This paper outlines the experiences of an undergraduate social work program (Bachelor of Social Work) in Belfast, Northern Ireland. Two terms used throughout the paper include: 1) “service user,” equivalent to “client” in the North American context and 2) “caregiver” also known as “carer,” a term used to describe individuals who play the role of caring or supporting service users/clients.
This first author (KD) had the rare opportunity to learn about social work education from a different vantage point while living for a period at Queen’s University in Northern Ireland. Her experiences of working in the North American Social Work context suggest that the role of service users in the social work educational context still remains an elusive subject (Austin & Isokuortti, 2016). Her experiences, along with her academic team, are described in this institutional case study, which explores the roles that service users and caregivers play in educating social work students prior to their first field placement. The analysis showcases the rich experiences to which social work students are exposed when preparing both personally and professionally for a long-standing career engaging with service users and caregivers in various community, residential (group care), hospital environments and community settings.
While schools of social work strive to provide students with educational opportunities that will enhance their transition into field-placement settings, many remain challenged at how to teach the core skills of social work practice. Educators can be removed from the day-to-day realities of practice. This makes is difficult to provide real-world examples to students. Students, however, want clarity about the realities of practice. Providing students with exemplars is critical in preparing them for competent and confident practice. Exposing students to the real-world challenges of service users’ and caregivers’ lived experiences is an essential component in the development of social work practitioners.
Northern Ireland Social Work Educational Context
Northern Irish social work education is a unique and, some would argue, enviable model of promoting student engagement, reflection and professional development. A particular feature in Northern Ireland is the professional regulatory body, the Department of Health, Social Services and Public Safety and Northern Ireland Social Care Council (2015), a body determines the framework for the degree. These governing bodies oversee the curriculum design and delivery of the course.
In addition to academic requirements, students are required to undertake two field placements of 85 and 100 days respectively. Prior to beginning a field placement, students must pass a course titled “Theory, Skills and Preparation for Practice Learning”. The Department of Health, Social Services and Public Safety and Northern Ireland Social Care Council (2015) determines the learning outcomes for this preparatory course. This mandate of this unique practice and educational partnership is to ensure regional consistency in the development and delivery of agreed aspects of the social work degree. Two universities provide social work degrees in Northern Ireland: Queen’s University Belfast and Ulster University. These two universities must adhere to the same agreed-upon aspects of course design and delivery. The Bachelor of Social Work degree program at Queen’s University Belfast is one of the largest social work training programs in the UK (Wilson & Campbell, 2013; Wilson & Kelly, 2010), offering a three-year undergraduate route (64 students), a five-year part-time route (8 students) and a two-year route for those who already have a relevant degree (e.g., in psychology or sociology; 40 students).
The “Theory, Skills and Preparation for Practice Learning” course runs for 12 weeks and incrementally encourages students to begin their professional development journey from student to social work practitioner. Students are required to complete three role-play examinations. In the first, students interview one of their peers acting in the role of a service user (client). In the remaining two role-play examinations, students must interview a service user or caregiver (who is, or has been, a user of social work services). The focus of the interview is on a situation that is real for the service user or caregiver. Students are also required to write a preparation for their service user/caregiver interview and a final reflective paper at the end of term.
The learning outcomes for this course aim to prepare students for field placements, focusing on the development of knowledge, skills and values with which to inform practice. The course includes a broad range of robust learning outcomes designed with the singular focus of supporting students for their debut field education experience. These include: 1) enhancing student understanding of theories and methods for social work practice with individuals, groups and communities; 2) equipping students to develop interpersonal communication skills for engaging with services users and caregivers at each stage of the social work process; 3) supporting reflective and reflexive practice to promote student self-awareness and enhanced skill development; and 4) fostering an emerging understanding of an anti-oppressive approach within the context of engagement with service users and caregivers.
The course comprises two teaching days per week: one day is reserved for linking theory with practice, while the other day focuses exclusively on supporting students to prepare for social work practice. Given the breadth and depth of this dual-content course, two social work educators are assigned as course coordinators—one to the theory element and the other to the Preparation for Practice (P4P) course. The theory stream uses traditional lectures and seminars to reinforce the learning gained through case studies and group-work approaches. P4P, however, employs a distinctly different learning application. Each day begins with a two-hour lecture, following which students move into smaller groups (15 maximum) to engage with a qualified field instructor and social work educator. These workshops cover a wide range of skills, such as assessing one’s own learning styles and making effective use of supervision. The main method of learning is through role-playing. Each group is provided with an iPad so they can record and review their respective role-plays every session. Every week, students are required to prepare for each role-play. Each student role-plays various scenarios using a unique service user engagement framework called the “tuning-in framework.”
