Seminar 7 Recap – Presentation Slides & Notes

Links to the presentation slides from the 7th and final seminar in the Co-Production series. Thanks to all those who presented and to all who shared their thoughts during the lively discussions.

  • ‘Education, Training and Supervision for Professionalism Based on Co-Production: the Elephant in the Room’ by John Wattis (Keynote), view the presentation here.
  • ‘Co-Production: Education, Learning or Transformation?’ by Julian Raffay and Nadine Crawford, view the presentation here.
  • ‘Professionalism and Co-Production a need to Refocus’ by Matt Ellis, view the presentation here.
  • ‘Shared Solutions to Support Educational Experiences’ by The Public Partnership Group (University of Huddersfield), view the presentation here.
  • ‘A Tool Kit For Co-Production’ (Researchers: Pamela Fisher, Louise Warwick Booth, Susan Coan, Ruth Cross, Katrina Kinsella), view the presentation here.

 

Advertisements

Seminar 7: Education, training and supervision for co-production – Programme

University of Huddersfield 27 October 2017

We warmly invite you to participate in the 7th seminar of the series.

Encouraging debate across boundaries between service users/survivors and carers, academics, and professionals from voluntary and public organisations.

This seminar will explore conceptual frameworks for a redefinition of professionalism based on coproduction and power-sharing, and how this might be fostered through educational experiences. REGISTER YOUR INTEREST HERE

To make enquiries or to apply for a travel bursary (available to service users, carers, and professionals in voluntary organisations, please email: j.m.callaghan@leedsbeckett.ac.uk 

Follow us on twitter @ESRCcopro

 

The programme 

09.30 Registration (with tea and coffee available)

10.00 Opening with Christine Rhodes and Pamela Fisher

10.15 Keynote: Professor John Wattis EDUCATION, TRAINING AND SUPERVISION FOR PROFESSIONALISM BASED ON CO-PRODUCTION: THE ELEPHANT IN THE ROOM The use and meanings of terms like professionalism, education, training and supervision will be discussed. A distinction between education and training will be made and a brief critical account of competency-based education will be presented. The need will be emphasised to combine competencies with personal professional development and situational factors to deliver co-production of mental health. Some possible competencies for professionals working to co-produce mental health will be presented for later discussion. These are based the International Coach Federation standards for professional coaches. Personal professional development will be considered in terms of socialisation into the professional role as a ‘limited expert’. As well as understanding professional standards and how to apply them, the methods of acquiring the attributes of the professional role will be considered. These involve interactive learning involving people who use services, group discussions of ethical issues, complex situations and professional dilemmas. In addition, the importance of role models, coaching and mentoring and compassionate motivation will be stressed. Resilience – the ability to sustain knowledge, skills and motivation in the face of adverse circumstances – is another important attribute. Situational factors that obstruct co-production of mental health will be considered as will factors that promote co-production. An example of NAViGO, a comprehensive adult mental health service that operates on co-operative lines, will be briefly discussed; but it will be emphasised that this kind of working is counter-cultural and we need to recognise the need to persist in seeking cultural change.

11.15 – 11.30 Discussion of arising themes (with tea and coffee available)

11.30 – 12.30 Julian Raffay and Nadine Crawford CO-PRODUCTION: EDUCATION, LEARNING OR TRANSFORMATION? Effective co-production benefits both people and organizations. This interactive seminar explores how insights from mental health services can serve education, learning, and supervision. We consider the interplay between education, learning, and transformation. We begin with our experiences of co-production. We then explore useful conceptual frameworks. We suggest a targeted approach to value everyone’s contribution. We close with practical suggestions. We expect this seminar will interest service users, carers, academics, and service managers.

