Unbenanntes Dokument

1 Introduction

How to improve social services practice is of major current concern, especially when public sector funding is decreasing and welfare systems in many countries are undergoing major restructuring. In addition, how to include the perspective of service users is also becoming of increasing interest, although it is still regarded as an area which requires further development. In this article we aim to contribute to both these areas of thinking by focusing on the issue of partnerships in research on practice. This will be done by detailing some experiences from the Oslo Region of a Norwegian project (the HUSK program) which involves a formal collaboration between government (social services and practitioners), universities/colleges (researchers) and service users to undertake research and knowledge development to improve social services. In particular this article attempts to identify some issues raised from the experience and process of establishing partnerships between users, practitioners and educators/researchers to conduct research to improve practice in the social services

The article will be organized in the following way: first we will review the main issues regarding partnerships in practice-based research as outlined in the literature; then we will describe the main features of the HUSK program in the Norwegian context; and lastly we will detail aspects of the HUSK (Oslo) experience in attempting to form research partnerships.

We should note that this article is written by authors who come from the position of researchers. Although we recognize that it would have been desirable to include the direct perspectives of practitioners and users, we do not believe that what we present in this paper precludes these perspectives, nor do we claim to speak for practitioners and users. However we do hope that this paper represents as faithfully as possible the views expressed by the practitioners, users and researchers who participated in the workshops which we later describe.

2 Practice research and partnership: the main issues?

2.1 What is practice research?

In social work the term “practice research” is generally used to refer to research which is directly about, or contributes to, the practice of social work (Fook, 1996). However clearly it is not an uncontested term, as how both practice and research are defined, the reasons for such research, what epistemologies and methods are used, and who does practice research are all questions on which perspectives may vary (“The Salisbury Statement” 2008). For example, what research is and the reasons for it may vary according to who is conducting the research (for instance, practitioners may have different interests from researchers) (Uggerhoj, 2008).

However, since practice research must to some extent involve some kind of collaboration between what are often regarded as two reasonably separate worlds (the world of practice and the world of research) then some kind of collaborative relationship appears necessary to the effective conduct of practice research.

In addition, there are several different ways in which a researcher may relate to the field of research, which have a particular bearing on practice research.

  1. The researcher has no contact with the field of research ( for example, if simply using already collected data)

  2. There is a relationship between researchers and practitioners, but they have distinctive roles and tasks.

Practitioners conduct their own research, possibly with guidance from a researcher.

Research in partnership, where practitioners and users participate in the research process, and all are equal partners

This article focuses on the last type of practice research.

Practice research may involve the practitioner at any of the levels described in the section above, or may be initiated by the practitioner. The literature mainly discusses issues arising from practitioners combining research with their existing role. It is useful, however, to note that there is a difference between user involvement, and working in partnership.

Partnership is more than involvement and co-operation. Partnership is a form of work used in which partners with complementary and sometimes overlapping interests and areas of responsibility are involved in common planning, decision-making and implementation process. The aim is to promote participation in order to mobilize and co-ordinate resources and those improve the efficiency of the work. A partnership entails a real commitment on the part of those that become partners. In order to be successful, the work of a partnership requires support and understanding, willingness to change and commitment on those that form the partnership (Svensson & Nilsson 2008, 10-11).

Collaboration and partnership are therefore clearly intertwined. In addition, when the collaborative partnership between the worlds of practice and research is extended to included collaboration between researchers and research participants, then clearly there will be additional issues. Such relationships are obviously not unproblematic. Issues involved may depend on whose perspective is in question. For example, researchers may see collaboration as simply a question of how to most effectively explore participant’s views (Thomas & O’Kane, 2000) rather than about involving participants in an equal manner in the design and execution of the research. Participants and researchers may disagree over both the method and content of the research (Coughlan & Collins, 2001). Pragmatic concerns may militate against the ideal of collaboration, such as if participants are not considered to be able to fully participate (eg. if participants are considered to have a disability) (Coughlan & Collins, 2001)

2.2 Partnerships in health and social care research: mapping the field

For the purposes of this article it was important to examine the general literature on health and social care research and elicit the main approaches to partnerships between researchers, practitioners and service users. The key phrases used while searching the literature were: “partnerships in health and social care research”, “partnerships/collaboration in social services research”, “patient/service user involvement in social services research” and “interactions between service users, practitioners, and researchers”. Most of the material was found in three databases, ASSIA (Applied Social Sciences Index and Abstracts), Social Sciences Index and Social Care Online. In addition, extensive search was carried out within the following journals: Social Work, Journal of Social Work, British Journal of Social Work, Scandinavian Journal of Caring Sciences, Social Science and Medicine, Social Work and Society, Health and Social Care in the Community.