The “tuning-in framework,” which was developed by Douglas and McColgan (1999), is a model unique to Northern Ireland. The framework encourages students to empathetically engage with service users and caregivers based on various engagement points. Key features of the framework include: 1) understanding the relevant legislation that might apply to the situation; 2) identifying the relevant policies and procedures that should be considered (e.g. confidentiality); 3) applying theoretical considerations (e.g. strengths-based practice, systems theory); 4) employing previous knowledge of the case (e.g. case records); 5) tuning into one’s feelings, which is relevant to Shulman’s tuning-in concept (Shulman, 2006); 6) identifying the skills required (e.g. empathetic engagement); and 7) considering values (e.g. non-judgmental perspectives).
An important element of the social work educational experience is being exposed to direct observations. P4P sets the foundation for students beginning this process of structured observations and feedback provided in real time. Grounds rules are set at the beginning of the semester about providing supportive and constructive feedback. As the semester progresses, students are exposed to feedback from service users and caregivers. Students find this feedback particularly essential for skills development, as these individuals have lived experiences and can provide authentic feedback about students’ engagement with them. These workshops, including role-plays with peers and later with service users and caregivers, become a microcosm of the future placement experience.
An important development in social work education in the UK has been the systematic involvement of service users and caregivers (Department of Health, 2002; Department of Health, Social Services and Public Safety and Northern Ireland Social Care Council, 2015). This innovation, which recognizes the distinctly important contribution of lived experiences, accompanied the UK-led reform of social work education in 2002. Since then, there are examples in the literature of service users being involved in the assessment of social work students’ capacity to make the developmental transition into their first field placement (Advocacy In Action with Staff & Students from the University of Nottingham, 2006; Crisp, Lister, & Dutton 2006; Elliott et al., 2005), providing feedback on students’ assessed work (Bailey, 2005), taking part in role-plays to assess practice skills (Duffy, Das, & Davidson, 2013), providing feedback to students during practice (Ferguson & Ager, 2005), providing “live-in placements” for students (Gee, Ager, & Haddow, 2009) and helping students understand the impact of political conflict (Duffy, 2006, 2012; Coulter, Campbell, Duffy, & Reilly, 2013).
The UK is the only country where service user involvement is a mandatory part of the social work curriculum (Anghel & Ramon, 2009; Robinson & Webber, 2012). There are innovative examples in the literature of service users working with higher-education providers to increase students’ understanding of key aspects of social work knowledge (Gutman, Kraiem, Criden, & Yalon-Chamovitz, 2012; Kjellberg & French, 2011; Zaviršek & Videmšek, 2009).
The literature is at quite an early stage with respect to evaluating the longer-term impact of service user involvement on the practice of social work students, particularly those who have completed their degree studies. However, Tanner, Littlechild, Duffy & Hayes (2015) demonstrate the impact on newly qualified students, after one year of employment, of exposure to individuals’ lived experiential perspectives through their education. This research also, however, highlighted the challenges faced by newly qualified social workers in achieving personalized and person-centred approach to social work when faced with the demands and challenges of a highly regulated and managerial social work practice landscape. Nonetheless, Trevithick (2014) has argued that social workers need to navigate their way through these challenges to achieve a practice that emphasizes the importance of humanity.
The very idea of involving “outsiders” (Banks, 2006) in social work education has been discussed in the literature (Carey, 2009; Cowden & Singh, 2007; Crisp et al., 2006; El Enany, Currie, & Lockett, 2013; Rimmer, 1997). The underlying inference is that this type of knowledge is subjective and highly individualistic, and therefore of less value than more traditional, positivistic standpoints (Beresford, 2013). The emotional nature of exposure to personal narratives has also been discussed and recognized in the literature (Duffy et al., 2013). Duffy et al. (2013) have also examined the ethical issues associated with the very idea of service users and caregivers sharing personal experiences that could generate possible distress through their recall. The “ethics of care” approach has, however, been applied in this type of work and been shown to be very useful in helping all parties involved ensure that ethical issues are openly acknowledged and carefully managed (Hugman, 2005; Ward & Gahagan, 2012).
