4.2 Introduction to Self-governance and personal autonomy
How do you teach -train self-determination?
It is important to remember – when you want to learn, stimulate and develop other people’s prerequisites for exercising their self-determination – that in the situation itself and in different situations, prerequisites can vary from anything to virtually none to everything.
It is more important that you as employees are constantly aware of where the next development potential is for the person in question and what the next stage of development is for that person.
THE PEDAGOGICAL TASK
This part provides an insight into how you as an pedagogical staff and/or social worker/care worker can specifically work with user influence and self-determination in the pedagogical work.
What it is important to be aware of when user influence is put on the agenda, and what can be done in practice to create changes in everyday life and space for more user influence and self-determination.
PUTTING USER INFLUENCE AND SELF-DETERMINATION ON THE PEDAGOGICAL AGENDA
Putting user influence on the agenda in social services is a professional and managerial task.
Employees and managers play a very important role in creating a framework that allows for and space for users’ influence.
It is about creating a culture where it is a natural part of the pedagogical work, and a culture where users, employees and managers constantly question everyday truisms; who decides on what and how everyday life is planned and structured.
It is rarely the users themselves who put more user influence and self-determination on the agenda.
The explanations can be many. Users may be authoritative, they may feel dependent on the help and goodwill of others, and therefore will not talk about their own needs.
Users do not necessarily have knowledge about citizens’ and users’ rights, they are used to others making decisions on their behalf – they are not ‘trained’ to use their influence; or users’ lives are so chaotic that the issue of user influence is pushed into the background.
Employees and managers on social services therefore have a great responsibility in relation to ensure and support a focus on user influence and self-determination.
This requires active work to change the culture of users, employees, managers and relatives.
And this means that all actors must break with old habits and attitudes.
This presents both organisational and professional challenges.
CREATE SPACE FOR JOINT DISCUSSION
In order to succeed in increasing user influence and self-determination, it is crucial that:
employees and managers move from a ‘position of care’ to being inspiring and supporting users’ own resources.
This can mean that the employees’ professional foothold and identity as caregivers are challenged and changed.
And it can be experienced unsafe and unsafe for both users and relatives.
To put user influence and self-determination on the agenda is in this sense a development process in the organization.
Both managers, employees and users need to actively participate in the process in order to succeed.
CREATE SPACE FOR JOINT DISCUSSION
It is crucial that everyone involved has the opportunity to talk about what user influence and self-determination is and how it can be related to it; specific social offers:
- What are the attitudes towards user influence and self-determination?
- How can user influence be increased?
- Do we even agree that this is a good idea?
- What can we do to maintain a focus on user influence and self-determination?
- How can we imagine changing current practice?
These are just some of the issues on which there should be joint discussion.
In the first instance, it is the responsibility of management and employees to create this space for reflection and exchange of views, but work must be done towards the users in such as far as possible takes an active part in the process.
For example, by deciding how and when the discussions best take place – by planning meetings and deciding themes themselves, and by being moderators and facilitators themselves.
IMPORTANT FACTORS TO CONSIDER
There are several formal and informal frameworks and conditions that play a role in the users’ opportunities to have an impact on their own lives and the offer they receive, as well as for employees and managers’ prerequisites for working to increase user influence.
Some of these frameworks relate to practicalities, legislation or local guidelines for social services, while others are about habits and routines of both users, employees, relatives and managers.
Some are subject to change, others are immutable terms. It is always important to be aware of these frameworks and conditions that have or may have an impact on the work with user influence in practice.
For example, it may be relevant to question and relate to:
Power:
Who ‘has the power’ on the social offer? Who sets the agenda and who makes decisions on the ground most often?
Actors:
Who plays a role in working with user influence?
Users, relatives, employees, others? What opinions and attitudes have, for example, the relatives, and what role do they play in increasing user influence and self-determination?
Cultural norms and standards:
What is the culture of the social offer?
What truisms and ‘how-we-usually-do-practices’ are there that have impact on user influence and self-determination on the ground?
Regulatory framework:
Which legislation is relevant to consider in relation to user influence on the social offer?
Local municipal practice:
Are there any specific local guidelines that need to be addressed or changed? – e.g. that users are not allowed to enter the kitchen due to hygiene considerations or the like.
Resources:
What resources are there that can help support a Process? Time, employees, finances, political objectives, etc.
Competences:
Does the work on user influence require attention to the development of competences?
Do employees have the necessary knowledge and professional skills?
