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Beyond Participation to CoproductionNerida Hyett MHSc BOTPhD Candidate, LecturerLa Trobe Rural Health SchoolJuly 2013latrobe.edu.auCRICOS Provider 00115M#La Trobe UniversityMy presentation today will provide an overview of:-Our research program on community participation and health-What we are learning about participation-New methods and models of participation that are achieving good health and social outcomes here in Australia and overseas

1Improving the Health of Communities through Participation

INTERNATIONAL CASE STUDIES ON COMMUNITY PARTICIPATION AND HEALTHINCLUSION AND EXCLUSION IN COMMUNITIESCOMMUNITY HEALTH LITERACY#La Trobe UniversityResearch programResponding to health service quality and safety standards, and international calls for better community engagement in health careIncreasing recognition that research needs to be grounded in local communities, and,Rural health needs local solutions that are developed with communities, rather than one-size-fits-all approaches developed elsewhere

Aim is to work with communities to develop plans and solutions for targeted local health issues, to understand how to work with communities, and to improve outcomes for health and wellbeing.2Community Participation and Health

Schmidt & Rifkin (1996) defined community participation in health as:

A social process whereby specific groups with shared needs living in a defined geographic area actively pursue identification of their needs, take decisions and establish mechanisms to meet their needs

#La Trobe UniversityCommunity involvement in health care is not a new phenomenon, and the role of communities was first recognised in the international health policy agenda in the Declaration of Alma Ata (WHO and UNICEF, 1978), and by the WHO (1985), which defined community involvement as ... a process by which partnership is established between government and local communities in the planning, implementation and utilization of health activitiesto increase benefit from self reliance and social control over the health infrastructure, technology and process (p. 4).

Definitions and models of community involvement, or participation and engagement are prolific. Principles shared by these like terms are the central role of citizens, and the utilisation of community strengths, resources and assets, for the development of solutions to local problems through cooperation and partnership.

Community participation has been defined as a social process whereby specific groups with shared needs living in a defined geographic area actively pursue identification of their needs, take decisions and establish mechanisms to meet their needs (Schmidt & Rifkin, 1996, p. 346). 3Iap2 Spectrum of Public ParticipationIncreasing level of public participation INFORMCONSULTINVOLVECOLLABORATEEMPOWERAdapted from the IAP2 Spectrum http://www.iap2.org.au/documents/item/83#La Trobe UniversityDoesnt specify which publics, where or whenDoesnt explain challenges associated with these processes4Arnsteins Ladder

Arnstein, S. (1969) #La Trobe UniversityUnidimensional

Power and empowerment, resulting from paternalistic manipulation

Implies that lower levels of participation are inadequate at all times

May lead to increased marginalisation of latent publics, people who choose not to participate

Does not consider how people participate in different ways5Inclusion and representationSeeking a diversity of views rather than a representative view Public is not homogenousDynamic and self-defining entityActive public whose positions are formed through a process of engagement, and dialogue, with others

#La Trobe UniversityWho participates and why?

Historical methods that relied on sampling techniques do not have the capacity to represent public views

New ideas about the public, or a community of place:

Instead seek out diverse views from range of publics

Sciencewise have proposed 4 groups which will change depending on the issue: activist group who are organised around the issue, community sector who are not organised around specific issue but have important input, latent community no reasons to engage but have four groups proposed)

Dynamic, self-defining and active public whose positions are formed through a process of engagement with others (social process and dialogue is critical)

6Mobilisation and SustainabilityReadinessCommunity assets, skills and resourcesFundingCommunity organisingLocal solutionsLongevityIntensity

#La Trobe University7Coproduction Involving consumers in the production of the services they consumeLived experience has equal weight with clinician experienceOvercome challenges posed by health service silosSocial processNew health care delivery models resulting in long term changesMore effective use of natural and existing resourcesVolunteersNew pathways into education and training#La Trobe UniversityIf participation gives people a voice, then coproduction builds on this by suggesting that a voice is no good if nobody is listening

Predicted NHS 7% reduction in Emergency admissions, planned/unplanned admissions, and outpatient admissions, representing 4.4 billion pounds

What it isnt:

An adjunct service that is filtered through to health professionals and managers need to have direct conversations inputs/outputsService user networks that are primarily for peer support and operate in parallel to services

8Examples of coproductionNational Health Service UK: Consumers co-design care pathways, primarily for chronic diseasePeterborough Citizen Power: Recovery Champions working with AOD services to co-design more effective interventions for service users, and institutional mapping to integrate care between servicesService Users Network South London: Co-design and co- facilitation of a group program for people with personality disordersMore examples available here: http://allinthistogetherwales.wordpress.com/coproduction/co-pro-case-studies

#La Trobe UniversityService Users Networks coproduction group program for people with personality disordersThe project was established in response to a South London and Maudsley NHS Foundation Trust survey, which identified 4,000 people diagnosed with personality disorder who did not have access to a service meeting their needs. It was formed in consultation with existing service users, with the continual development of the service shaped though forums and conversations. The model achieves a 50% reduction in in-patient psychiatric bed use after 6 months of membership, which is sustained over two years. There have been no completed suicides in members in the 3 years since the project began, despite being a very high-risk population. http://www.innovationunit.org/blog/201306/supporting-mental-health-wellbeing-sunhttp://www.hear-us.org/aboutthem/croydonslam/slamsservices/touchstoneansthesunproject/thesunproject.html

Peterborough Citizen Power: Recovery Champions working with AOD services to co-design more effective interventions for service users, and institutional mapping to integrate care between health and social care services

Peterborough Citizen Power http://www.thersa.org/action-research-centre/public-services-arts-social-change/citizen-power

9Lessons learnedDialogue is criticalSocial and financial imperativeThere is no panacea and this is not easyRequires a cultural changeAssumes that people want to be involved, some may not want to be, and this might change for different issuesDoes not necessarily need expensive or time-consuming methodsBuilding coproduction into existing processes is more cost effective and meaningful#La Trobe UniversityWhat have we learned through our research and from international case studies?

10ReferencesArnstein, S. A. (1969). A ladder of citizen participation. Journal of the American Institute of Planners, 35, 216-224. Bovaird, T. (2007). Beyond engagement and participation: User and community coproduction of public services. Public Administration Review, 67(5), 846-860. Coproduction Network. Resources. Retrieved from http://coproductionnetwork.com/page/transitioning-to-coproductionDraper, A. K., Hewitt, G., & Rifkin, S. (2010). Chasing the dragon: developing indicators for the assessment of community participation in health programmes. Social Science & Medicine, 71(6), 1102-1109. doi:10.1016/j.socscimed.2010.05.016Nesta. (2011). The Business Case for People Powered Health. Retrieved from http://www.nesta.org.uk/areas_of_work/public_services_lab/health_and_ageing/people_powered_health/assets/features/the_business_case_for_people_powered_healtNeedham, C. (2007). Realising the potential of co-production: negotiating improvements in public services. Social Policy and Society, 7(2), 221-231. Rifkin, S. B., Muller, F., & Bichmann, W. (1988,). Primary health care: On measuring participation. Social Science & Medicine, 26(9), 931-940. doi:http://dx.doi.org/10.1016/0277-9536(88)90413-3h#La Trobe University11Contact:Nerida HyettN.Hyett@Latrobe.edu.au

Dr Amanda KennyA.Kenny@Latrobe.edu.au Thank youlatrobe.edu.auCRICOS Provider 00115M#La Trobe University12