Speaking up

Advocacy has been around for 20 years and is now backed by
the government, but does it work? Project manager Andrew Eustace reports on a
study that analysed the workings of a local advocacy project.

It is official – citizen advocacy has achieved the government’s
stamp of approval. The learning difficulty white paper Valuing People is
unequivocal: "Effective advocacy can transform the lives of people with
learning disabilities by enabling them to express their wishes and aspirations
and make real choices."¹

Both citizen and self-advocacy are seen to be central to the
principles that lie at the heart of the government proposals: rights,
independence, choice and inclusion. For the first time, the government is to provide
finance (£1.3m for each of the next three years) to establish a range of
independent advocacy services. The self-advocacy movement has complained about
the lack of funding and the short-term nature of the advocacy schemes
available. But there have also been concerns that an advocacy scheme financed
by a statutory agency could have its independence compromised.

While funding is obviously crucial there are also other
areas important to the development of citizen advocacy: most notably, what
makes it work (if indeed it does), how it can be improved, and crucially in
what direction should citizen advocacy develop in the future.

Citizen advocacy, of course, is not new to this country. It
arrived in the 1980s when the Advocacy Alliance was formed. By 1997 there were
thought to be 200 projects in the UK mainly working with people with learning
difficulties but increasingly with other groups, such as older people or those
with mental health difficulties. However, despite two decades of development,
there are concerns associated with the research in this area.

First, the amount of independent research or evaluation is
relatively small and what there is can be criticised for being more concerned
with the process of citizen advocacy then the efficacy of its outcome. Second,
much of the work most often quoted² is now becoming dated, and some
of the literature is either partisan or more akin to a "how to"
manual than a serious critique of the citizen advocacy approach.

Even the bibliography of Valuing People contains no
work or research specifically on citizen advocacy.

So the aim of our study³ was to find out if
citizen advocacy schemes contribute to the empowerment of people with learning
difficulties. We contacted, with the co-operation of a local advocacy scheme, a
range of service users (both with and without learning difficulties) and
volunteer advocates. The manager and a social worker from the purchasing local
authority were also contacted. Surveys were carried out either by interview or
questionnaire. The research findings were analysed in terms of level of
satisfaction with the scheme, and by addressing four questions:

– Is there evidence of people feeling empowered?

– If so, what associated factors can be identified?

– Does citizen advocacy increase the ability of people with
learning difficulties to participate in individual and local service planning?

– Do people want to be involved?

Although a small-scale piece of work, the results are
interesting. For service users, volunteers, and the service purchaser
interviewed, there was evidence that this scheme was held in high regard. This
was expressed by the self-assessment of service users, the comments of their
volunteer advocates, and evaluation by social services staff and it was borne
out by the length of volunteer commitment, and the meeting of social services
department contract targets.

There was also a clear indication that service users felt
empowered through their involvement in the scheme. This was reinforced by the
view of the volunteers. There was evidence to show that involvement in the
advocacy scheme increased participation (in both content and expressive
ability) in individual planning or review meetings, but this was not the case
for wider service planning or consultation.

At the centre of any citizen advocacy scheme is the
relationship between partner (service user) and volunteer, and all who were
contacted indicated the fundamental importance of this. Three key elements for
a successful advocacy relationship were identified:

– Length of commitment.

– Consistency.

– Clarity of purpose.

In addition, flexibility of approach was found to be
important.

There were differences in the way citizen advocacy was
perceived by the partners and their volunteers in terms of the scheme’s main purpose.
Service users rated highly the support given to resolve practical issues of
day-to-day survival (often dealing with officialdom in its various guises).
Volunteers, while recognising the importance of this, saw the value of the
scheme much more in terms of empowerment, and therefore as part of an ongoing
process.

Both the supporters of citizen advocacy and the government
should be keen to establish more clearly what works, and why. But even with the
evidence we have now, citizen advocacy could have an important role in the
immediate future.