Do users have the skills to make better use of their right to influence?
Physical environment:
Does the physical framework support the work with user influence, or do they create barriers?
Motivation:
Who has decided that user influence should be worked on? What motivation factors or resistance can there be among those involved?
Methods
What methods are available? Where can inspiration be found? Can the site itself initiate the change process, or is outside support needed?
The mentioned factors are examples of topics and areas that you as an organisation, employee group and individual must relate to.
There may be much else at play, and the mentioned factors will not always be equally relevant in all social offers.
The point is that the work with user influence is influenced by and concerns many different aspects of the social offer.
TASK FOR REFLECTION
CONSIDER WITH YOURSELF
What other factors may influence the work of increasing user influence and self-determination?
As an pedagogical staff/social worker, what factors can you immediately influence yourself? And how?
ACTORS AND PERSPECTIVES
Many different people can be involved in ensuring a focus on user influence, involvement and self-determination: users, employees, management, relatives and others.
When user influence is put on the agenda, it is essential to have an eye for all actors.
Both what they can and must contribute to the process, and what can cause resistance from the individual actors.
It is crucial to succeed in motivating all parties involved to support increasing user influence.
This requires that there is an ongoing discussion and exchange of views on the subject, where all perspectives are presented and taken seriously.
The perspectives are many.
Below are a number of examples of what can create challenges and resistance among the various people involved, and which it is therefore important to discuss together:
Users
Do not know his own possibilities for self-determination, influence and involvement.
Are used to many things being done for them – and they really like that.
Feel insecure about the responsibilities that come with increased influence and self-determination.
Employees
Perceive it as a criticism of their professionalism: ” Aren’t we doing well enough?!”
Are concerned that the increased influence could harm users because they are unable to make sensible choices and see the consequences of these.
Are afraid of having to answer for users’ own decisions if problems arise.
Don’t want to let go of control – their work becomes more unpredictable and harder to plan.
Management and organisation
Imagines that working with user influence requires more resources and can lead to more costs.
Are nervous about scandals if users are given more responsibility.
Relatives
Are afraid that their relatives (users) are unable to understand consequences and make ‘the right’ choices.
Are afraid that their relatives may go wrong or regret choices they have made.
Sees the increased user influence as abdication of responsibility on the part of employees.
It is important to talk to everyone involved about ideas and expectations for the work to increase user influence.
CULTURE AND HABITS
The culture of employees and residents at a social service plays a major role in the users’ ability to influence and self-determination.
This is often expressed in the form of a number of habits, routines and unwritten rules, which are experienced as ‘a natural part of everyday life’, and which are therefore not questioned.
In many countries, the concept of institution is increasingly being abolished as part of the ongoing process from stay in a total institution towards private life in their own housing and inclusion in society for citizens in need of social inclusion.
By abolishing the concept of institution, the aim was to separate housing and social support, so that help would no longer be given as a ‘package deal’ with housing and social support in one offer.
Social support, on the other hand, should be given where the citizen already lives, just as: – it applies to all other citizens.
Thus, the citizen did not have to change housing in order to receive the necessary social assistance, unless it could not be given at all in the previous housing.
The incentive for this change was a political desire to strengthen the residents’ position in relation to employees and management and thus clarify that the right to self-determination and privacy in their own homes applies to all citizens, regardless of the type of housing they have.
CULTURE AND HABITS
CASE: 5
IDA AND HER SISTER
Ida is 45 years old and lives in a residential facility for people with learning disabilities.
It means a lot to Ida that her hair fits nicely. She wants to get a haircut regularly and sometimes also curled.
At one point, Ida’s sister approaches Ida’s contact person and expresses that she thinks Ida is at the hairdresser too often.
It is too expensive in her opinion.
Therefore, she would like the employee to contact her before they arrange a visit to the hairdresser next time.
Ida likes to go to church.
She is often picked up on Sundays by her sister, who takes Ida to church.Occasionally, the sister of the employees comments that Ida has not been in ‘the right place’ clothing.
The sister has marked Ida’s clothes with discreet dots in different colours.
The one with the blue dot is for doctor and visits out of the house, the one with the red dot is church and party clothes, and the one with green dots is everyday clothes.
TASK FOR REFLECTION
READ CASE 5 AND REFLECT:
What is at stake in terms of user influence and self-determination in the situation?
