Exploring young people's participation in interprofessional education, taking a children's rights approach

© 2008 The AuthorsJournal compilation © 2008 Blackwell Publishing Ltd.

Learning in Health and Social Care

,

7

, 4, 219–226

Original article

Blackwell Publishing Ltd

Exploring young people’s participation in interprofessional education, taking a children’s rights approach

Alison

Bennett

CQSW

MA

* & Tracey

Race

CQSW

MA

Associate Senior Lecturers, Faculty of Health, Leeds Metropolitan University, Queen Square House, Leeds LS1 3HE, UK

Abstract

The Children, Young People and Families module was developed at Leeds

Metropolitan University, UK in 2004. The module is jointly taught to community

health and social work students with the active involvement of a Barnardo’s Young

People’s Group. This module was developed in direct response to the challenges of the

UK

Every Child Matters

policy agenda highlighting the importance of partnership and

participation as the bedrock of effective practice in integrated children’s services. For

the writers, a commitment to the value base of social work means that it is not enough

to lecture about child-centred practice, children’s rights and the importance of

participation, without modelling these principles in our practice as educators. This

article outlines key aspects of the module and its delivery, including the authors’

learning from partnership work with the Young People’s Group. The work is evaluated

drawing on student feedback and findings from an evaluation exercise carried out with

the young people.

Keywords

children’s rights,

interprofessional

education, service user

participation, social

work education

*Corresponding author. Tel. 0113 2832600 ext 24442; e-mail: [email protected]

Introduction

Any teaching for community health and social work

students aiming to prepare them for professional

practice with children, young people and families in

contemporary integrated children’s services needs

to address the key principles of partnership,

participation and children’s rights. In this paper,

we outline how lecturers at Leeds Metropolitan

University, working alongside a Young People’s

Group, developed an approach which integrated

these key principles into the design and delivery of a

joint module. Influenced by increasing recognition

of the importance of interprofessional education

(IPE), the module provides an opportunity for

community health and social work students to learn

together about working with children, young people

and families. The paper discusses the policy

background influencing the development of the

module, key theories which have informed our

analysis of the work, outlines issues in relation

to the delivery of the module and examines our

learning from evaluation of this ongoing piece of

work.

220 A. Bennett & T. Race


The theory and policy framework for the development of the module

The definition of IPE used by the Centre for the

Advancement of Interprofessional Education

(CAIPE) is ‘occasions when two or more professions

learn with, from and about each other to improve

collaboration and the quality of care’ (Freeth

et

al

.

2005). The emphasis is on the interactive element of

learning and in particular the potential for new

knowledge to be generated through that interaction.

The IPE movement in the UK can be traced back

to the 1960s. Hugh Barr, a leading commentator

on IPE, has highlighted how the movement has

developed to meet a range of differing agendas.

These mainly relate to developing more effective

professional practice, for example:

Improving trust and communication between professionals,

developing collaborative competences, coping with problems

that exceed the capacity of one profession, creating a more

flexible workforce. (Barr 2002)

In contrast, this paper focuses on interaction by

different professionals with service users and carers

in the classroom, in this case, young people. The

recent Social Care Institute for Excellence (SCIE)

Report (Sharland

et

al

. 2007) on IPE for Qualifying

Social Work highlights the lack of attention to

service user involvement in IPE. Other publications

(Taylor & Le Riche 2006) also indicate that although

progress has been made in service user involvement

in social work education, the literature refers mainly

to the participation of adults rather than young

people.

The requirement to involve service users and

carers in the design, delivery and evaluation of social

work education was introduced in 2002 with the

launch of the new qualifying degree in social work

across the UK (DH 2002). The need for interprofes-

sional training, collaboration and shared respon-

sibility in relation to safeguarding children and

promoting their welfare has been reinforced by

the Children Act 2004 and is a key theme of the

Government’s

Every Child Matters

Policy. These key

drivers provided the impetus for the joint delivery of

the module under discussion here. The assessment,

learning and teaching approach has been developed

by a teaching team of health and social work

lecturers at Leeds Metropolitan University, working

alongside a Young People’s Group involving a

Barnardo’s participation worker.

Our approach to this work has also been influ-

enced by the useful framework devised by Nahapiet

& Ghoshal (1998), originally applied to understand-

ing social capital within organizations. This model

highlights three dimensions which enable the

development of social capital and which can also be

seen to promote interprofessional practice:

1

Structural – the ability of individuals to make

connections with others across boundaries, to have

common interests and to feel an integral part of the

network

2

Relational – the development of strong relationships of

trust

3

Cognitive – the extent to which people share a common

vision and language

(Nahapiet & Ghoshal 1998)

This framework identifies effective interprofes-

sional practice as needing to be developed along

each of these three dimensions. In the module under

discussion, we provide opportunities for students to

interact in ways which enable interprofessional

learning in each of the dimensions. Working

together in mixed disciplinary groups students are

able to explore the challenges of interprofessional

practice as they begin to define their own profes-

sional identity.