If the cornerstone principles of inclusion and choice are to
mean anything, they must also apply to the development and implementation of
the policy proposals of Valuing People.

The potential for improved participation in, and control of,
the policy debate by people with learning difficulties is there. The minister
responsible, Jacqui Smith, has announced a task group to oversee the
implementation of Valuing People. Surely this, together with the other
structures proposed, such as the learning disability partnership boards,
provides an opportunity for significant involvement of people with learning
difficulties in these key groups. The potential for citizen advocacy in
facilitating this process is clear.

As well as establishing the most effective methods of
operation for citizen advocacy, work also needs to be done to clarify the
future development and direction of this approach. There is a hint in the white
paper that citizen advocacy has a particularly useful role "enabling the
voices of people with more complex disabilities to be heard". In that
case, should the citizen advocacy movement focus on those people who find it
most difficult to express their views? What is the scope for wider use of
citizen advocacy around disability rights issues, linking up with the work of
the Disability Rights Commission on the rights of people with learning
difficulties?

Clearly, citizen advocacy is at a significant crossroads of
its development. Established now as a contributor to practice that empowers,
citizen advocacy now has the opportunity to contribute to policy development
that also empowers.

Andrew Eustace is project manager, Ripon Community Link,
a local service which aims to enable adults with learning difficulties to realise
their potential in the community.

References

¹ Department of Health, Valuing People, A
New Strategy for Learning Disability for the 21st Century, The Stationery
Office, 2001

² L Holly and B Webb, Citizen Advocacy in
Practice, the Tavistock Institute, 1993; and K Simons, Citizen Advocacy:
The Inside View, Norah Fry Research Centre, 1993

³ The research project was completed as part
of an MA in public services management (disability studies) at the University
of York, 2001

Background Reading

1 D Atkinson, Advocacy: A Review, Pavilion
Publishing, 1999

2 K Butler, S Carr, and F Sullivan, Citizen Advocacy:
A Powerful Partnership, National Citizen Advocacy 1998

Websites

1 Valuing People at www.archive.official-documents.co.uk/document/cm50/5086/5086.pdf 

2 Articles on Valuing People at search archive at
www.community-care.co.uk 

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Children’s services in disarray

The demands on children’s services are widely recognised as
overwhelming local authority provision in many areas of the country. Here,
former assistant director of children’s services Christine Doorly explores the
current malaise and suggests how far policy makers need to change course to
remedy it.

There is growing recognition of the pressures currently
affecting social care services for children and their families in the UK.
Recent coverage of the tragic deaths of Victoria Climbie and Lauren Wright have
highlighted issues of low morale, lack of qualified staff, increased dependency
on agency staff and overseas recruitment, and the general demands on child care
services, as well as issues of practice and interagency co-ordination.

Recent Association of Directors of Social Services and Local
Government Association spending surveys show that most local authority social
services budgets are overspent, with children’s services being the chief cause.
Directors of social services have recently been departing in unprecedented
numbers, often unwillingly as scapegoats for systematic failure, and partly as
councils anticipate the possibility of major structural change through the
Health Act 1999, and the development of care trusts.

It is widely speculated (whether accurately or not) that the
Victoria Climbie inquiry will lead to a major overhaul of children’s services –
child protection in particular. Indeed, many councils are now working towards
"integrated children’s services", bringing together health, education
and social care services. But radical reorganisation will not solve some of the
core problems unless careful thought is given to identify what needs are to be
met, and how this can be achieved. Reforms that are driven by budget pressures
will not get to the heart of the matter, and reorganisation of vacant posts or
demoralised staff will achieve nothing.

While the government’s modernisation task force on children
is starting with a welcome blank sheet of paper, it will be some time yet
before its work, and the National Service Framework for Children, is delivered,
and meanwhile funding and service pressures will drive forward change. So what
are the key issues which any change must address?