It emerged that in the field of service user involvement in health and social care there is a general consensus on the two main ideological approaches to participation: 1) the managerialist/consumerist approach, whose focus is the service system and whose aim is to get public, practitioner and service user input to inform services and provision and 2) the democratic approach, which focuses on how social problem situations are analysed from the viewpoint of service users and whose goal is to improve people’s lives by giving them the opportunity to have a greater say in how services are designed and delivered (Beresford, 2005; Braye, 2000; McLaughlin, 2009). A third approach to participation, called the ‘therapeutic model’, is also noted. In this model, participation is considered to have intrinsic value because it is good for people and the goal is to enable people to express things that are burdening them, without however changing the balance of power within the relationship between user and provider (Barnes & Wistow (1994) in Braye, 2000) which means that there is no interest in altering the distribution of power or who makes the decision. The therapeutic model therefore is not relevant to this article, as the emphasis here is on partnerships whereas practitioners, researcher and service users are equal partners.

The first two general approaches to participation, i.e. the managerialist/consumerist and democratic ones, have also informed the different types of service user and practitioner involvement in health and social care research. Building on the classic work of Arnstein (1971), but also on Christensen and Prout (2002), Hanley et al. (2004) and McLaughlin (2009), it is possible to identify a typology of service users as objects (where they are merely researched), as subjects (where their views are placed in the foreground of the research but ultimately the researcher decides on the ‘validity’ of these views), as social actors (where service users are agents who can act, change and be changed by their actions) and finally as active participants (where service users lead the research process). The managerialist/consumerist discourse is reflected in the first two levels of service user involvement in research and the democratic one in the other two levels, where service users either actively collaborate with researchers or actually lead the research (McLaughlin, 2009).

These types of service user involvement stem from different epistemological traditions and at a conceptual level may seem opposite. However, at a more practical level, the two exist side by side on a continuum and consequently they run the risk of overlapping and being confounded (Braye, 2000). Indeed several authors have pointed out that accountability within the research process remains a highly contested issue, as different groups of people with different interests have to find ways to collaborate, while at the same time there is widespread confusion about the ultimate purpose of user involvement in health and social care research (Begun et al., 2010; Heron & Reason, 2006; Matthies, 2005; Nolan et al., 2007; Rutter et al., 2004).

One reason for this ongoing confusion may be the fact that, even though the involvement of service users in health and social care policy and service development is widely supported and welcomed, there remains little evidence that it improves health or social care outcomes (McLaughlin, 2009: 3). Indeed, despite partnership working between service commissioners, practitioners, and service users being a policy objective, it is certainly not clear that there is any systematic evidence base for that objective (Rummery, 2009). Generally speaking we have little systematic knowledge about what the gains and achievements of different types of partnerships may actually be. But if we accept that the key role of health and social care research is seen as providing the evidence base for policy and practice and a basis for change, then there needs to be a clear understanding of the processes involved in actually achieving this change (Beresford, 2005: 8).

At the present moment in the field of service user involvement in health and social care research there is agreement on the need to move beyond static approaches, such as Arnstein’s (1971) linear model of citizen participation, which has been unable to capture the dynamic nature of involvement and the different relations unfolding between participants (Hernandez et al., 2008; Tritter & McCallum, 2006; Webb, 2008). There is growing support for interdisciplinary, community-based research (King et al., 2009) and a general acknowledgement that the different participants’ roles and responsibilities are not fixed but change along the research process, which is why service user involvement in research should be considered in the context of a dynamic continuum (Alabaster et al., 2000-2 in Lowes & Hulatt (2005).

