Service user involvement in teaching about conflict – an exploration of the issues

Introduction

This teaching initiative occurs against the broader backdrop of service user and carer involvement in the social work curriculum. Social work education in the United Kingdom experienced significant reform in 2003 with the introduction of a three-year honours-level degree aimed at preparing students for employment in a range of generic practice settings (DOH, 2002). In recognition of the emerging importance of service user and carer perspectives to the social work knowledge base (Trevithick, 2008), such user involvement also became a mandatory component of social work education as part of the broader reforms. In the UK, it is therefore now commonplace for service users and carers to routinely be involved in teaching, selecting students for social work courses, evaluating modules and collaborating in research (Waterson and Morris, 2005). The exposure of students to service user perspectives in this way is not only linked to helping their understanding and insight into service users’ experiences (Stickley et al., 2010) but such critical pedagogy, it is argued, also enables students to make effective links between theory and practice (Agnew and Duffy, 2010; Atkinson and Williams, 2011; Skilton, 2011). These developments in the UK have not however been without challenge. Service users and carers in this role do need support in undertaking a powerful role which may be at odds with personal lived experiences of powerlessness (Skilton, 2011). Social work students may also harbour concerns about in some way adding to their perceived vulnerability of service users in the teaching/assessment situation (Costello and Horne, 2001; Duffy et al. 2012) and have reported reluctance to challenge issues raised by service users (Barnes et al., 2006). The UK is the only country where service user involvement is a mandatory aspect of the social work curriculum (Anghel and Ramon, 2009). Internationally, however, there are also examples of innovative developments in this direction. Gutman et al. (2012), for example, cite examples from the United States and Israel where mental health service users are regularly involved in teaching social work students. Kjellberg and French (2011) also describe a novel project in Sweden where service users and social work students together study a six-week module. These authors nonetheless acknowledge that this innovation is an exception in social work education programmes in Sweden, where the majority of institutions do not report service user involvement in teaching. Some Eastern European countries also struggle with overcoming negative perceptions towards service users. This is starkly highlighted by Zaviršek and Videmšek (2009) who observe: ‘seeing service users as only as demanding and with problems is the major cultural obstacle which prevents the development of service users’ involvement in research and teaching’ (p. 209). Nonetheless, these authors optimistically conclude that service user involvement is now beginning to take hold in some Eastern European countries but such development is very much owed to the significant efforts of some individuals who have campaigned to have their voice heard since the mid-1990s. Zaviršek and Videmšek also importantly observe from their research that the involvement of service users has enabled students to talk more freely about their own personal experiences of trauma: ‘being taught by a disabled teacher offered a safe space for many students to talk about their traumatic events’ (2009: 218).

Similar requirements around service user and carer involvement were also stitched into Northern Ireland’s revised social work curriculum in 2004 (DHSSPS, 2003). An additional unique requirement to Northern Ireland however was that social work students also needed to understand how this country’s history of violent political conflict has affected society. In its curriculum guidance to course providers, Northern Ireland’s regulatory body, the Northern Ireland Social Care Council (NISCC), stipulated that course content had to therefore directly address: ‘the personal and community consequences of the Northern Ireland conflict for individuals, families, groups and communities’ (DHSSPS, 2003: 16), the latter referred to as the Northern Ireland Context. The NISCC expanded upon this requirement in stating: ‘. . . the impact of past and current violence, conflict and divisions in Northern Irish society requires particular emphasis in the education and training of social work students in Northern Ireland’ (DHSSPS, 2003: 6).

With explicit expectations already stated about the contribution of service users and carers in the curriculum, research indicated that service users and carers, with direct experience of the effects of conflict, could also contribute to assisting social work students in their understanding about the impact of conflict in Northern Ireland (Duffy, 2006).

This article describes a project in which service users who have been injured, traumatized and bereaved through political violence, assist social work students in their understanding of the skills of engagement which they need in responding to the needs of those who have been traumatized through conflict. First, however, by way of context, it is important to provide relevant background information in relation to aspects of Northern Ireland’s troubled past.