12.30 – 1.30 LUNCH

1.30- 2.00 pm Paul Frazer, Heather McDonald and Leanne Winfield THE RISK TRAINING GROUP Paul, Heather and Leanne were instrumental in a Multi-Agency Clinical Risk Training project which was a good example of co-production. Firstly, we will give an introduction of our training project. One of the participants, Paul, will then provide a practical example of the training provided, by reading out an account of his personal experience. After a demonstration of the training, Leanne will then offer how she sees co-production, by providing her definition of co-production, and a comment on the term “professional”. (For Leanne, co-production means people from different areas coming together as equals to work towards a goal that has been decided in collaboration. There will be value to all experiences, whether “Experts by Experience” or “Experts by Learning”. Leanne also has a question of the term “professional” – and argues that it is an approach, rather than a status.) Once we have given thought to co-production, Heather will detail some of the benefits of co-production, and in particular provide some feedback from the participants of the training. Then Leanne will again offer a critique of co-production, and look at how some voices may be included despite offering a view which is factually incorrect. This leads into looking at the difficulties we may have faced with this training, and Heather will provide some suggestions as to how this could work better in future. Finally, Paul will look at how we think professional education and training could be reformed in order to facilitate co-production, with specific ideas of continuing future training, training specifically for service users, use of a steering group to share experiences, and the possibility of a newsletter.

2.00 – 2.20 Matt Ellis Kirklees Recovery Colleges CO-PRODUCTION AND PROFESSIONALISM THE NEED TO REFOCUS What are the barriers to making co-production happen from a professional point of view? How do organisational culture and the ideas around “professionalism” hinder or help? What are the challenges that professionals need to own and face up to? Matt will contend that it is time for honest discussions that cut to the very heart of what it means to be a professional. Professionals need to locate themselves in the complex tapestry of society, communities and services, unpicking the threads that bind them to organisational and “professional” barriers that have warped reality and distanced them from the very people they seek to serve. There needs to be a refocus from improving services to improving lives. The only way to make and bring sustainable, enabling change is through co-production that allows influence not only on what professionals do but on how they do business and who with. How we as professionals work within our communities needs a radical re-think and that is challenging, inspiring and frightening!

2.20 – 3.00 Huddersfield University Public Partnership Group (PPG) SHARED SOLUTIONS TO SUPPORT EDUCATIONAL EXPERIENCES The involvement of service users/carers/ people with experience, in health and social care professional curricula is a central theme, and expectation, in government reviews, reports and policy directives. It is also a requirement of professional regulators approving and reviewing curricula, for example, the Nursing and Midwifery Council and the Health and Care Professions Council. However, there is significant evidence that the ability to develop such partnerships and collaborative working is still lacking in practice and is often, despite efforts from all parties, tokenistic. This session will include a specific focus on the approach that the PPG have adopted to support educational experiences. The discussion start with some consideration to the infrastructure required followed by examples of the challenges and opportunities the PPG have experienced in their quest to adopt a collaborative approach to find shared solutions to co-create meaningful involvement.

3.00 Tea and coffee and identification of the main points arising from presentations and discussions

3.30 Additional networking opportunity

 

Speaker Biographies

John Wattis was appointed visiting Professor of Psychiatry for Older Adults at Huddersfield University in 2000, John worked as an NHS consultant in the specialty until 2005. Before coming to Huddersfield, he was responsible for pioneering old age services in Leeds for nearly twenty years. He completed his training in Birmingham and Nottingham where he was Lecturer in the Department of Health Care of the Elderly which pioneered a holistic approach. He has experience of management as Medical Director of a large Community and Mental Health Trust and as Director of Research and Development for several NHS Trusts. After ‘retirement’ he provided part-time support to medical management in several NHS organisations, including the award-winning NAViGO care social enterprise. Until last year he also worked as a life and business coach, supporting people working in the NHS, Higher Education and Voluntary sectors. He has published research on the development of old age psychiatry services, alcohol abuse in old age, the prevalence of mental illness in geriatric medical patients, educational issues in old age psychiatry and outcomes of psychiatric care for older people. More recently he has focused on spiritual aspects of health care, co-supervising several research projects in this area. He has written or edited several books, the latest of which is the co-edited work Spiritually Competent Practice in Health Care*. At the University, he gives occasional lectures mostly on Spiritually Competent Practice. He is involved in the research supervision teams for several PhD students. He is a committee member of the School of Human and Health Sciences Spirituality Special Interest Group. This has been involved in several research projects concerning healthcare professionals can assess and support patients in this area and how educators can prepare them for the task. This seems to share a great deal with ideas about co-production of mental health.