What can you do as employees? What would you as an employee do
CULTURE AND HABITS
However, vestiges from the institutional culture can sometimes mean that neither the residents themselves, their relatives nor the employees expect a particularly high degree of self-determination and user influence, but let the residents’ everyday lives be shaped by the habits and routines that consciously or unconsciously characterises the existing pedagogical work.
A fixed culture can thus lead to a reduction in the residents’ possibility of self-determination and influence.
It is therefore important to question the habits and routines that set the framework for the residents’ lives.
Who decides, for example,
- when to get up in the morning;
- whether you can have guests stay overnight;
- how the dwelling is decorated; whether one can go out with a heavy garbage bag, even if it is slippery outside;
- whether you wash your own clothes;
- what to eat for the evening?
Working with self-determination and user influence will often involve changing the culture of the offer, both among employees, users and relatives.
It requires that everyone dares to ask questions about both their own and others’ habits and routines that shape everyday life.
Below are a number of examples where it becomes clear how the culture of social services, among other things, has an impact on user influence:
■ Mads is 32 years old and lives in a residential facility for people with extensive help needs. He is physically disabled and it is very limited what he can handle on his own in everyday life. His disability also makes it difficult for him to speak clearly.
The employees are busy – they have to help the residents with many things, and in this connection they go in and out of the residents’ apartments without knocking.
Mads has never experienced anything else, except when he was a child and lived at home, and does not question it. Mads’ father and mother think that ‘it’s part of living in such an institution’ and don’t say anything about it either, even though it wouldn’t happen at home.
■ Beate has recently moved into a nursing home and one day asks a nursing home employee if it’s possible that a friend from a city far away can stay with her this coming weekend.
The employee immediately answers:
“We don’t usually have overnight guests here.”
She kindly adds:
“But there is a nice guest house just around the corner where you can stay overnight for a cheap price.”
■ Nine people live in a cohousing community, all of whom have serious mental disorders.
The employees have a small one-room apartment. Here’s there is a workstation with a computer, folders with sensitive information, a spiral calendar of appointments (which are always posted and displayed) and a large blackboard.
On the board, all the residents’ names are vertical and the days of the week horizontally.
The fields are filled with information about, for example, taking antibiotics, doctor visits regarding cystitis, appointments with legal aid and help to apply creams.
Occasionally, employees hold meetings in the apartment with the residents individually.
After a meeting, several residents commented on what is written about other residents on the board and in the calendar.
■ A booklet on a nursing home states that all residents are weighed when they move in, and then the weight of the residents is continuously monitored.
A relative who is at an enrolment interview with his father asks; “Why is that?” “Then we have control over whether something needs to be regulated in relation to the composition of the diet,” the manager replies.
■ Sarah is slightly mentally retarded and has just moved into a residential facility. Sarah’s sister Sigrid visits her often, just as she did before Sarah moved into the residential facility.
The two sisters sit comfortably on the same sofa that they have so often sat on before.
They drink coffee and talk about anything and everything. Sigrid has taken off her shoes and is sitting back with her feet on the edge of the coffee table – as usual.
An employee of the housing facility comes by to ask Sarah something.
Sigrid immediately takes her feet off the coffee table.
TASK FOR REFLECTION
DISCUSS WITH YOURSELF
What are your thoughts on the five examples above in relation to how culture affects the right to self-determination?
ASK USERS
Pedagogical staff are responsible for facilitating, supporting and creating user influence – they must support people in need of help and support to get a good life based on their own values and desires.
It is important not to question whether there should be user influence, but what changes are required and how these changes can be made;
Employees can never know in advance what users want to influence, or how much influence they would like to have.
Often it turns out to be completely different areas that users want influence on than employees and management imagine.
Therefore, it is necessary to ask about the wishes of the users before you can together start working on increasing user influence.
It can be done on different Ways.
This is followed by three examples:
USERS SET THE AGENDA AT WORKSHOPS
Example 1
An employment offer for people with learning disabilities, held three joint user workshops to involve users and get their views and assessments of what they want more influence on.
The users were divided into smaller groups, each with its own moderator/facilitator, and then the groups worked with specific questions such as:
- What should employees keep doing?
- What should employees stop doing because we can do it ourselves?
Through the workshops, it became clear, among other things, that users wanted “weekly group meetings, where we are part of the planning of the work on the employment offer.”
The users’ many inputs and ideas were sorted and structured into folders with each its title such as
“We want to have more influence on our work tasks.
” After this, the content was divided into subthemes, which were written down on a piece of paper,
e.g
“We need individual help to solve our work tasks.”