Students only really learn who they are when they have to

define themselves and their professional focus in the

context of others – who may overlap with them in some

areas and share a common identity, or be complementary

to them in other important dimensions of clinical

practice. (Fineberg, Wenger & Farrow 2004, p. 2)

One of the learning outcomes for students to

achieve on the module emphasizes the importance

of learning about working in partnership with

children, young people and their families. The

opening session of this module places interprofessional

work within the framework of the United Nations

(UN) Convention on the Rights of the Child (1989),

ratified by the UK Government in 1991. The UN

Convention emphasizes the participation of children

as legal persons (Mason & Fattore 2005). Article 12

seeks to ensure that the child’s right to express their

Exploring young people’s participation 221


own views and have them taken seriously should be

part of all relevant considerations by State parties.

Those of us who have worked in an advocacy role

with children and young people know how easily lip

service is paid to this principle and how rarely it is

genuinely implemented. In fact, although the

Convention on the Rights of the Child was

published in 1989, it took until 2002 and the UN

General Assembly on Children, for the voices of

children to be presented

by

children. At this special

session, children were included for the first time as

official delegates. Children aged seven to eighteen

from around the world were able to address

decision-makers from about 180 nations, which

resulted in the document

A World fit for Children

(UNICEF 2002). According to Sidoti and colleagues,

the UN Convention had highlighted that children

should be the centre of their communities; the

special session went further in seeking to ‘change

existing adult–child relationships and recognize

children’s abilities and rights to be active in their

communities’. (Sidoti, in Mason & Fattore 2005,

p. 20).

As social work educators, we believe that it is

central to teaching about children to take them

seriously as individuals with rights and agency and

not just to focus on what might be seen as a deficit

approach to them relating to their vulnerability,

their relative powerlessness and the duty of adults to

safeguard and protect their welfare. The judgement

of Lady Justice Butler-Sloss, at the outcome of the

Cleveland Inquiry, demonstrates this understanding.

She emphasized that ‘a child is a person, not an

object of concern’ (HMSO 1987, p. 245). This

philosophy is also proving to be central in the

growth of child-centred research. Hutchby & Moran-

Ellis (1998) discuss the ‘competence paradigm’ and

emphasize the need for research that seeks ‘to take

children seriously as social agents in their own right’

(p. 8).

However, little research has been undertaken

around the participation of children and young

people in social work education. Furthermore, the

literature about partnership working with service

users is limited. Although the Department of Health

requires that ‘all social workers will learn and be

assessed on partnership’ (Department of Health

2002, p. 16), there remains conceptual confusion

about what is meant by partnership with service

users and carers and little research about the

effectiveness of partnership practice (Sharland &

Taylor 2007). The growing body of literature for

Health and Social Care practitioners about partner-

ship practice tends to focus on work with adults

and pays little attention to the particular issues of

developing work in partnership with children and

young people.

In considering different understandings of

partnership and participation relevant to our work

with the Young People’s Group, the writers have

found the following perspective on empowerment

practice helpful:

What workers need to adopt in empowerment work are

‘bottom-up’ strategies whereby they learn from the

oppressed, from those who, more or less effectively, deal

first hand with the problems of racism, poverty, sexism,

ageism, etc.; then bringing the best knowledge and

expertise, collaborate with the oppressed to build more

just societies. (Breton 1994, p. 25)

This position acknowledges that partnership

working is rooted in the social work value base,

driven by ideas about empowerment and is

fundamental to an approach that is concerned with

social justice. Arnstein’s Ladder of Citizen Participation

(1969), which has been adapted to analyse levels of

participation or partnership working with service-

users, has also proved to be a useful tool. Corby

(2002) emphasizes that partnership may be viewed

as a process and that different levels may be

realizable or appropriate in different situations. This

perspective is useful in acknowledging that many

children and young people are not voluntary service

users and may be resistant to social work involvement.

Arnstein’s model has been adapted by Roger Hart

(1992) to explore levels of participation work with

children and young people. The levels are conceptualized

as the rungs of a ladder, ascending levels of

participation being set out from one to eight.