Context of the project

Northern Ireland is a small country with a population of 1.7 m situated to the northwest of mainland Europe. Political identity and citizenship are hotly contested in a country experiencing more than 40 years of violent political conflict resulting in many thousands of people being killed, injured, bereaved and traumatized (Fay et al., 1999). Such a violent context resulted in Northern Ireland being perceived as a place apart in the United Kingdom and as one of Western Europe’s most violent societies. Such perceptions related to the fact that Northern Ireland had seen a protracted period of conflict, euphemistically described as ‘The Troubles’, dating back to the partition of Ireland in 1921 (Campbell and Mc Colgan, 2001). Up until the signing of the Peace Agreement in 1998, Northern Ireland had been directly governed by the UK through Direct Rule. More peaceful times however, would see the restoration of Northern Ireland’s own devolved government with the passing of the Northern Ireland Act in 1998. Within the latter, the signatory governments of the UK and Republic of Ireland committed to: ‘. . . dedicating ourselves to the achievement of reconciliation, tolerance, mutual trust, and to the protection and vindication of the human rights of all’ (Governments of UK and Ireland, 1998).

The broader milieu of violent political conflict also profoundly affected the complexion of social work practice to the extent that social workers were inclined to adopt a stance of neutrality as a way of insulating and protecting themselves from the violent devastation occurring around them (Smyth and Campbell, 1996). These authors used the term ‘benign detachment’ (p. 90) to describe the type of distancing behaviour and attitudes that characterized the challenges facing social workers operating in such a violent occupational context. Similar reluctance for social workers to become involved in issues which are seen as political has been observed in other international contexts affected by division, such as the Israeli-Arab/Palestinian conflict. Shamai (1999), for example, observes that engagement with controversial subject matter could adversely affect the counselling relationship, a point also supported by Baum (2007), who argued that Jewish social workers were reluctant to get involved in political debate in their work. Baum (2007) also cites from the earlier work of Ramon with Jewish and Arab social workers who she described as ‘shutting the issue out’. Shamai and Boehm (2001: 345) contest that ‘keeping private opinions outside the intervention is in line with the ethical rule of being non-judgemental towards clients’ behaviours and attitudes’. In Northern Ireland, the fact however, that being directly anti-sectarian in approach, could involve personal danger to social workers, is also acknowledged by Campbell and McColgan (2001) in their reference to social workers needing to think about self- protection when there is a real fear of death and injury. Nonetheless, Shamai and Boehm (2001) believe ‘that intervention that ignores the political context may miss the possibility of opening up new alternatives’ (cited in Baum, 2007: 875). Linked to the latter point, it is also important to refer to the concept of shared traumatic reality and the positive aspects of practice which may emerge from open social work engagement with those directly affected by trauma. Dekel and Baum define shared traumatic reality as ‘those situations in which social workers help survivors cope with the very traumas that they themselves have been threatened by and/or exposed to, given the reality that they live and work in the same community as their clients’ (2010: 1927). Whilst many studies have highlighted the problems that social workers face in helping those affected by trauma which similarly affects them, there is also some evidence pointing to equally positive consequences. Tosone et al. (2003), for example, reported that social work students following 9/11 ‘experienced feelings of gratitude, strength, hope, defiance and love, as well as a renewed desire to find meaning in life. Some of the students also experienced an increase in feelings of empathy and connection towards clients . . .’ (cited in Dekel and Baum, 2010: 1932).

It is therefore recognized that social work education has an important part to play in preparing students to work as professionals in situations where potentially they may encounter the adverse effects of trauma in the context of political conflict (Hamilton and Fauri, 2001; Nuttman-Shwartz and Dekel, 2009). Dekel and Baum (2010: 1939) referring to the work of Ramon et al. (2006), argue that ‘special attention should be paid to training social workers in how to handle the ethical dilemmas that might arise during shared traumatic realities, particularly in cases in which political conflict forms the basis of the traumatic event’. Nuttman-Shwartz and Dekel (2009), in describing a project they undertook with social work students who were working with young people affected by forced relocation from the Gaza Strip in 2005, emphasize that social work students are particularly vulnerable if they are not adequately prepared through social work education for working in stressful and traumatic conditions.

For its part however, Northern Ireland social work education has struggled to depart from the social work practice tradition of ‘distancing’ from political engagement. In the year following the Northern Ireland Peace Agreement social work educators were offered guidance in the aptly-named Central Council for the Education and Training of Social Workers publication Getting Off the Fence (CCETSW, 1999). This was the first time that Northern Ireland’s social workers and educators would be presented with a range of standards and guidance to examine sectarianism in a more open and less threatening environment. The fact that NISCC would then go on to include the Northern Ireland Context as a particular requirement would cement the permanent presence of conflict-related teaching in the social work curriculum.