*Wattis J, Curran S and Rogers M. Spiritually Competent Practice in Health Care.2017: Boca Raton; CRC Press.

Julian Raffay works for Mersey Care NHS Foundation Trust as Specialist Chaplain (Research, Education and Development). He is co-producing an action research cycle to show that co-production delivers better mental health services, improves satisfaction, and is cost-effective. This is yielding deep insights into co-production and challenges superficial understandings. It is practical but draws on theoretical approaches to education, management, psychiatry, and ethics. He is also involved in research evaluating a recovery college. Julian is in his fifth year of a part-time Professional Doctorate at Durham University, focussing on relationships between mental health services and faith communities. He teaches ethics and professional practice to healthcare chaplains at Cardiff University and identifies himself as having experienced mental health problems.  Julian holds degrees in Psychology with Management Science, Theology, and Chaplaincy Studies. He has been a vicar, social worker, psychology technician, and support worker. He has published articles and book chapters and is co-producing an edited book.

Nadine Crawford works for Mersey Care NHS Foundation trust formerly as a Recovery College tutor now as a Pathways Advisor. Working in front-line services is a totally new career for Nadine. Previously she worked her way up in the Civil Service whilst studying a part-time Law degree. After qualifying in Law Nadine had a complete change of heart and mind and decided to take a career break. She left her home, job and family and travelled around 14 different countries across 3 continents in just over a year. Nadine found this a valuable experience, mixing with people from all walks of life and gaining insight into other cultures. During her varied career Nadine has experienced co-production in a variety of guises. Whether leading on a project or volunteering her time she has found the output and co-operation levels are far better when a model of co-production is used.

Paul Frazer is an active service user based in Leeds. He has made very positive contributions through his involvement with different services and organisations including; Leeds Involving People, Service User Network (SUN), Sunrays and Better Lives in Leeds. In addition he has contributed to mental health research at Leeds University and Bradford University.

Heather McDonald is a team leader of One-to-One services within Leeds Mind. After gaining an interest in psychology during her college studies, she went on to study Psychology with Nutrition and Health studies at Leeds Trinity University. Heather has also worked within the Voluntary and statutory sectors and within a range of services; from support worker within Intermediate hostels, Care coordinator within Rehab and Recovery services. She also has a great interest in “risk”; what this means, how this is managed and how individuals can be supported to take control of their own risk assessment and safety planning to encourage self-management. Heather had the great pleasure of working with Leanne and Paul on the Multi Agency Clinical Risk Training project as project lead; this was funded by the CCG and through Leeds and York Partnership Foundation Trust. It was through this project that they were able to coproduce a multi-agency attended Risk training package aimed at changing the culture of risk assessment and management and the practices associated with this.

Leanne Winfield is a Patient Champion with NHS Leeds CCG Partnership and has been involved in developing co-production training being delivered across Leeds. Leanne is also the co-ordinator of the monthly West Yorkshire ADHD Support Group meetings held at Pinderfields Hospital. In these roles Leanne has delivered training on a number of topics, including co-production, clinical risk, and dual diagnosis and is currently participating in an Advanced Health and Wellbeing Training Programme with Leeds City Council. In 2016 Leanne was part of a team of four service users awarded First Runners Up at the LYPFT awards, in the Developing People category, for our Multi Agency Clinical Risk Training.

Matt Ellis is Principal of Calderdale and Kirklees Recovery Colleges at part of South West Yorkshire Partnership NHS Foundation Trust (SWYPFT). He has worked in Social Care for over 25 years and in Mental Health as a qualified Social Worker, Approved Mental Health Professional and operational Manager. He is known for his innovation and leadership pioneering creative approaches. He managed the Garage Project, a Mental Health Service for Young People that won a NIMHE (National Institute for Mental Health) positive practice award in 2005. He also chaired the local Kirklees collective for Creative Minds winner of the HSJ award for ‘Compassionate Patient Care’ in 2014. More recently Matt was responsible for establishing a Recovery College in Kirklees and now has the additional responsibility in co-ordinating “Recovery” development and the 5 Recovery Colleges within SWYPFT. Matt is passionate about co-production, strengths based and creative approaches which value the contribution of those with a “lived” or “caring” experience.