The ladder of participation:

8. Young People initiated, decisions are shared with adults

7. Young People initiated and directed

6. Adult initiated shared decisions with young people.

5. Consulted and Informed



4. Assigned but informed

3. Tokenism

2. Decoration

1. Manipulation

(Hart 1992)

We have applied this model in our planning and

evaluation of the involvement of the Young People’s

Group in the module.

The development of the ‘Children, Young People and Families’ module

The Children, Young People and Families module

was conceived and delivered in 2004 to coincide

with the second year of the new Social Work degree

at Leeds Metropolitan University. The development

of a joint module was a result of discussions between

Health and Social Work lecturers. The Social Work

team and the lecturers for Child Health are co-

located within the Faculty of Health. The fact that

we are physically located within the same building

was significant in developing the module from

initial informal discussions.

The teaching team recognized that there were

specific strengths in combining our professional

knowledge and experience as lecturers, and con-

solidating our experience of delivering parallel

courses with very similar aims and objectives. We

wanted also to address the growing challenge within

child welfare around the importance of multi-

disciplinary practice and interprofessional learning.

This was highlighted in 2000 with the introduction

of the Framework for the Assessment of Children in

Need and their Families:

Inter-agency, interdisciplinary assessment practice requires

an additional set of knowledge and skills . . . It requires all

staff understand the roles and responsibilities of staff

working in contexts different to their own. Having an

understanding of the perspectives, language and culture

of other professionals can inform how communication

is conducted. This prevents professionals from

misunderstanding one another because they use

different language to describe similar concepts or because

they are influenced by stereotypical perceptions of the

other discipline. (Department of Health 2000, p. 63)

The decision to overcome reservations around the

possible erosion of the distinctive elements of each

professional group and to develop the joint module

was founded on the recognition of the major reform

of children’s services being implemented through

the

Every Child Matters

policy agenda. The development

of Integrated Children’s Services demands that

practitioners have a shared understanding of the five

key outcomes for children (be healthy; stay safe;

enjoy and achieve; make a positive contribution;

achieve economic wellbeing), and a common

language to facilitate effective collaborative work in

achieving those outcomes.

The module is taught to four different student

groups: health visitors, school nurses, community

children’s nurses and social work students. The

community health groups are postgraduate can-

didates, the social work students are pre-qualified

MA year 1 and BA level 2. In order to respond to the

challenge of timetabling across different groups, the

module is structured as six full day workshops. Each

workshop has a specific theme, introducing the

current policy and legislative context, and progressing

through the module from looking at services for

vulnerable children, children in need, children at

risk of harm and children who are looked after. This

reflects the increasing level of professional involve-

ment in children and young people’s lives.

The module is formulated to ensure that service

user and carer perspectives are central to all teaching.

This is consistent with the standards promoted by

the GSCC (2005) since the introduction of the social

work degree and continues a strong tradition of

working in collaboration with adult service users

and carers within the Faculty of Health. Although

there was an established adult service user and carer

group who had worked in partnership with the

social work team since the inception of the social

work degree course, and members of this group

continued to have input into this module, we

recognized that we needed to go much further if we

genuinely wished to turn our rhetoric about

children’s rights and the meaning of participation

into reality.

The staff team were able to build on an existing

partnership with Barnardo’s, who assisted social

work staff in developing the Young People’s Group

of six young people aged between 16 and 21. They all

had experience of being ‘in care’ or significant



contact with social workers and health professionals

during their lives. The older members of the group

felt strongly that they had something to contribute

to teaching around working with children and

young people due to their life experiences and were

committed to working with us to develop the

module, rather than joining the adult user and carer

group. The reality of young people’s experience of

social work and our role as social work educators

seeking to provide students with a positive learning

experience created some tension at the outset. Some

members of the group expressed negative views

about their personal experience of social workers

and were surprised to find out that the social work

lecturers were also social work professionals. This

was not unexpected but did mean that we all needed

to consider what this partnership would offer

students and how they would engage with young

people who at times expressed negativity towards

the profession the students were training for. We

used a variety of approaches to introduce the young

people to each other, to the teaching team and to the

university, before their involvement in teaching

began, for example, introducing them to social work

students who were care-experienced and who were

prepared to share their views on why they had opted to

pursue a social work career and why the young people’s

involvement in social work training was important.

The delivery of the module

Students are divided into learning groups for the

whole module. The groups include a mix of students

from the different professional courses. The

learning groups in effect model the working world

of interprofessional teams, enabling learning about

the changes in children’s services and about

colleagues’ roles and responsibilities through formal

and informal means. A ‘rolling’ case study which

develops each time the groups meet supports

students learning together in applying theory, policy

and legislation to practice. The students therefore

have the opportunity to work together around the

table building a sense of group identity, building

relationships and developing a shared vision and

language, in line with the three dimensions of the

Nahapiet & Ghoshal (1998) model.