The project – Involving victims and survivors of political conflict in social work education

The project described in this article reflects an approach to service user involvement which, by its very nature, has many ethical challenges. The teaching initiative involves engagement with service users, who have not previously been involved in social work education. In working with all service users and carers in such work, we know from research that preparation and support is vital (Duffy, 2006; Levin, 2004). This is particularly the case when working with groups and individuals who are seldom heard. Aware also of the often negative perceptions of ‘otherness’ (Banks, 2006) and paternalism that can often characterize how academic colleagues may view the involvement of service users in social work education (Zaviršek and Videmšek, 2009), this project sought to be very transparent in openly discussing the many ethical issues that could arise in asking service users to share their experiences of trauma associated with Northern Ireland’s conflict. Pre-planning meetings ahead of the teaching and tutorials therefore always occurred and following these sessions, a detailed de-briefing meeting would take place to share any collective experiences and issues that arose for those providing the training.

The project involves a university teaching team of five members, with special interests in mental health, child care, family therapy, trauma and service user involvement, working with eight members from a large non-governmental organization, established in 1991, whose main work is in providing services to victims and survivors of the conflict in Northern Ireland. The work is funded through grant assistance from the European Union’s Peace III initiative. One of the central aims of this project is to facilitate social work students in their understanding of Northern Ireland’s troubled past as a way of in turn promoting their effective, skilled and sensitized engagement with those service users who have been affected by the ‘Troubles’. The project therefore directly involves service users sharing their experiences of trauma and thus fits within the model proposed by Manthorpe (2000) who situates service user and carer involvement occurring within the three domains of sharing personal testimony, teaching as co-trainers and relating direct experiences of receiving care.

With this in mind, the key areas that the project focuses on are: discussing our understanding and fears of ‘the other’, exploring stereotypes and histories, developing skills of engagement and communication in working with victims and survivors of the conflict and generating knowledge about available resources. In addressing these areas, the first aspect of the project involves several lectures to the students on historical aspects of the Northern Ireland conflict, sectarianism and policy aspects of service delivery to victims and survivors. These lectures occur over a two-week period, taking place in the morning and later followed by two-hour tutorials, with groups of 15 students, in the same afternoon where the service users work in pairs with academic staff to concentrate on the knowledge and skills that social workers require in responding effectively to their needs. As a basis for focusing discussion in the tutorials, case study/vignette material was prepared in advance jointly by the academics and service users, typifying the types of issues which students might encounter in practice when working with service users who have been affected by the conflict in Northern Ireland. Mindful of the fact that teaching and discussion on such emotive issues can result in strain and discomfort in student interactions (Garcia and Van Soest, 1997; Hyde and Ruth, 2002), it was important to introduce an appropriate ice-breaker exercise, called the ‘name game’, to encourage the students to share with each other, aspects of their own history and identity, reflected in this instance by talking about the origins of their own name. Whilst the exercise is in many ways light-hearted, it does help introduce the students in a non-threatening way, to important aspects of identity and family history which are associated with their names. This technique is borrowed from family therapy and was designed to facilitate the students in making links between aspects of family background and learning (Byng-Hall, 1998). In starting this exercise off, it was always important that the academic staff member took the lead, as a way of setting the scene and also in terms of initiating a positive learning atmosphere in the tutorial in talking about content about which hitherto there may have been relative silence.

Important ground rules were also agreed with the students given the emotionally charged nature of the tutorials and the ever present reality that Northern Ireland, at the time of writing, is still experiencing quite high levels of low level violence, albeit of a significantly reduced nature than before. Issues around confidentiality were therefore paramount in the context of the last point given that some of the service users continue to express concerns about their personal safety.

Project methodology

It was very important to evaluate the impact of this teaching initiative from the perspective of the students, the academic staff, the participating service user trainers and practice teachers supervising the students when on placement. Ahead of undertaking this evaluation, ethical permission was granted from the university school’s Ethical Committee. The evaluation first involved self-completion by the students of a detailed evaluation questionnaire, containing a mix of qualitative (open response) and quantitative (Likert scale) questions. In addition, semi-structured interviews were conducted among the service user and academic teams where service users, as participant researchers, interviewed the academic staff, who then, in turn, interviewed the service users. The interviews were then recorded and thematically analysed. The service users were involved in the design of the research instruments and in this way were regarded as ‘collaborators’ in research design (Lathlean et al., 2006). A research methods training session was also provided to the service users as a way of preparing them for this aspect of the evaluation. The final aspect of the survey involved practice teachers (field instructors) completing a questionnaire examining the impact of the teaching on the students’ practice when on placement (practice learning).