Huddersfield Public Partnership Group (PPG). The PPG is made up of a number of service users and carers and staff from the University that work together to take a lead role in shaping and delivering the public involvement strategy that includes education and research. The PPG was established as the School of Human and Health Sciences believes it is of great value to staff and students to involve a wide range of people who have experience of health and social care. The overall aim is that through a partnership approach service users and carers have the opportunity to make a difference and influence the work of the School and future health and social care services. Individual biographies of the people presenting will be provided in the seminar pack.

An example of co-production – LYPFT’s Multi Agency Clinical Risk Training Project. By Leanne Winfield

I’ve been asked to write a blog about co-production in action, and I have a very good example which I was involved with that I’d like to share with you. The Multi Agency Clinical Risk Training Project started in 2016 with a series of workshops, open to a wide range of staff from various statutory and voluntary organisations, carers, and service users, to look at the issue of clinical risk training.

Guided by Heather McDonald from Leeds and York Partnership NHS Foundation Trust (LYPFT), the project looked into the training various organisations provided on clinical risk, and if there was a way of both making the training more relevant, and consistent between different sectors (NHS, adult social care and the voluntary sector).

From the workshops many ideas were generated, and there was a lot of enthusiasm towards the project. A steering group was formed, which I became a member of, alongside Heather and other service users. We co-produced a training package, drawing on our own personal experiences and the themes that resulted from the workshops.

The training was then delivered to participants in sessions which cut across different job roles and sectors, and prompted the attendees to take a broader look at the concept of ‘risk’, and their own experiences – both within and outside their professional roles. The steering group worked as equal partners both in the planning and delivery of the project.

The basis of the training was two real life case studies detailing the experiences of myself and another service user. During my session at two points in the account participants were faced with a ‘What would you do?’ exercise. Then, after feeding back, I continued with what actually happened. This approach worked really well, and we gained very good feedback from the participants. They hadn’t been sitting watching a powerpoint all day!

Over 2016 and 2017 I was involved in delivering training to four cohorts, with participants drawn from various roles and sectors, and also a group of student mental health nurses. Additionally, as part of the project, I was able to access a funded place on the ASIST (Applied Suicide Intervention Skills Training) course as a participant.

Due to our involvement in this project we were nominated, and shortlisted, for the Developing People Award in the LYPFT 2016 Trust Awards. For the 10 awards a total of 115 nominations were received, so it was an honour to be named as Runners-Up.

Overall I’ve really enjoyed being part of this project, and it shows what can be achieved with proper co-production. It was great to be recognised as equals regardless of either being Experts by Learning or Experts by Experience. Hopefully our success can inspire future projects, and make a strong case for what can be achieved with co-production.

 

Thanks to Leanne Winfield for her contribution.

Co-production in Coercive Environments Seminar Summary by Harminder Kaur

Co-production in Coercive Environments Seminar

The seminar ‘Co-production in Coercive Environments’, which took place on 6th July 2017 at the University of Huddersfield, was the sixth seminar of seven in the ERSC Seminar Series ‘Re-imagining Professionalism in Mental Health: Towards Co-production’. About 35 delegates attended, these being  a mixture of researchers, academics, professionals, carers, and service users. Appropriately, the seminar took place in co-production week which was organised by The Social Care Institute of Excellence (SCIE) to celebrate the benefits of co-production and share good practice.

 

The seminar day consisted of an introduction by Dr Christine Rhodes of the University of Huddersfield and Dr Pamela Fisher of Leeds Beckett University. There was then a keynote talk by Professor David Pilgrim, followed by a talk from social worker and PhD student Charlotte Scott. After lunch the room was divided into smaller groups for an activity co-produced by service users, carers, staff from the University of Huddersfield, and external partners. Information and videos of the talks will be available on the web at https://coproductionblog.wordpress.com/

 

The appropriate definition of co-production was a topic of discussion and debate at the seminar. Roughly speaking, however, the term ‘co-production’ refers to service users and professionals working in a genuinely collaborative way in relation to some project, which might be provision of services, research, public involvement and campaigning, or any other matter of shared interest or concern.