However, this dynamic interchange of roles and responsibilities is not fully reflected in recent empirical literature on partnerships in health and social care research: there are several studies focusing on step-by-step reporting of processes and actions that led to improved health and/or social care outcomes but they do not explore systematically the interactions unfolding between all three groups of participants (i.e. service users, practitioners and researchers); the focus is on collaborations unfolding in dyads, that is, either between researchers and practitioners (Atwall & Caldwell, 2002; Lunt & Fouché, 2009; Petersson et al., 2009), researchers and service users (Fleming, 2005) or between practitioners and service users with little reference to the researchers’ involvement (Elsey & Lathlean, 2006).

It should be noted that there are some studies which capture in greater detail the dynamics of joint working by exploring how all groups of participants interact during the research process (e.g. Begun et al., 2010; Hernandez et al., 2008; Higham, 2001; Roose & De Bie, 2003; Rowe, 2006; Schensul et al., 2006; Sicotte et al., 2002). These studies focus more on describing processes not outcomes, with the exception of the work of Hanson et al (2006), whose participatory research promoted partnership working between researchers, practitioners, service users (older people) and their family carers and at the same time showed specific health and social care outcomes for frail older people.

Although in Norway service users have been involved as co-researchers in research about mental health (Kristiansen and Borg 2009), and in child care (Slettebo and Seim 2007), HUSK is the first project in the social services in Norway where users are involved on equal bases (Child care is not a part of the municipality social services in Norway).

The present article discusses the issues raised by participants in several projects involving partnerships between users, researchers and practitioners in the HUSK (Oslo) program. Even though it does not present concrete outcomes deriving from the HUSK (Oslo) program, it nevertheless highlights a range of very important issues regarding partnerships that need to be taken into account before as well as during carrying out practice research.

3 The HUSK project and Social Services in Norway

Municipal social services in Norway are viewed as an important aspect of efforts to combat poverty. These social services have a particular responsibility for providing financial support to those who cannot support themselves from wages earned in employment or from the national Social Insurance Scheme (includes disability benefits and rehabilitation benefits). Economic aid is intended as a temporary provision for those who are attempting to be self-supporting. It is means-tested and discretionary, therefore a residual provision.

Since 2007, a Qualification Program has been instituted in Norwegian municipalities. This program provides job training and on-the-job training for those who want an employed position or who want to pursue meaningful activity. It is also undertaken by those who wish to determine their eligibility for the Social Insurance Scheme (if they are unable to do the work required in an ordinary position of employment). The program is therefore for people who receive longer term economic aid, or for those who risk becoming long-term recipients. The Qualification Program requires full-time participation. Participants receive a wage and vacation time, like other ordinary employees. Participants themselves, to a great degree, can determine the contents of the program.

In addition to the Qualification Program, municipal social services must provide applicants with temporary housing, counsel, supervision, financial advice and debt settlement to enable them to better cope with difficult life circumstances.

Recipients of municipal social services do not make up a uniform group. For some, assistance is one -off. However, even though economic aid is supposed to be temporary, some receive this for a longer period of time and it is their most important source of income. Studies show that a great portion of long-term aid recipients have extensive and sometimes very serious health problems, and there is a tendency for problems to build up (see amongst others, Wel et. al. 2006).

4 HUSK: The university research program to support selected municipal social service offices

In 2006, The Norwegian Directorate of Health and Social Affairs provided funds to establish a university research program for selected municipal social service offices (the Norwegian abbreviation is HUSK). The goal of HUSK is to strengthen the foundation of knowledge used by municipal social services and the quality of the services that they provide. Three strategic goals have been identified by the HUSK program:

  1. To promote structures and arenas for binding cooperation on an equal footing between municipal social service providers, social service users, social researchers and social work/welfare educators.

  2. To strengthen practice-based social research.

  3. To strengthen the foundation of knowledge that underpins the practice of social work.

The Directorate provided funds for four regional HUSK projects, one of which is in the Oslo region. This article will document experiences from the HUSK project in the Oslo region and will primarily discuss some of the work done to achieve the two first strategic goals.