The employment offer then worked with one user influence folder at a time.
The folders with the users’ statements and wishes made it easy to maintain focus on the users’ perspectives and wishes over a longer period of time.
It could be worked systematically with one folder and one theme at a time.
MEASURING THE EXPERIENCE OF USER INFLUENCE
Example 2
A shelter for the homeless used the measuring tool Bindeks13 to uncover users’ wishes for user influence.
Bindeks is an electronic questionnaire that measures the experience and wishes for user influence of users, employees and managers, respectively.
B index shows the difference between how much influence there is in selected areas (e.g. influence on the pedagogical support provided or the rules on the ground), and how much influence the three parties want users to have on the different Areas.
The measurement highlights which areas users want more influence on, and thus where it is interesting to work on developing user influence.
The measurement also highlights when there are different perceptions of the degree of user influence of employees and users, and may give rise to discussion of different perceptions of what user influence is and when there is enough user influence.
At the shelter, the results from Bindeks were presented at a residents’ meeting, where users determined what they would like to work on in relation to increasing user influence at the shelter.
https://www.brugerindflydelse.dk/maal-effekten/bindeks-brugerindflydelsesindeks/
it is a Danish developed tool – you will be able to visit and read about the tool at this link. The webpage can be translated to English.
THE MONOPOLY MONEY METHOD MAKES IT EASIER TO CHOOSE
Example 3
At the housing facility for people with learning disabilities, the users chose at a joint meeting that they would work to have more influence on the interior design of the common areas.
They decided to start with their common living room and kitchen.
From the start, the residents received a pile of matador money in a box, which represented the amount available for the furnishing of the housing facility.
The matador money made visible how much the different things cost and what the balance would be if they chose to buy one sofa over the other.
The matador money made it easier for the residents to prioritise between different fixtures as they would like.
It became easier for the residents to discuss and make choices in relation to the interior design.
Subsequently, the residents went out and bought the things they had decided they should have.
One resident says that when they had to buy a stove and had found out how much money was available, he was able to call a kitchen equipment dealer himself to examine what type of stove it was possible to get.
In the past, it would have been one of the employees or managers who had the financial overview and therefore the competence to make the decisions and buy furniture and other fixtures.
USER INFLUENCE IN PRACTICE
There is no recipe how actually work to increase user influence.
As an Pedagogical/social worker, you need to use your professionalism and creativity to work with the users to figure out how to create the necessary changes in the best possible way.
It is important that what is set in motion makes sense in the specific context – to ensure this, you need to be inventive and attentive.
It is a good idea to steal methods, ideas and examples from other people’s work on user influence and adapt these to local conditions.
Below are a number of examples of what some social services have done to increase user influence.
For inspiration.
THE RESIDENTS CHOOSE THEIR OWN PARTNER
Social psychiatry in the Danish municipality of Høje Taastrup has for several years worked with the concept of resonance as the starting point for their work with users.
Among other things, the work has meant that users today do not have contact persons but partners among the employees.
The users decide who their partner should be, and they can have more than one partner because they may need the employees’ different skills at different times.
For example, one of the users said to his former contact:
“You know, Nina, I like you, but now I want to work with Signe, because she can do what I need right now.”
By being able to choose their own partner, the residents’ influence on their own lives increased, and their coping skills strengthened.
They experienced that their choice was recognized by the employees.
Both employees and users came to understand that it is perfectly acceptable for users to have a better relationship with some employees rather than others, and that this may also depend on what they need help with.
SAFETY PLANS INVOLVE USERS IN PREVENTING VIOLENCE AND THREATS
Orion is a specialised residential and rehabilitation facility for adults with particularly complex psychosocial difficulties.
Orion works with user influence in many different ways, including residents’ meetings, where residents can come up with their views.
Some of the users also educate employees, including by telling their life stories and telling how they have mastered past challenges in their lives.
The residents of Orion have a mental disorder, and many also have an addiction.
Conflicts are an inevitable part of everyday life, but in everyone’s interest it is important to prevent conflicts from escalating and perhaps ending in violence.
They do this, among other things, through close collaboration with the residents to prepare individual safety plans.
The purpose of the security plan is, as the name says, to create security among residents, day users and employees.
The plan will support cooperation to prevent and reduce the risk of residents and employees being injured.
And ensure that the handling of conflicts and violence is done as gently as possible and with maximum consideration for residents.