 

Introduction

 

Christine Rhodes and Pamela Fisher opened the seminar and stated that the ultimate aim when working with ‘involuntary’ service users is co-production, if this is at all possible. They pointed out that there is no single agreed definition of ‘co-production’ and indicated the risk that the term might be misused.

 

Pamela Fisher gave an introduction to the topic. She made an interesting connection between postcolonial theory and co-production arguing that there needs to be a ‘decolonisation’ of knowledge. She argued that service user perspectives are often not taken seriously as legitimate forms of knowledge.

 

She proposed that co-production is about authentic power-sharing and requires a fundamental democratising of relationships; it is connected to wider questions of citizenship and is associated with significant challenges. She ended by emphasising that it is important not only that service users should be heard, but also that their voices should carry the power to effect real changes.

 

Professor David Pilgrim, ‘Co-production of Mental Health Services: The Art of the Impossible?’

 

David Pilgrim argued persuasively that true co-production in involuntary settings is impossible. He made his case in a clear, step by step fashion. Although involuntary services could be ‘humanised’ or ‘softened’, it was his contention that this would not be ‘co-production’.

 

He drew attention to something that many people in secure services are affected by, but rarely speak about, namely the ‘peculiarities’ of mental health services and mental health law. Looked at afresh, he argued, it is extraordinary that people are detained, often against their will, for periods of up to six months, without trial. In any other context, he said, the State would be accused of false imprisonment and possibly assault. He also contended that the act of detaining a service user under the Mental Health Act (MHA) is less about protecting or enhancing mental health, and more about removing people exhibiting deviant or transgressive behaviour from society. He said that this may or may not be a bad thing, but called for more honesty about what was being done, to whom, and for what reason.

 

He set out four characteristics that in combination define co-production:

 

  • The citizenship of non-professionals is respected and enhanced.
  • Citizens and professionals are mutually dependent.
  • Both parties are agreed to be rational moral agents.
  • Citizens and professionals have a common agenda.

 

He proceeded to argue that none of these four necessary features of co-production could be achieved under the conditions of enforced psychiatric treatment. This is because:

 

  • Enforced psychiatric detention and treatment diminish citizenship rather than enhancing it.
  • Mental health professionals and service users are not mutually dependent. Service users in detention are heavily dependent on professionals, but professionals are only dependent on service users in the sense that they need jobs and salaries, and not in any wider sense.
  • Service users who have been detained under the MHA are presumed not to possess rationality and moral agency.
  • Professionals and mental health service users do not have a shared agenda in involuntary settings. The interests of the patients are sacrificed in the interests of those who are not patients.

 

David Pilgrim pointed out the interesting fact that whereas poor people under-utilise healthcare in general, this is not the case in involuntary mental healthcare where poor people are over-represented. He also touched on the inequalities present in mental health services in regard to race. He argued that mental health law should be abolished and a form of ‘dangerousness act’ should replace it.

 

While David Pilgrim’s position was clearly stated and well argued, I disagree with his perspective on the MHA. As a service user who has been detained under the MHA a number of times, my view is that when employed well, the MHA protects vulnerable people from danger and risk of exploitation. While I agree that MHA legislation is distinctive and ‘peculiar’, I would put forward the argument that mental distress, specifically psychosis, is itself both distinctive and ‘peculiar’, and that the legislation cannot be properly assessed without acknowledging this. I did not get much of a sense of what a ‘dangerousness act’ would entail, but I would be very worried about any dismantling of the Mental Health Act. Home treatment sounds benign, but in reality it is about a lack of funding and it can put an unbearable strain on service users and carers.

 

During the discussion that followed David Pilgrim’s paper, a carer made the important point that she found the talk pessimistic and passionately argued for hope for change in services. This led to a discussion about whether co-production is a product or a process. Pamela Fisher wondered whether it was something you could work towards, a journey rather than simply a destination.

 

Charlotte Scott, ‘Power Sharing within Coercive Environments’

 

Charlotte Scott is a social worker with a background in community Mental Health. She is also an Approved Mental Health Practioner (AMHP). She is in the final stages of a PhD looking at how AMHPs make decisions during MHA assessments, drawing on service users’ views of these assessments.