The HUSK project in the Oslo region is directed and administered by faculty members attached to Oslo University College and Diakonhjemmet University College. The activities are decentralized and are undertaken i in three wards of the capital city of Oslo, and in the neighboring municipality of Baerum. In addition, the social service user organization, Creative and Manifold Work Life (Norwegian abbreviation KREM), is involved in the projects that are connected with programs andpractices within municipal social services. KREM is an independent organization that also has responsibility for its own activities outside of the HUSK research program.

A great deal of space would be needed to discuss all of the projects and activities in the Oslo Region HUSK program. A few of the activities are listed below to illustrate the work that is being done: 1) Establishment of a university clinic in social work to raise the competence of leaders and employees of municipal social service offices, social work/welfare educators, social work students and social service users. 2) a service user forum specifically for service users that have an ethnic minority background. 3) Design and implementation of a course to be delivered at Diakonhjemmet University College to develop methods for promoting user participation in social work practice (the target group includes social work students and users of municipal social services). 4) A project for young people between the ages of 15 and 25 years who have dropped out of their high school educational program. 5) The implementation of Dialogue Conferences, for social service users and social service employees, as a step in evaluating municipal social services. 6) Seminars and courses to enable service users to make a positive and competent contribution in research studies.

The HUSK program for the Oslo region stipulates that all partners must be represented in all levels of program management (for example, steering groups, boards of directors) and in all activities. The active involvement of service users is a particular priority. The two last activities (numbers 5 and 6) referred to above were initiated by service users and have already been implemented. They are pioneering ventures and, as such, fulfill the requirement set by the Directorate that new forms of cooperation between the parties should be developed.

Social work practitioners, social researchers and social work educators have relatively clear and defined roles, and service users have traditionally been seen as being the ones who are in need of help. Seeing service users as equal partners however, represents quite a new perspective, for everyone - users and their partners. As already mentioned, many of the users of municipal social services have extensive and serious problems, so their contribution as equal partners in research efforts needs to be thought through. However, many of the service users who are involved in the HUSK program have extensive and relevant resources. KREM does not want to merely be a service user organization that makes demands upon municipal social services. The organization wants to make a creative contribution, , to build bridges between service users and municipal social services.

Service users within the HUSK program have participated in creating new roles for themselves. They are important in communicating the experiences of service users. Service users have also contributed to HUSK by providing new ideas and suggestions for new projects. The personal experiences that service users have in coping with very difficult life situations, and their experiences with municipal social services combine to make for very significant competencies which can be used to strengthen the foundation of knowledge and practice competencies of social work practitioners employed by municipal social services.

The HUSK program has been in operation for three years, and the partnership has not functioned without difficulties. The partners in this program have very little experience with this kind of partnership, where all participants must adjust themselves to the demands, expectations and needs of other parties. This has been more demanding than we had imagined it would be at the outset. In several cases, service users, in particular, have challenged established attitudes and structures.

5 Research on the partnership within municipal social services

The HUSK program aims to strengthen practice-based social research, and there is a continuing discussion on the relationship between social research and social work practice. In addition to this, there is also a continuing discussion on the relationship between social research and social service users. An important contribution of HUSK is therefore to help conceptualise the nature of social work practice research and successful partnership relationships associated with it.

6 Method

To help achieve this contribution, several full day workshops were held, to discuss project members’ experiences and to begin to outline the features of good collaborative working under the HUSK umbrella which arose from these experiences. Four workshops were held between May 2008 and April 2009. Invitees were HUSK project leaders as well as other participants in HUSK projects. Attendance at all workshops comprised researchers, users, practitioners and academics, as well as some co-ordinators of HUSK projects from participating colleges (Oslo University College and Diakonhjemmet University College). Attendance at each workshop ranged between 8-25 people. A small core of people attended all workshops.

Jan Fook [one of the authors of this article] has been employed as a consultant with HUSK Oslo since 2007 and has facilitated these workshops. The first workshop format was designed by HUSK co-ordinators and began with brief reports on selected projects followed by a discussion to outline the major questions which arose about social work research more generally and HUSK research in particular. The subsequent workshops developed themes which had arisen from earlier workshops, as formulated by the attending participants. These latter workshops had little pre-planned structure but were designed to broadly follow on from previous discussions: specific topics were decided by participants at the beginning of each session. Jan Fook facilitated the discussion and recorded notes on the board at each session. These notes were coded and thematically anaylsed to provide the summaries reported here.