First, the government must address the question of its own
methods of management, accountability and control. The NHS and Community Care
Act 1990 was successfully implemented by two simple key mechanisms: money and a
needs-led approach. On the whole, these arrangements have produced a wide range
of flexible and cost-effective services for older people and people with
disabilities, despite coming under some pressure recently.

This is in contrast to children’s services, which were not
funded at the passage of the Children Act 1989, and although there have been
strong policies (such as messages from research and the recent assessment
framework) which particularly aim to push the service in the direction of
family support, this has not generally happened. The reasons for this include
lack of funding to provide additional family support services (as opposed to
redirection of child protection funding) or even the provision of bridging
funds.

Second, child care social work is carried out in a now very
risk averse climate. The increase in scrutiny through modernised political
structures, part 8 reviews, off-line reviewing and court processes has led to
more defensive practice, and to a decrease in direct contact time with children
and their families. Increasingly, direct work is undertaken not by qualified
social work staff but by unqualified family support or residential staff, and
child care social workers increasingly see themselves more as "reporting
in" to a process, rather than acting as a catalyst for change. Government
policy has encouraged this approach by adding layers of guidance about process,
the assessment framework being the latest. Although the Quality Protects programme
has provided some welcome additional funding, it has tied local authorities to
a very specific set of targets, again, many of which measure process rather
than outcome. The aims and aspirations of these programmes cannot be faulted,
and yet their overall, unintended, impact is to decrease the scope for
innovation, creativity and action, and to encourage the development of a
top-down, command and control culture.

Meanwhile, external to core social work services the
government has been increasingly channelling funding elsewhere: Sure Start, On
Track, Connexions, Early Years Partnerships, social inclusion and education,
for example. Since public spending over the period of the last Labour term of
office stood still, these programmes have effectively been achieved by draining
away funds from specialist services. Nevertheless, if these new areas of
activity begin to address some of the fundamental issues of family breakdown,
parenting capacity and young people’s healthy and positive development, they
could potentially address these pressures. However, the evidence so far casts
doubt as to whether this will be the case. For example, all the evidence of
Sure Start seems to indicate that increased referrals for child protection are
generated. Even at the completion of the whole programme, only a quarter of all
vulnerable families will access Sure Start, and it is in any case designed to
achieve a longer term preventive approach rather than relieve immediate
pressures.

Early Years Partnerships have received huge levels of
funding, but have not been particularly inclusive, with disabled children, for
example, generally coming low down in the struggle to meet capacity building
targets.

Connexions, a new universal service for 13-19 year olds,
will need to dedicate substantial resources to the minority of young people
most at risk of social exclusion. There will be a major challenge in getting
schools to concentrate on anything other than educational targets and
achievement, and this is a major barrier to a more inclusive approach. Both
Connexions and Sure Start will continue to drain social care of skilled and
motivated staff. The track record of universal services, for all the commitment
and awareness of many of the individuals working within them, has not been good
in relation to the most vulnerable young people.

Even the children’s fund reflects the government’s lack of
confidence in social care, in that funds are to be channelled direct to the
voluntary sector rather than through established partnerships, many of which
are clear about the innovative services that could be developed by the
voluntary sector were funding available. So, if there is to be a radical new
approach towards children and families services, what are the issues which need
to be addressed?

The service needs to return to a basic principle of being
needs-led; the resources must match the needs, and the assessment process must
be about clearly identifying these.

Needs should be expressed in terms of the child’s needs, and
the resources which will meet them, drawing on research findings and best
practice. Local authority children’s services already have the potential for
such a planning system, in the shape of their looked-after children and child
protection systems, but these have tended to be deployed instead in ensuring
procedures are followed, rather than as a planning tool.

One of the major causes of low morale in children’s services
is the mismatch between needs and resources. This gulf has widened in recent
years as residential resources have shrunk, foster caring has become less
attractive, and adoption resources have not kept up with the level of support
needed to meet the complex needs of the families and children involved, pre-and
post-adoption.