 

Like David Pilgrim, Charlotte Scott drew attention to the extraordinary and unique situation whereby the MHA could deprive someone of their liberty. She argued that detention under the MHA produces a highly coercive environment and that co-production in this setting is not achievable.

 

Charlotte provided a very helpful overview of a MHA assessment. While for service users this might begin with a knock at the door, for AMHPs there would have been prior behind the scenes discussion. She referred to something known as the ‘dominant narrative’. I took this to be the predominating professionally-produced account of the service user’s episode which can help build up and shape a sense of what is going on for the service user, but which can also get in the way of listening to what the service user is actually saying.

 

Charlotte explained that she is interested in looking at how AMHPs could empower service users, promote rights, and work in the least restrictive way, specifically during a MHA assessment. In particular she is interested in how service users’ voices can be heard. Indeed, she pointed out that the guiding principles of the Mental Health Act code of practice set out that,

 

“Patients should be fully involved in decisions about care, support and treatment. The views of families, carers and others where appropriate should be fully considered when taking decisions. Where decisions are taken that are contradictory to views expressed, professionals should explain the reasons for this.”

 

Charlotte Scott stated that these guiding principles are all very well, but she said that what matters is how they are translated into practice. In her sample (which she acknowledged may be biased because practitioners willing to be observed may be more likely to be less coercive, and to adhere more closely to the guiding principles) she found that there was a will to find the least restrictive option. She suggested that there was a “stillness to listen” and a desire to advocate for the individual person being assessed; but she noted that there was also a sense that by the point of referral for a MHA assessment other options had usually already been explored.

 

Although co-production in a MHA assessment was felt to be impossible, Charlotte Scott did point out some things that could help mitigate the effects of the power imbalance. These include creating an environment that is more conducive to involving the person being assessed, ensuring that the individual being assessed has time to pack, time to phone people they need to, and has money in their pocket, and also a consideration of the impact of the means of transport, for example being aware of the stigma of having an ambulance or police car on a quiet cul de sac. In addition she stressed the relevance of advance directives. These might set out what the individual would prefer to be called, what language they would like used to describe what’s going on, and jointly agreed circumstances in which intervention would be necessary.

 

Charlotte Scott’s talk was followed by discussion. Questions arose around how she had got ethical approval to observe MHA assessments. She explained that she had worked with a service user group from the outset to shape the study and was guided by them. Another point that arose was made by a carer who was surprised to see the guiding principles of the MHA assessment, as she had never been consulted during the MHA assessment of her sons.

 

‘Team Huddersfield’

 

The small group discussion which then took place, ‘Team Hudd’, was co-produced by service users, carers, and staff from the University of Huddersfield and external partners. At the table where I was sitting there were approximately six delegates, a facilitator and a Trust service user who also had experience of being a carer. The facilitator asked the service user questions which related to the power imbalance he had experienced in mental health services and his experience of coercion. The service user spoke about being a service user, and also being a carer to his mother who had experienced mental health problems. His mother had been given Risperidone for long periods of time without review and this had had a bad effect on her. The group discussed this situation. Each table then fed back key points to the group as a whole.

 

Finally, there was a discussion initiated by a delegate called Jacqui Dyer focussing on the Conservative Party’s plan to re-write the Mental Health Act. Some discussion took place, and it was suggested that Jacqui should set out her initial thoughts and the opinions of people in the room in a blog.

 

The seminar day was fascinating and by the end there was a real buzz of energy and excitement in the room. The talks were high quality and the general feeling was that although co-production is not possible in coercive environments, this need not stop stakeholders from aspiring and working towards it and making significant changes.

 

Harminder Kaur

 

 

My Story: The importance of hope and some positives about co-production. By Chris Thompson

Chris Thompson:  has lived experience of being a mental health service user and is a member of the Public Partnership group in the School of Human and Health Sciences at the University of Huddersfield and is a member of Recovery College. He is passionate about talking openly of his experiences to combat stigma and improve understanding of mental illness. He has also started a self-help group called RECONNECT, for people who have suffered from Stress Anxiety and Depression at work. As a retired marketing director of an international company, he has professional experience of working in an environment where power and coercion are everyday occurrences. Despite being unable to attend the seminar Chris has made this contribution through a pre-recorded video.