A summary of themes relating directly to research and partnership which were discussed at the workshops has been included, in order to provide some context to the more specific discussions on making partnerships work. Other themes arose, such as conceptualisations of the nature of research, and it appears that understandings of partnership may have evolved as experiences with projects evolved, and as participants’ understandings of research developed. However these other themes have not been included because of space limitations. Nevertheless it is interesting to note that over time discussion in the workshops changed quite a bit in focus. At the outset discussion was much more about a general understanding of social work research and its overarching aims, paradigms, methods and approaches. In the last workshop the discussion was much more about the experience of making partnerships work (especially learning from instances where it was perceived that partnerships were/not successful). In between the issues which were important were more to do with the nature of partnership, differentiating research and development, and finding relevant ways to document HUSK research and make it visible. This may partly reflect a process of participants becoming more comfortable in airing specific concerns. At the end of the last workshop participants drew up some recommendations for encouraging the partnership process.

7 Main themes

The themes discussed in the workshops included the broad aims and understandings of research, roles and perspectives, the process of research and the design of research programs, as well as the nature and practice of partnership. However for the purposes of this paper, we have decided to focus on two main themes:

  1. the aims and outcomes the nature and what counts as research, and the distinctive nature of HUSK practice research

  2. partnership

It is also important to note that there were often terms used in the discussion which were not necessarily clarified or discussed further (eg. “equality”; “paradigm”) but they have been included as they were terms raised by participants themselves.

1. The aims and outcomes of HUSK practice research

It was clear form the outset that participants believed that HUSK research should benefit service users and have a user focus. What is research, and what counts as research however became a significant ongoing questions, which had both technical and political aspects. On the technical side, it was more a matter of methods (ie. what is the difference between research and development, and what methods are appropriate?). From a political perspective, it was more a question of who has the power to decide what research is, and how it be made more visible and acceptable to these groups?

From this latter perspective the issue of how to document such research became paramount, and was intertwined with the issue of how to make the research more visible. Issues here involved how to document a “moveable target” and/or material which is tacit. At what part of the process is it appropriate to document?

2. Partnership

The notion of partnership, what it means, how it works and how it is developed underlay most discussions but became more explicit and specific in the later workshops. Interestingly it was not mentioned as a major concern in the first workshop. In the second workshop several important preliminary issues were noted:

  • What does partnership mean? An important aspect of partnership involved showing respect for the contexts in which other partners work. This meant, for instance, recognizing and acknowledging that different contexts place different demands, such as academics being expected to publish; practitioners being expected to be available to service users. Openness to each other and how to do things was raised as important in working out how to work together, in that people need to be aware of how they do things and be open to the possibility of doing them differently. Acknowledging differences in resource allocation (between researchers, users and practitioners) was also seen as particularly important, in that some partners are better resourced to undertake research. This was seen as a particular issue for pracititoners, who were often not financially supported to take part in seminars or conferences which might assist in building research partnerships.

  • What does equality mean? There should be equality in an ethical way, but there also should be acknowledgement of different types of contributions. There perhaps should also be equality in terms of power and resource allocation.

  • “partnership” or “collaboration” may be better terms than equality. Partnership leads to new or combined developments, through an exchange of perspectives. This may lead to a change of paradigm, and the place of users’ perspectives is important in this.

  • that an important aspect of HUSK research is to create spaces, opportunities and arenas for partnership.

8 Making Partnerships Work

In the third workshop it was noted that an important issue is how to engage people in partnership - the groundwork involves developing a partnership culture, and establishing trust. Some ways of doing this might be to: use flexible contracts; outlining respective roles and expectations; revising these as projects evolve. It was also suggested that focusing on ‘what works” could help in developing a set of guidelines for partnership.

Significant time was devoted to discussing how to create a space for partnership to develop. Some time was spent discussing the “Turkey” experience. Users and some researchers had been attending several 2 week ‘retreats’ in Turkey, organized by users. These retreats were seen as crucial in developing user empowerment, but also in forging strong partnership relationships. (A separate evaluation of these experiences has been undertaken by Slettebø, Brodtkorb, Dietrichson and Lyhne (2009)). The “Turkey’ experience had become somewhat symbolic of a space which could help develop partnership. Features of this space included: time away in a meditative environment; a more neutral space where people related not in terms of roles and without too many preconceptions of each others’ roles.

