields. Service users and carers, in fact, can aid researchers in conducting research projects.
Participatory research2 is an unconventional research approach that allows people who are experiencing, or have experienced, in their lives the topic under investigation to collaborate with the professionals as co-researchers.
The research is therefore carried out with the people who are the target of the research and not on them. Citizens, service users, and caregivers take on the role of co-researchers and interact with the researchers every step of the way. Participatory research is based on the concept of skill integration: researchers deploy their own technical and professional knowledge, while service users and carers are involved to the extent of their experiential knowledge – that is, their “subjective” knowledge, which they have acquired as a consequence and product of their life experiences. The service users are therefore considered “experts by experience.”
The literature describes different degrees of participation, from the simple “advice” level assigned to the participants to user-led research, where service users themselves promote the research and lead it from start to finish (Aldridge 2014). Participatory research is particularly appropriate for investigating the areas of vulnerability and marginalization that prescribe the direct involvement of those who experience the problem being investigated firsthand. Participatory research also provides access to groups that are “hard to reach” (such as homeless people or abused women), being emphatically far from the researcher, by using appropriate search tools to address counterparts’ constraints.
For years, similar efforts have been made in experimenting and studying this across different parts of the world (Beresford 2010; Faulkner 2004; Fleming 2010; Healy 2001). The fields in which this approach is utilized are several: child protection, disability, adoption, caregiving; a lot of participatory research has been conducted with the elderly or children, for example – to study the phenomenon of undeclared work (Bertozzi 2010) or the great emergency of young caregivers.
These fields, as well as the involvement of vulnerable people, require the researcher to pay particular attention to the implementation of the participatory process: there are a lot of ethical implications in participatory research, and that requires the researcher to have a higher level of sensitivity and availability besides counseling and group facilitation skills. For these reasons, this research approach is particularly suited to the field of social work. In this branch of knowledge, in fact, the researchers are also often social workers, and thanks to this they already have the necessary training to facilitate this type of research process.
Participatory research offers several benefits over a conventional approach. To name a few, we will take as examples some insights that have been reached from a participatory research project conducted with some families who were living in a marginalized neighborhood of Reggio Emilia, a city in Northern Italy (Panciroli & Corradini 2019). In this research, families in poverty have been co-researchers alongside academic researchers. The involvement of people who experienced poverty led to some benefits:
• their involvement as co-researchers made it possible to reach families otherwise difficult to contact: they were not known to the local services, as many of them do not ask for help out of shame or distrust;
• The redefinition of the research purpose with the co-researchers made it possible to investigate issues that would otherwise not be considered by researchers as priorities;
• The participatory nature of the tool made it possible to insert questions using a simple language that was understood by the families, thus avoiding technical or devaluing language;
• the data collection conducted by co-researchers who had lived life experiences close to those of the sample families made the latter share more and overcome the sense of shame they could have felt if interviewed by professionals;
• it was possible to collect useful data for a deeper understanding of the poverty phenomenon; the researchers received new insights and knowledge.
Last but not least – it was a way to promote human rights and anti-oppressive social work.
Participatory research, in its different fields of application, addresses empowerment as both a goal and a natural consequence of the process of involving the concerned persons (Warren 2007). By giving part of the power, usually in the hands of the researcher, to the subjects involved in the investigation, the perspective of the research is reversed or expanded.
During the participatory research process, the researchers experimented with the concept of empowerment, which led to the realization of what Folgheraiter (2004; 2017) calls “relational empowerment,” referring to the coping process that is activated in a helping relationship within the social work field. This is defined as mutual empowerment.
During the research process, a reciprocal dynamic has been generated between co-researchers and researchers. What many authors (Kidd & Kral 2005) underline is that from this union, new knowledge emerges.
For these reasons, the field of social work could gain many advantages not only in terms of studying and research but to foster processes of change and the dynamics of relational empowerment.