The plan, which is filled out jointly by the employee and the resident, is based on questions about the resident’s experiences with situations that can lead to violent reactions.
The plan also notes the resident’s experience of how such situation best preventable or manageable.
Finally, note the resident’s good advice to the employees on how best to help defuse a conflict as well as the resident’s special wishes in connection with handling conflicts, forced hospitalisation or other violent situations.
The safety plan is part of the resident’s individual plan. It is about collaborating on wishes, goals and dreams, and gives users influence on their own lives – also when it comes to handling conflict-filled situations.
RESIDENTS AND RELATIVES HIRE STAFF
The senior centre constantly focuses on involvement and equality in the residential homes, which are divided into four living units.
In everyday life, the employees attach importance to supporting the resources, wishes and needs of the elderly residents, and that they can continue to live their lives as much as possible before it moved to The Apple Garden.
This is supported by the fact that a large group of volunteers are responsible for various weekly activities at The Apple Garden – including walks, bingo, bowling and singing together.
The fact that it is largely the residents who set the agenda at the Apple Garden is emphasised in addition, that they and their relatives are helping to hire both new employees and senior centre managers.
As Grethe, who lives at The Apple Garden, puts it;
“I’m the one who has to be dragged along with them in everyday life, and then I also want to help decide who they are.”
At Æblehaven, the focus is on the good relationship between employees and residents, and therefore ‘good chemistry’ is important – skills can be learned, chemistry cannot.
TO HELP THE CITIZEN TO MAKE USE OF THE RIGHT TO INFLUENCE AND INVOLVEMENT
As an employee in a social offer, you must help the user to be heard, involved and have an influence – also outside the offer.
Either by attending meetings as an assessor or by talking to the citizen about his or her rights in relation to, for example, case management, decisions or the action plan that is prepared. In order to do this, it is important to know the user’s rights. Here is a simple review of some of the most important ones.
RIGHT TO A SUPPORTIVE PERSON
Although public authorities in most countries have a special duty of guidance in the social field, having someone to help you can be an advantage and perhaps sometimes a prerequisite for real involvement. at meetings with the authorities.
Therefore, all citizens have or should have the right to bring a supportive person to meetings with public authorities.
A supportive person is a person of your choice.
It can be a relative or someone else you trust, e.g. an pedagogical staff / social worker
The task of the supportive person is to support the citizen during the meeting and be an ‘extra ear set’.
The supportive person can help the citizen to ask the authority about planned questions, and to remember what is said and agreed at meetings, etc.
The citizen decides how much the supportive person should ‘fill’ during a meeting with the authorities.
TASK FOR REFLECTION
DISCUSS WITH YOURSELF
What other circumstances could speak in favour of a citizen bringing you as a co-sitter to crucial meetings?
OTHER IMPORTANT RIGHTS
When public authorities in most countries deal with cases, the citizen has rights during the proceedings that support his or her involvement.
These rights could be, for example:
■ Right to advice and guidance15;
You have the right to receive advice and guidance from the social services to solve the social problems you have.
The advice can be given anonymously.
■ Consent requirements;
The authorities cannot normally obtain information about the citizen from other professionals or private individuals without the citizen having given the authority permission to do so through consent.
■ Right of access to documents
The right to see what the authorities have written in the citizen’s own case. The authorities have a duty to take notes, i.e. all-important information must be written down.
You don’t have to give a reason to want to see what’s in your case.
■ Right to be heard
Before rejecting an application, the authorities must inform the citizen of essential information that the citizen is not aware of or knows the significance of.
The authority may not take the decision until the citizen has had a chance to comment on this information.
OTHER IMPORTANT RIGHTS
■ Right to reasons and instructions for complaints
If an authority rejects an application orally, the citizen has the right to obtain a written decision stating the reasons for the decision.
You don’t have to be a lawyer or social worker to decide whether a reasoning is good enough.
It should be the case that if one can ask the question ‘why’ to the decision that has been made, then it is not sufficient to justify it according to the following answer – with “that it has been done according to the rules of the Administrative Procedure Act”.
You have to be able to see why the outcome of the decision turned out the way it was.
It must also be possible to see what considerations the authority has taken into account in the decision.
In the case of assistance to persons with disabilities, the authority may be asked how the CRPD has been included in the authority’s considerations.
■ Right to action plan
The action plan must reflect the citizen’s current need for help and the efforts needed to meet this need.
If there is a discrepancy between the need and the effort, the employees can contact the authority to reassess the action plan.