The entire final workshop was devoted to discussing how to develop and maintain partnerships, and in particular to discuss learning from specific experiences.

First, two key issues were noted:

  • Acknowledging the difficulties of making change, especially a paradigm shift, therefore:

    • Noting what attitudes are necessary for successful partnerships, such as willingness to change

    • The ease of falling into the “old” way of doing things, therefore needing to be constantly mindful of how the collaboration is being practised

    • Noting that people might be “stuck” in roles (perhaps because of comfort, or expectations of others) therefore a need to redefine potential roles/contributions from the beginning and through the whole process

  • Acknowledging differences in perspectives and positions:

    • Of the 4 partners involved (users, researchers, educators and practitioners) users are a more dispersed group which means they do not have an organization or role to fall back on as easily as other partners

    • There is a need NOT to assume a “common” user - a need to look at assumptions/generalisations made about each group

Next the group discussed what makes a partnership work (drawing from their own experiences). Whilst some of these features would be expected to form part of any successful relationship, such as “good communication” and a “capacity to select appropriate team members”, there was much emphasis placed on less tangible aspects: “Having a space to get to know each other and establish trust”;: “a preparedness to open up to change roles, and sometimes to give up power”; “a willingness to learn from each other on the basis of specific contributions (not just predefined roles, including gender)”. Also emphasized was the importance of the partnes’ ability to develop and ability improve the performance of individual team members. Lastly, “creating new labels” such as ‘co-researcher’ was an important practical suggestion to support these less tangible features.

Participants posed the following question, which arose through some of their experiences when team members had worked well together, but it still did not seem as if they were working in terms of some of the principles of partnership: “What might contribute to a partnership working well, but still not necessarily achieving the goals of partnership?”

Power issues were first raised as clearly playing a role, for example:

  • Whose assumptions or premises are dominant?. Sometimes the views of the more powerful group or persons are assumed to be the “right” ones and everyone accepts this unquestioningly, and therefore these are not discussed openly from the beginning

  • When change is happening it is important not only for some people to let go of roles/power but also for others to step up to these. It may be difficult for users to “step up” to what they see as more powerful roles

  • The relative role/power of different partners is a factor and needs to be acknowledged from the beginning

Issues relating to group culture were seen to have an influence on who speaks up and whether dissenting views are heard. For example: “Sometimes it is hard to dissent when the culture is friendly (ie. Hard to be unfriendly or “stick neck out”); practicalities may take over when differences are hard to resolve; if group membership is inconsistent (ie. different members attend at different times), it is hard for new members (especially users) to have an equal say in a group which is already formed.

There was quite a deal of discussion regarding the reasons group members might not “push the case” if they feel they are not being heard. This was fruitful as it helped to highlight how specific experiences and perspectives might militate against changing a group culture towards better collaboration. Reasons suggested included:

  1. It may not feel worth the risk (ie. May not feel that they can make a difference or change the views of the group)

  2. It is not always clear what is happening and people may be reluctant to speak out until they are clear (and then it may be too late)

  3. Sometimes “testing the water” may yield no encouragement to continue

  4. Some people may feel their role/status is less important, or they have less experience and therefore authority to disagree

  5. Fear of not being further included, fear of criticism, or of “standing alone”

  6. There may be unconscious ways of silencing or being silenced

Finally the workshop group formulated a set of recommendations to encourage the partnership process, based on the foregoing discussion:

  • Clarify the goals and directions of the project (and basic assumptions and expectations) early on, but also continuously

  • Clarifying the kind of partnership which is needed to achieve the specific goal/s of the project (ie. What combination/proportion of roles, who leads, etc).

  • Keep an open culture in the group to include all different viewpoints, and to explore differing expectations, viewpoints, experiences.

  • Take into account the more subtle ways of creating group culture, and reinforcing more powerful cultures.