In addition, improvements in the scope of the assessment
process, and revised guidance on Working Together, while welcome in
themselves, have highlighted areas such as domestic violence, where resources
remain limited to hard-pressed women’s refuges and perpetrators groups only for
convicted offenders. Services for children who are victims of domestic violence
or to improve assertiveness of adult victims are obvious needs for which
resources are, on the whole, lacking. Some of these could be provided by a
refocusing services such as community education and schools, through community
safety networks. However, this will require a policy shift, since these
networks have tended to see youth as a crime "problem".

In other service areas, too, there are major challenges.
Parents of disabled children face a bewildering array of access points, and are
prone to receiving more assessment, and less service, than is ideal. Attention
deficit hyperactivity disorder and behavioural disturbance among youngsters are
increasing with Ritalin prescriptions rising rapidly. Yet, anecdotally, many
workers feel that much of this need is often more closely related to poor
parenting skills, lack of boundaries, junk food diets, and emotional, sexual or
physical abuse.

However, the sound principles of adult mental health services,
such as avoiding a medical approach to social care needs, do not feature
strongly. In part because child and adolescent mental health services remain a
consultant-led, rather than a multidisciplinary service, and partly because
services are so strongly rationed that at least a diagnosis offers some hope of
meeting eligibility, even if it does potentially label the child.

A multidisciplinary community service, offering a range of
options through a single entry point, based on need, is an urgent priority for
these children. Such a service should have a developmental role and wrap itself
around an inclusive family support service, working with schools, local
communities, and voluntary organisations in a non-stigmatising and accessible
way. Much progress could be made by co-ordinating existing services, reducing
duplication and creating clear pathways. However, there will be some challenges
in achieving this, and the method of implementation of this change must address
several key issues.

The government must review its centralised, top-down
approach. By constantly setting targets, behaviour is not changed to improve
performance, but merely to meet targets. If a radically different approach is
required, it must be implemented in meaningful local networks which are free to
work in a community-based, "bottom up" way to define local needs and
identify the partnerships needed to meet them.

While it is absolutely right for the government to set tight
objectives for these services, local discretion must enable intelligent and
coherent translation of these objectives in outcomes for children, and systems
for measuring whether these are being achieved. All aspects of community
services need to have agreed targets which encapsulate this inclusive approach.
This means schools, leisure services, public health community safety and so on,
and vulnerable children and families need to be at the centre. While the
potential to deliver some aspects of this approach exists through the local
modernisation review, there are some key "high level" aspects that
cannot be ignored.

In particular, urgent attention must be paid not to
structures but to getting the human resources strategy right. This means making
sure that the skill mix, training and recruitment strategies are coherent across
all of these partners, including foster carers and adoptive families and other
providers. It also needs to include training and co-ordination of adult
services staff since, as these and children’s services seem set to part
company, there is a danger that care packages for children whose parents have
mental health needs, learning difficulties or substance misuse will become even
more unco-ordinated.

Finally, the leadership skills and culture needed to
successfully generate this climate must prevail. While accountability must of
course exist, the further reinforcement of a blame culture only serves to drive
staff further away from these core functions. A climate of open and honest
review, a creative approach, putting listening to the children at the heart of
the process, and generating vision through a commitment to a bottom-up process
are all essential.

For real change to occur there needs to be the leadership
skill, time and capacity to devote to a truly inclusive and properly resourced
management process. If this can be achieved the gains for some of our most
socially vulnerable children and their families will be enormous, but the scale
of this challenge of turning so many initiatives into a coherent and socially
inclusive service should not be under-estimated.

Christine Doorly is former assistant director for
children’s services, Suffolk Council.

References

¹ Department of Health, Home Office,
Department for Education and Skills, Working Together to Safeguard Children,
The Stationery Office, 1999

Website

Working Together to Safeguard Children document at
www.doh.gov.uk/quality5.htm