Service Users as Co-Educators
In educating students to become social workers, it is necessary to seek help from service users, as happens in social work practice and research. In the actual context of the delicate process of teaching, it is no longer sufficient to transfer knowledge and competences. Furthermore, we know that in social work education, the educators’ responsibility is not for something but toward someone. It is a kaleidoscopic responsibility that involves human, ethical, societal, scientific, and social justice issues (Cabiati 2016). An inspiring example is a book by two authors titled The Courage to Teach Social Work (East & Chambers 2007), which is titled thus to not only highlight the sense of responsibility but also express the idea that the personalities, integrity, and values of educators are involved in the education process.
In the mission to educate a social worker, service users and carers could be co-educators, alongside professors and practice teachers.
The rationale behind such an involvement could be summarized by the following statement: “If you learn to drive a car, you are taught by someone who can drive; if you need to speak French, you are taught by someone who speaks French, but at the moment if you need to know about disabled people’s lives, you are taught by someone who wrote a book about it” (a service user, quoted in Branfield 2007, 9).
The rationale behind this involvement derives from the acceptance that knowledge derives from a variety of different standpoints (Beresford & Boxall 2012). In the international context of education, service users and carers are considered Experts by experience and collaborate with social work courses in a different manner: as testimonies, educators, co-teachers, recruiters of students, or assessors (Cooper & Spencer-Dawe 2006; Boylan, Dalrymple, & Ing 2000).
The involvement of Experts by experience give several benefits to the education of social work students:
• it allows students to lessen the gap between “us-the students” and “them-the service users” and to facilitate the creation of positive aid relationships;
• it increases the connection between theory and practice (Cooper & Spencer-Dawe 2006; Irvine, Molyneux, & Gillman 2015);
• it is part of a collective and collaborative pedagogy (Morin & Lambert 2017) and allows the preparation of social workers to work in coherence with the basic values and principles of social work;
• from it, students may be more able to develop an anti-oppressive approach (Natland 2015; Morin & Lambert 2017) by decreasing the imbalance of power between professionals and non-professionals (Boylan, Dalrymple, & Ing 2000);
• it promotes the development of positive attitudes toward clients (Corrigan & Penn 2015; Cabiati & Raineri 2016), helping students to emphasize strengths rather than deficits (Corrigan & Penn 2015), both by overcoming approaches exclusively focused on the problematics (Morin & Lambert 2017) and by reducing their negative attitudes (Cabiati & Raineri 2016).
Benefits for Experts by Experience
Regarding the benefits of having experts by experience on their teams, previous studies suggested that to be co-educators is for service users:
• the opportunity to make something good for themselves;
• to experience a non-hierarchical relationship;
• to have the possibility to tell their personal story and receive attention and appreciation;
• to increase their self-esteem: for them, it is a real dialogue in which to make their voice heard (Austin & Johannessen 2015; Green & Wilks 2009), a space for a reciprocal exchange of life experiences, and an occasion to critically revisit their personal story (Green & Wilks 2009).
Inspired by the international experiences and by the relational social work method (Folgheraiter 2004; 2017), in our university, EBEs have been actively involved in the bachelor’s and master’s degree programs for ten years.
Showing in practice the idea that social workers must regard them as partners on the mission to educate students to become social workers, EBEs have been participating in workshops, academic lessons, practice placements, and full day meetings with first-year students.
An Example of Experts by Experience Involvement: Full Day Meetings
In some countries (like the UK), the involvement of EBEs is becoming a mandatory requirement on all qualifying social work programs. At the Catholic University of Milan (Italy), the involvement of EBEs in social work education has been driven by the personal initiative of the academia. Involvement is not regulated by official directives and there is no support for collaborative learning programs provided by the Italian government.
Hence, collaborative learning experiences in the Italian social work education context are rare. However, at the Catholic University of Milan, inspired by international developments and the relational social work method (Folgheraiter 2004; 2017), EBEs have been key participants in undergraduate and postgraduate degree programs for ten years.