The literature also recognizes the positive impact on social work students of exposure to service users’ lived experiences in social work education. Gutman et al. (2012) have argued that social work education is the most appropriate place for students to most effectively understand the meaning of partnership work with service users. Gutman et al. (2012) have also argued that by promoting the very concept of inclusivity in the social work education experience through the direct involvement of service users in a teaching role, social work students are more amenable to appreciating the importance of inclusive knowledge. There are also examples in the literature of students’ understanding of the meaning of “threshold concepts” (Foote, 2013; Meyer & Land, 2005), such as social work values and the impact of political conflict, being facilitated by their exposure to service user and caregiver teaching (Duffy, 2012; Duffy & Hayes, 2012; Duffy et al., 2013).
The involvement of service user and caregiver perspectives is not without challenges and requires careful planning and preparation (Duffy, 2006; Levin, 2004). Social work students are necessarily exposed to a myriad of different types of knowledge (Trevithick, 2014). To include service user and caregiver knowledge in the educational experience for social work students is to endorse the argument that there is no universality of knowledge, and the acceptance that knowledge derives from a variety of different standpoints (Rose, 2009).
The case study that follows focuses in more detail on how service users and caregivers are involved in the process of assessing and preparing students for practice in Northern Ireland.
The Northern Ireland Social Care Council requires that students successfully complete P4P, with students interviewing each other and then gradually transitioning towards incremental engagement with service users and caregivers. While the experience is transformative for students, the complexities of preparing for this process can be challenging and require careful planning, thoughtful consideration and a high degree of emotional intelligence (Goleman, 2011). By positioning this experience at the beginning of students’ careers, it is possible to shape and cultivate an empowering and collaborative understanding of how service users and caregivers deserve and demand the best-quality service.
The authors have worked collaboratively on this course for the last three years. They have begun to crystallize their understanding of the complexities and opportunities involved in making this experience a successful one for the participating students, service users and caregivers, and the teaching dyad of the field instructor and social work educator assigned to each small group. The teaching team includes this larger group of academic and agency staff, service users and caregivers. This case study breaks down the authors’ experience into different phases of implementation so that others can benefit and create similar models within their own institutions.
Tuning in to our Teaching Process
Providing the teaching team with an overview of the organizational requirements for the course can allow the team to better adapt to the intricacies of possible future pedagogical challenges. Service users and caregivers are invited to meet with the teaching staff. Cups of tea and biscuits are important in supporting this group! It is important for the group to feel nurtured, supported and empowered. These pre-planning discussions often evolve into unique conversations that can include more experienced service users and caregivers exploring and sharing their stories with others. More experienced service users and caregivers often share stories with new members of the teaching team of student successes, challenges and methods for providing compassionate feedback following assessed role-plays.
Prior to the assessed scenarios, each service user and caregiver writes his or her story in a concise, 100-word vignette. With only this small amount of information provided, students are encouraged to hypothesize about what scenario might arise during the role-play. However, students often tended to focus on and sometimes over-rehearse this scenario developed by the service user. In the last rotation of this course, there were challenges whereby the service user and/or caregiver shifted their scenarios, sometimes in such a way that the student was thrown off-balance. On occasion this resulted in students feeling demoralized, and that they would never be successful in their engagements with service users and caregivers. The authors learned from this experience and, at the next assessed role-play, worked hard to ensure that the group of service users and caregivers were more fully prepared to stay closely aligned with their written scenario, without coming across as being too prescriptive.
Another challenge was service users and caregivers wanting to share more than was necessary in the assessed role-play. They spent much of the short interview time (5 to 10 minutes) verbalizing their experience. Students needed to be able to demonstrate their skills of effective interviewing, including open-ended questions, reframing and empathetic engagement. If the service user or caregiver was too verbose in the interview then it became challenging for the student to interject and make key points to demonstrate his/her competence.
Following each of the assessed role-plays, the social work educator, field instructor and service user and/or caregiver meet briefly to compare notes on how the student performed during the interview. Service users and caregivers are central to providing this feedback and students have stated repeatedly that this feedback is essential to their learning journey. In some instances, service users and caregivers have provided feedback that was, at times, quite harsh. The individual service user’s or caregiver’s own previous experience of social work engagement can play a role in how feedback is shaped. Some students appeared distraught after hearing their feedback and, while this experience provides real-world learning, students also need to have opportunities for success, particularly at the beginning of their social work educational journey. The authors therefore returned to their service-user/caregiver group to provide further coaching on providing constructive and balanced feedback to students.