  • Recognize that there are different types of power which may operate differently in the group

  • Create a more “neutral” routine space to discuss the more “emotional” experience of the process (eg. Perhaps a small segment at the end of each meeting)

  • Be aware of attitudinal changes which are needed

  • Try to be self reflexive to appreciate the limitations of one’s own perspective and the subtle ways this might influence our behavior towards others.

9 Discussion and conclusion

What are the implications of the foregoing themes which have been raised by partners in the HUSK program?

What has been raised demonstrates the need to clarify very fundamental understandings about research, its methods, approaches, and the differing nature of roles and perspectives, in order to forge robust collaborations between the different parties involved. Whilst this is hardly a surprising finding, it is well worth re-emphasising this, particularly in the context of new partnerships, and taking into account the more subtle ways in which dominant ideas about research can be reinforced.

Creating spaces (and the subtle cultural and less subtle practical changes that this involves) for hearing and enabling the expression of differing viewpoints also emerges as a major theme from the HUSK experience. Clearly it is easier to talk about partnership than to practice it effectively.

The role of power and its operation in collaborative relationships is also an important theme, extending from decisions about legitimate research, knowledge and ways of documenting it, to how it functions within relationships at micro-levels.

How does the HUSK experience of collaboration and partnership in research relate to what has already been identified in the literature as major issues?

Interestingly, with regard to the two main approaches to user involvement identified in our review (managerialist and democratic ) there appears to have been a movement from a more managerialist perspective towards more democratic perspectives, and most particularly to a strong emphasis on empowerment of users involved in the research process.

Clearly also the issue of confusion about the approaches taken (Braye, 2000) and therefore the actual purpose of user involvement is echoed as an issue in the HUSK experience. Users experienced empowerment, and they clearly needed to become empowered in order to participate more fully in the partnerships. So empowerment is both a means and an end.

The HUSK experience contributes to the literature which examines the dynamics of partnership relationships. For example, technological and practical issues are noted (Begun at al (2010); and negotiation and dialogue are important (Higham, 2001). The necessity for administrative formalization (Sicoffe et al 2002) and a longitudinal perspective (Rowe 2006) on participant development are also key issues. While the HUSK experience confirms these points, it also adds a dimension regarding the micropolitics of developing day to day relations between partners.

Two more studies should be mentioned whose observations were aligned with the political insights derived from the HUSK program: Roose and De Bie (2003) presented the development in action research of a participative care practice in youth care and Hernandez et al (2008) discussed how they developed a practice model by interviewing a sample of seldom heard users and staff of social-care services. In both studies, it was not taken for granted that interdisciplinary collaboration would automatically result in better outcomes for the service-users. It was acknowledged that partnership is not a straightforward solution to a problem of inadequate services or policies because numerous tensions-(usually arising from power issues and rigid group cultures- and dilemmas are created as all groups involved interact. In order for partnership principles to underline the entire research process it is crucial to realise these tensions and dilemmas, discuss them openly and continuously negotiate them. The experience of the HUSK program which discussed how partnership principles can be restituted as collaborations unfold, clearly gives further support to the above position.

As identified by the literature, little evidence exists about the benefit of user involvement in research on improving outcomes of services. This aspect of the HUSK experience reported here was not designed to examine this issue, and clearly a differently designed project would be needed to investigate it systematiclly. However the experience of partnership reported here also suggests that there are many issues of importance regarding partnership which also need to be addressed before we are able to confidently assert the value of user involvement in research. These include a better understanding of the actual dynamics of establishing and maintaining successful partnerships between users and researchers in the joint goal of research for service improvement. This paper has contributed to this understanding by tracing the developments in thinking about research and the nature of collaborative partnerships from the perspectives of users, practitioners and researchers involved in the HUSK (Oslo) program.

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Author´s Address:
Professor Jan Fook, PhD
University of London
Royal Holloway
South West London Academic Network
C/- Dept Health and Social Care
TW20 OEX
UK
Tel: ++44 1784 443679
Email: jan.fook@rhul.ac.uk

Dr Maria Psoinos
Research Assistant
Faculty of Health and Social Care Sciences
St Georges University of London and Kingston University

Asbjron Johannessen
Associate Professor
Oslo University College

urn:nbn:de:0009-11-29253