Abstract
User participation is nowadays a desirable feature of social services work. The International Federation of Social Workers states that staff shall promote the participation of clients so as to “enable them to be empowered in all aspects of decisions and actions affecting their lives.” The statement is codified in various national ethical codes; the Swedish Code of Conduct and Ethical Behaviour for Social Workers specifies that interventions shall build on client participation and common agreement. However, a 2012 Swedish governmental report noted that among 16 methods for user participation in the social services, psychiatry, and abuse and addiction care, only one, shared decision making (SDM), had been evaluated in randomized controlled trials (RCTs). Given this lack of evaluations, how ought professionals to choose between the various methods? The aim of this article is to introduce distinctions in order to answer the question of how social workers ought to choose between different user participation methods, to suggest how this choice could be made, and to argue that the case for SDM seems to be stronger than for other methods. We can distinguish between justificatory, motivational, and explanatory reasons in order to clarify what types of reasons are relevant when choosing between methods. Another distinction concerns general and specific reasons for user participation. No particular method for user participation can inherit its support only from general reasons, since these ordinarily do not point out any method as better than another one. Rather, specific reasons are needed. Social workers do have good reasons for choosing certain methods for user participation rather than others. These methods can be found by looking at specific justificatory reasons. The case for SDM is strengthened by its having been evaluated in RCTs and also because the SDM components harmonize with relevant components in the presented (Swedish) legislation.
Highlights
In several countries, service user participation, or service user involvement, is considered a desirable feature of social services work
In their “Statement of Ethical Principles,” the International Federation of Social Workers (IFSW) states that “[s]ocial workers should promote the full involvement and participation of people using their services in ways that enable them to be empowered in all aspects of decisions and actions affecting their lives.”[1]. The international statement is codified in various national ethical codes for the social work profession
The Swedish 1974 Instrument of Government states that the public institutions should “promote the ideals of democracy as guidelines in all sectors of society” and “promote the opportunity for all to attain participation and equality in society.”[11]. And in the Swedish Social Services Act, we find several values that, taken together, express a particular perception of what it is to lead a good life; this perception includes components such as meaningfulness and active participation in community life
Summary
Service user participation, or service user involvement, is considered a desirable feature of social services work. Do professionals in the social services have good reasons for promoting or choosing certain methods for service user participation rather than others? Among the several general justificatory reasons for the social services to work with user participation, many ascribe value to user participation in virtue of its being a means to something else that is considered good These reasons are often of a moral kind, such as arguments that have to do with promoting user autonomy and empowerment. The best available knowledge and/or research, the professional's expertise, the person's (the client's or service user's) situation, experience, and preferences and external circumstances (such as legislation, guidelines, and locally available interventions) should be taken into account in a systematic way. Choosing SDM brings with it further new choices and assessments
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