During the first two years of presenting the joint

module, the young people’s participation was

specifically around issues of communication with

children and young people and this formed a discrete

session separate from the rest of the teaching. In

response to their feedback and that of students,

participation has evolved and now the Young

People’s Group is involved in planning and delivering

teaching throughout the module, with a clearly

defined role in each of the six workshops. They

provide a range of learning opportunities for students

based on their own personal experiences and offer a

unique perspective. The young people’s involvement

is not limited to ‘testimonials’, they have developed

a variety of methods and approaches in conjunction

with the teaching team. One example is a session

about the use of life story work for looked-after

children, planned and delivered by a social work

lecturer and a member of the Young People’s Group.

The lecturer provides an overview of relevant theory

and literature, and a structured interview is then

used to support the young woman to discuss her

own experience of life story work. This brings to life

the purpose and process of life story work. The young

person has also developed her own presentation of

‘top tips for working with children and young people’.

The young people offer significant insights to

students about how children’s views of professionals

are shaped. One small illustration that left a lasting

impact on one young person was the experience of being

taken out by social workers, buying an ice cream and

being told she had to ask for a receipt. This led to a

wide-ranging discussion with students about how

they engage in effective practice with young people.

The teaching team coordinate the module via

regular planning meetings involving the Young People’s

Group. This ensures a consistent method of preparing

and evaluating each workshop, using feedback from

the students and the young people. The whole team

contributes to each workshop by facilitating the

learning groups and providing their specific profes-

sional and academic perspective to the focus of the day.

Evaluation of the module

The students are asked to evaluate each workshop

on the day and to provide an overview of their



learning at the close of the module. The Young People’s

Group are also asked to evaluate their involvement

in the module through a structured group interview

with a senior member of the faculty and a member

of staff from Barnardo’s. The following is a

summary of themes emerging from these processes.

The key message from students across the last

four years is that they have gained a clearer under-

standing of their own role and the role of others,

which builds their professional competence and

confidence in integrated team working. A sample of

student feedback from last year includes:

Realized we can’t do it alone, we need to work together,

no man is an island

The importance of communication, collaboration and

information sharing

Useful insight into other professionals’ roles and

responsibilities, boundaries and policies

Knowledge of own limitations, broke down barriers

Overlapping of roles, lots of common ground,

complementary

Appreciation of and respect for other’s roles (especially

Social Workers!)

Two very specific themes are evident from the

student evaluation of the involvement of the Young

People’s Group. The first is that they have

emotionally engaged with their experiences:

Felt their stories were very moving. Was very honoured

that they were able to share their experiences.

The second theme is that this would have an

impact on their practice, they would aspire to be

different from previous professionals, they understood

the importance of listening to young people:

Thanks for your talk today, as a second year social work

student it really made me think about how I am going to

become a more effective social worker.

Their experience will guide our practice.

These student quotations highlight the way in

which the module has enabled progress in relation

to all of the three dimensions of Nahapiet & Ghoshal’s

(1998) model, breaking down boundaries, building

trust and promoting a shared vision. For all students,

this supports the message about safeguarding

children and young people being ‘everyone’s

business’ (Department for Education and Skills

2006). We would argue that the involvement of the

young people required students to be emotionally

engaged. It allowed students insight into the

contrasting views of the power differentials between

young service users and professionals. It is difficult

to know at this stage whether this has added value

(Taylor 1997) for the professional development of

these students, but we anticipate that the experience

of ‘modelling’ service user participation will

contribute to students’ understanding of practice

with children and young people.

The young people’s own evaluation of their

involvement confirmed that they considered

themselves to be active participants in the process of

planning and delivering the module. The young

people were introduced to the Ladder of Participation

(as adapted by Hart 1992), and asked to identify

where they thought they were in relation to their

involvement in the module. One person identified

herself as at level 5, she felt that she had been con-

sulted and informed; the others identified that they

felt they were at level 7, which is to initiate and direct.

This work has developed over a period of 4 years

and we have learnt from our experience. Certainly,

at the early stages there were issues in contact with

students that were particularly difficult for some of

the members of the Young People’s Group and these

still resonated during our evaluation exercise 3 years later:

We have had some trouble. There was a table – they

weren’t all social workers, I think they were nurses and

stuff like that. They were uncooperative and misbehaved.

I thought they were really immature.