It might be suggested that engaging service users and caregivers in students’ learning is simply too complex. But practice is complex, and the authors’ belief is that setting the stage and providing real-world opportunities at the beginning of the social work educational journey gives a more realistic perspective and enhances the opportunities for learning how to engage with service users and caregivers within the context of a safe and supportive learning environment. The teaching team has met the challenges of engaging with service users and caregivers in this context by setting up the learning environment to focus on the “ethics of care” approach. The authors cultivated supportive and resilient working relationships with all members of teaching team, with an increased emphasis on creating caring relationships with service users and caregivers. Rather than viewing this population as too “difficult to engage,” the authors instead chose to cultivate strong working relationships with service users and caregivers right from the beginning. By meeting regularly over the course of the semester with all members of the teaching team, the authors were able to address complex issues such as providing constructive feedback to students. In doing this, the authors were able to provide a rich learning environment that paralleled a caring and compassionate social work partnership.
Over the course of the past three years, the internal teaching team of assigned social work educators has been able to draw out several themes that have seemed to resonate across years, student groups, including course evaluations, and engagements with service users and caregivers.
First, service users and caregivers often drifted from the written vignette when they met with students in person. This challenged the students, because what was written on paper was not being portrayed in the role-play. The challenge for students was to remain “unrattled” by the shifting scenario in front of them. Some students rose to the challenge, but others were overwhelmed by the apparent change to the script. Service users and caregivers held that their stories could not be neatly packaged into 100-word scenarios; their lived realities were more vibrant and detailed when spoken in person. While students had to learn to move with the evolving discussions, the authors also needed to ensure that students were provided with a fair and equitable interview experience. If service users and caregivers shifted their stories dramatically with students, the authors explored with them how this might cause stress for students and make it difficult for them to meet their expected competencies for an assessed role-play.
The second theme identified revolved around the issue of providing feedback to students in a supportive and constructive way. When feedback was overly negative some students expressed great distress. They became upset, anxious and fearful that this one experience would set the tone for the remainder of their social work career. Helping students to recognize that they did indeed have the necessary skills despite challenging feedback could be a difficult feat. At times, the authors had to meet with service users and caregivers to ask them to be authentic but compassionate in their feedback to students.
The internal teaching team managed these challenges through an “ethics of care” approach, where these difficult issues could be discussed in the context of a caring, supportive relationship already established with all of those involved in the teaching process: service users and caregivers, social work educators and practice teachers. It was through these relationships that the hard conversations could be had. The upfront meetings, discussions and evolution of relationships built over time allowed for deeper, richer and more productive outcomes for students. The course coordinator actively sought feedback from students after each of the assessed role-plays. She asked them how the role-play had gone, and what could be changed to support their journey. Students provided rich feedback that was, in turn, fed back to the teaching group. The authors actively integrated the feedback and kept conversations going about how to evolve the learning environment.
Given their journey and experience, the authors were able to ask themselves, and those around them, challenging questions about the intersection of engagement with service users and caregivers and their own evolving practice. Several key questions came to mind. A paramount question included: If it is important to assess and mark the practice of student social workers and involve service users in that assessment, then why not routinely utilize either of those processes with social workers in practice? The bar is set very high at the beginning of a student’s social work career but, over time, expectations diminish or disappear altogether.
With technology and informed consent, it is possible for social workers to record interviews using smartphones and to review these sessions in supervision sessions. The social work educational journey should be the beginning of observing our practice, not the beginning and end of this process.
Another foundational question is whether actors or service users and caregivers should be engaged for role-plays. There are anecdotal perspectives that engaging actors involves less work when preparing assessed role-play sessions. While this may be true, the reality is that students will interact with service users and caregivers during their first field placement. The authors believe it is better to provide an opportunity for such interactions ahead of the field-placement experience so that students can gain the confidence and competence to take on this challenge in the real world.
While it is true that this format of teaching students to prepare for practice is complex, organizationally challenging and emotionally demanding, the authors believe that it is the best possible model with which to prepare students for real-world challenges. Educators have a duty to prepare students as best they can before students enter a field placement. By engaging with upfront practice and with service users and caregivers, educators can create a path that is less traveled but far more reflective and transformative for present and future students. The authors hope their model will inspire other social work programs to consider these unique and foundational ideas.
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