In sum therefore, 144 students completed the evaluation questionnaire out of a total (n = 210) which represented a response rate of 69 percent. The interviews involved a total of eight service users and five university lecturers and 38 practice teachers took part in the survey. The next part of this paper details some of the key messages emerging from these evaluations.

Findings

The trainers’ perspectives

The second strand of the project examined the perspective of the trainers (the combined academic staff/service user team). All of this team have lived through the Northern Ireland conflict, with the service user trainers having had direct experiences of loss, trauma and bereavement directly attributable to the conflict.

Practice teachers’ evaluation

The final aspect of the project evaluation, linked in with practice, evaluated the perceptions of practice teachers (n = 38) about students’ preparedness for undertaking work with victims and survivors when on placement following the teaching. Approximately 66 percent of the practice teachers surveyed were positive and confident that the students were well prepared to deal with issues related to sectarianism and the conflict in Northern Ireland as a result of their involvement in this project as the following sample quote endorses:

I felt my student was very well prepared as her placement was in a strongly nationalist area whilst she was clearly from a different religious culture. My student displayed evidence of being able to draw from her academic teaching and was very conscious of AOP issues in this arena.

The following comment was also made about the tentative approach by one student towards openly discussing conflict related issues in supervision:

There seemed to be a greater degree of apprehension in exploring these issues at the outset of placement. As time progressed and our working relationship developed, the student was less opposed to having these discussions.

The majority of the practice teachers surveyed (75%) remarked that the students were better prepared to address the needs of victims and survivors of conflict as a result of their involvement in this teaching, as the following quote suggests:

I feel these specific students are well prepared to assess the needs of victims and survivors of the conflict.

The practice teachers however were less positive about the extent to which their employers were prepared to effectively meet the needs of victims and survivors of the conflict, as the following quotes illustrate:

Our agency is just beginning to understand the importance of considering this issue. . . .

. . . this however is not discussed much within teams but is left to individuals.

Discussion

The effects of violent political conflict have far-reaching effects not only for service users but also on the social workers involved in service provision (Ramon, 2008). Despite calls to recognize the fact that social work is inherently political in nature and should therefore be more open to direct engagement with political issues (Burke and Ngonyani, 2004; Mmatli, 2008), the fact remains that the inclusion of such political initiatives in social work education are quite underdeveloped, with the exception of some skills-based initiatives that have occurred in the Middle East (see, for example, Gordon, 2009; Nuttman-Shwartz, 2008).

The educational project described in this paper occurs within such a developmental backdrop. The students have endorsed the added value of being open to directly addressing the needs of victims and survivors in their teaching and have recognized the integral contribution of such knowledge to informing social work intervention, which concurs with findings in other contexts affected by political conflict (Mmatli, 2008). The project has introduced students to open debate and discussion with each other on political issues which hitherto would have been characterized by silence. The initiative had a similar impact on the academic staff involved, who, whilst working with each other, may not have actually ever openly talked about such issues outside of this project. This mirrors to an extent the observations of Dekel and Baum (2010: 1940) about social workers needing to be able to ‘relate to clients and colleagues who are from the ‘‘other side’’. Nonetheless, for some students, who have not lived through such a violent period due to their age and who have no memories of such distress, some questions of relevance have arisen. This does raise an interesting question though for such a generation of young people in a post-conflict society who wish to ‘move on’ in a society in which peace and optimism characterize the wider context. Nonetheless, the observations of Nuttman-Shwartz and Dekel (2009) about social work students being vulnerable if they are not afforded opportunities for training and knowledge development in trauma-related work, have stark significance, even though in Northern Ireland there is now some cause for optimism. This desire to move forward is also at odds with the needs of many victims and survivors for whom the past is very much part of a present reality. For those students with more acute memories and experiences of Northern Ireland’s violent past, there was an open willingness to share their own direct experiences, a tendency common to other contexts similarly affected by conflict (Nuttman-Shwartz and Dekel, 2008). Zembylas (2007) also points out that student engagement with both the positive and negative expressions of emotion can have a significant impact on their learning. The students did observe that this was ‘emotionally draining’ work, something also remarked upon by the academics and service users involved. This may have resonance with Maidment and Crisp’s (2011) assertions that ‘emotional responses can be considered as both outcomes and predictors of learning’ (p. 410).