It is interesting that the young people commented

about the maturity of the student group in reflecting

on a past incident when a specific group of students

had resisted participating in an activity led by the

young people. This experience reinforced the

necessity for clarity of purpose in teaching

sessions where there is a level of risk in using

‘unconventional’ methods of teaching.

The group noted the change in their relationship

with the teaching team over time, identifying that

they felt that we listened to them and they were



supported, which allowed them to take more risks in

the level of self-disclosure in sessions.

The lectures have gone much better recently. We used to

do loads of preparation with Barnardo’s – you know from

books and that – but now we don’t – it is more personal.

I think that works better. It is more personal and you are

more confident.

It is also that you grow as a person when you have been

doing it for 3 years.

I felt a bit stupid after the more intense ones – but they

make the most difference.

They also noted the role of the team in ‘protecting’

them from high levels of disclosure.

It is much heavier now than what we used to do.

(Members of the teaching team) tried to protect us,

emotionally and that, so that we wouldn’t get upset and

back out of it.

Now we can take more risks.

Although we recognize the progress we have made

in developing the module, we also recognize the

limitations of our current model, in that we have so

far managed to involve only students from our own

faculty. We are beginning discussions with other

colleagues outside the Faculty of Health to explore

the possibility of involving student teachers in the

work. Although such a development would create

a better fit with the development of Integrated Chil-

dren’s Services, student numbers pose a logistical

barrier. There would also continue to be an

absence of other key professional groups, such as

police and paediatricians.

Although these are some of the functional

limitations of the module, there are also other issues

related to the diversity of the professional groups.

Some of the difficulties we have encountered working

with the learning groups can be understood as

inhibiting factors to effective interprofessional

learning, and have been summarized by Frost,

Robinson & Anning (2005) in relation to the wider

context of multi-disciplinary teamwork. These

include, for example, different core professional

models, service boundaries and protocols for

information sharing, the incompatibility of agendas

and procedures, different priorities and externally

imposed targets, issues around power, status and trust.

These inhibiting factors have been demonstrated

in tensions occasionally surfacing between students

within the learning groups, because of a lack of

common understanding about roles and practice

models, stereotypical assumptions or values issues.

In one instance, use of language in relation to children

with disabilities led to conflict around whether

professionals should be referring at all to ‘normal’

development. For the teaching team, we learnt

about the importance of responding swiftly and

sensitively to expressed tensions, and seeking to give

students space to explore differences constructively.

Conclusion

The Children, Young People and Families module at

Leeds Metropolitan University is delivered through

a partnership of health and social work educators

and service users with the objective that the health

and social care students learn about partnership and

participation as it is modelled through the structure,

process and content of the module. It was developed

as a direct response to the challenges of the

Every

Child Matters

policy agenda, and has involved a

complex interweaving of the different needs and

perspectives of stakeholders: the students, the

lecturers’ and the Young People’s Group.

For the students, the module has provided

opportunities for interprofessional learning which

we hope will provide valuable preparation for pro-

fessional practice. Although the recent SCIE Report

(Sharland & Taylor 2007) on IPE for Qualifying

Social Work usefully highlights the difficulty of

evaluating what works in this area of academic practice,

feedback from our students over the years has con-

sistently emphasized the value of learning and working

together through this module. Tensions remain in

ensuring an appropriate balance to meet common

and specialist learning needs and in addressing the

factors that hinder effective interprofessional commu-

nication. Nevertheless, student feedback suggests that

progress has been made in each of the three dimen-

sions outlined in Nahapiet & Ghoshal’s (1998) model.

Our approach to developing the module has

aimed to model a commitment to the active parti-

cipation of young people in social work practice

and education. There have been many challenges in



seeking to ensure genuine participation and part-

nership rather than manipulation and tokenism,

in line with Hart’s (1992) ladder of participation.

We continue to grapple with these challenges in our

ongoing work with the Young People’s Group,

supported by Barnardo’s.

For us, as educators, it continues to be a demanding

and time-consuming process to provide appropriate

venues, prioritize the time to meet with colleagues

and the young people to ensure the continued

involvement of all in effective assessment, learning

and teaching strategies, as well as manage the

tensions in these complex and dynamic relation-

ships. Nevertheless, we trust the effort will be

rewarded through our contribution to the learning

of a new generation of community health and social

work practitioners, who are prepared for practice in

Integrated Children’s Services and who understand

the central importance of listening to children and

young people and promoting their rights.

Acknowledgements

We would like to thank the members of the Young

People’s Group and our colleagues from Barnardo’s

and the Community Health team for their work in

partnership with us developing the Children, Young

People and Families Module.

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Documents

Exploring young people's participation in interprofessional education, taking a children's rights approach