At the beginning of the education program, we organize full day meetings for first year students (studying in bachelor’s degree programs) and experts by experience.
The program of the training day is divided in two parts. In the morning, each student is randomly matched with an EBE with whom they share an individual, two-hour conversation. It is made clear to all participants that this conversation is not a professional or a research interview, but a simple conversation aimed at getting to know one another and exchanging life experiences. After lunch, which is shared in the university canteen by all participants, two-hour group meetings occur that mix students and service users and are led by academic tutors. In these meetings, all participants are called to express their thoughts and feelings about the experience. Finally, all participants end the meeting together with expressing gratitude to one another.
During the ten years of experience, the number of EBEs involved has significantly increased. In the first years, we counted 20 experts to have collaborated with us; in the last three years, the number of experts involved increased to around 100 persons each year. We began with EBEs from self and mutual aid groups on alcohol problems, and we later gained the opportunity to collaborate with EBE from groups on 8 different problematics. The students meet EBEs who had experiences with the following issues: mental health, drug addiction, alcohol addiction, eating disorders, disability, difficult partner divorce, parents of children in child protection, gambling addiction.
Recruiting Experts by Experience
Internationally, the recruitment of experts by experience for social work education programs could occur in several ways.
At the Catholic University of Milan, experts by experience are recruited through self-help and mutual-aid groups organizations, the so-called “umbrella organizations” that gather a number of self-help and mutual-aid groups for the same type of problem, or many groups with different targets. Experts by experience must have been members of a self-help and mutual-aid group for at least a year.
Why do we invite EBEs from these groups?
Self-help and mutual-aid groups imply an ongoing reflection on personal experiences, starting from the points of view of others, in a peer-to-peer logic. In this way, individuals can develop narrations and points of view enhanced by other members’ perspectives. This recruitment choice helps in avoiding or limiting the risk to present anecdotal, unrepresentative, or overly personal stories (Baldwin & Sadd 2006).
Our researches suggest that alongside the common benefits, full day meetings with experts by experience have a strong impact on our students; they show enthusiasm about EBE involvement, but for them the activity is not without challenges and happens to be emotionally demanding. This activity works on the students’ stigma toward life problematics, helping them revisit negative attitudes and supporting them in reaching a balance between negative and positive positions (“do-gooding positions,” too), combining enthusiasm and realism, feelings and rationality.
According to the international social work education arena, in these years, Experts by experience have shown generosity in supporting not only the learning of students but also the teaching of educators.
Thinking of the future of social work, it could be said that the idea of service users as collaborators, co-researchers, and co-educators sounds fascinating; however, it requires coherence, prudence, and a methodical approach so that the idea of such collaboration remains not a mere slogan.
The values of social work, such as self-determination, non-discrimination, and empowerment, imply the direct involvement of people who experience problems. However, recognizing the value of participation does not automatically mean knowing how to do it in practice in various fields: helping a project, planning social services, solving community problems, developing social policies, education, and research. The complexity required of the professionals is high: the participation of service users and carers requires of them the ability to question themselves, to open up to others, and to maintain the responsibilities of their role at the same time. Adopting a participatory work approach requires the ability to adapt to the perspectives of others and to know the risks of tokenistic participation, which can lead to manipulation and a greater frustration in people (Hart 1992; Nind 2011; Aldridge 2015).
The Relational Social Work method can give academics, social workers, and researchers some practical indications on how to involve people in a correct and ethical way. However, what is first of all useful is the sharing of good practices among those who, in different parts of the world, are experimenting with different and creative forms of effective and respectful involvement.
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1 Both authors developed the concept. “The person comes first” is the title of a book written by Tom Kitwood too about social work with people with dementia.
2 Researchers of Relational Social Work research group of the Catholic University of Milan are experimenting with participatory research methods in different fields (poverty and social exclusion, elderly people suffering from dementia, child protection, adoption and foster care).