Whilst such self-disclosure was viewed in a positive way by the service user trainers, this could raise issues about rights to privacy, safety and confidentiality for such students at a time when they are at an early stage of forming relationships with their peers on the course. Nonetheless, this tendency for openness on the part of students may assist in combatting their sense of isolation and interpersonal distancing which can occur in situations of political conflict as noted by Cunningham (2004) and Neumann and Gamble (1995). It was therefore important to build in safeguards to protect the students when setting down the ground rules at the beginning. It was equally important for the academic staff involved to be available for the small number of students who needed follow-up support after the teaching and to liaise with other academic colleagues as appropriate to build in additional sources of advice for such students. Such support was also recognized as essential to the work undertaken by social work students in the project reported on earlier by Nuttman-Shwartz and Dekel (2009).

It is therefore important in this type of work to be mindful of the potential to re-traumatize students when ‘bringing up issues’ from the past. Having said this, it was also interesting to note that the students’ views regarding the involvement of victims and survivors in social work education had changed. This could support the view expressed through Boler’s ‘pedagogy of discomfort’ (in Boler and Zembylas, 2003) where the students’ previously held assumptions have been questioned through their direct exposure to emotionally charged material.

There were similar issues relating to exposure of feelings which we noted in regard to the findings from the interviews with the participating service users. The importance of preparation as a form of practically supporting and safeguarding service users cannot therefore be overstated, especially in work such as this, where there are ongoing threats due to background societal conflict. Herein lies an important ethical issue which needs not only to be recognized, but managed. The need for detailed contracting, ground rules, pre-teaching preparation meetings and post-tutorial de-briefing meetings can all augment the sense of security, support, confidence and reassurance with which service users and academic staff can approach involvement in such projects. Duffy’s (2006) research suggested that a more peaceful Northern Ireland would provide an important context for service users to feel safer in talking about their stories. Five years later, however, this is not the case. For some service users in this project, there was still a sense of fear evident which, in turn, determined the extent of information they felt comfortable in sharing with the students.

The findings from the evaluations with the practice teachers are encouraging in evidencing that students are now more comfortable about extending their learning on conflict-related teaching into the practice context. Nonetheless, the challenges accompanying anti-sectarian practice have to be addressed on an ongoing basis, particularly in a society, where the norm has been to avoid openly discussing and engaging with sensitive and potentially divisive issues. There was some evidence from the practice teachers surveyed that this is an issue that is still challenging to employers and suggests that perhaps more time will be needed for social workers to fully depart from previously held positions of neutrality and detachment. The latter concurs with the earlier findings of Campbell and McCrystal (2005) who noted an absence of support by employers towards social work staff who had to deal with the aftermath of violent incidents.

Conclusion

Whilst this was a small-scale project, the evaluation findings indicate that students perceive the approach as adding significantly to the quality of their learning experience in understanding the impact of conflict on service users’ lives. In addition, the project has both positively affirmed the competence of the service users and highlighted the contributions they can make to student knowledge development by sharing their expertise in what has been a particularly fraught and challenging area in social work education. This latter point also affirms the author’s recent research findings which evidence the contribution of service user and carer representatives to enabling social work students to understand the meaning of key social work values in practice such as partnership working, empowerment, social justice and anti-oppressive practice (Duffy and Hayes 2012). Earlier research by Khoo et al. (2004) also points to positive trends in user-centred practice emanating from what social workers have learned from service users in their education.

This article commenced with referring to these participating service users as in many ways being ‘seldom heard’. This project, however, has validated the contributions of their experiential knowledge to helping social work students in an important domain of their professional development. We have also witnessed other unforeseen benefits expressed by the service users participating. Some, for example, have expressed more confidence and control in being able to recall and openly discuss traumatic events from the past, a point which links with previous research reporting service users feeling more empowered as a consequence of their involvement in social work education (Skinner, 2010). Nonetheless, there is still room for further development. There is a need to focus more on enhancing student skills in the university setting in preparation for placement, as it is in that particular context where many challenges will present, given the problems we know to exist still in mainstreaming such open approaches to engagement on political issues in social work practice. Perhaps it is apt to positively conclude this article with the thoughts of Gina Tyler, a service user and social work educator, who in many ways captures the essence of the opportunities to be gained by collaborating with service users in social work education: ‘The benefits of involving service users at a meaningful level, creates a ‘‘win-win’’ situation, and the rewards can be reaped for years to come as we see service provision being tailored to meet the individual needs of the people who use services’ (Tyler, 2006: 67).