EMPOWERMENT DECONSTRUCTED! A guide to outdo yourself and everyone around you - National Council of Social Service
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EMPOWERMENT DECONSTRUCTED! A guide to outdo yourself and everyone around you.
Prelude
1 Foreword by NCSS President
2 Foreword by AIC Chairman
3 Message by Sree Narayana Mission CEO
4 Executive summary
9 What is this guide about?
Understanding Empowerment:
the ‘What’ and ‘Why’
12 What is and why empowerment?
13 Common myths about empowerment
State of
Empowerment
16 Where are we at
as a sector?
C
A B
D
The Process
19 Do a self-assessment
25 Identify barriers to empowerment and actions to overcome
29 Design your solution and implement – learn from others!
44 Note to readers
38 Review your solution
Acknowledgements
45 References
President’s
Foreword
The concept of empowerment has taken centre stage in our social service
sector especially since the introduction of the 4ST (i.e. the Social Service
Sector Strategic Thrusts) in 2017. Our 4ST vision to empower every
person to live with dignity in a caring and inclusive society deeply resonates
with me. We should uphold the dignity of every person, independent of
race, language, religion, gender, age or ability by listening, giving them
choices and taking the choices which they make seriously.
Social Service Agencies (SSAs) play a key part in our community and as
such have a crucial role in empowering our service users. The way SSAs
engage service users affect the extent of choice and control our service
users have over their lives. While there may be physical and psychological
This guide aims
barriers faced by our service users, service providers can help overcome to promote
them by designing a conducive environment that encourages decision- empowerment in
making and pro-active ownership over these barriers and challenges. It is
practice by breaking
therefore important that our SSAs embrace the concept of empowerment
organisationally, so that practices can in turn be systematically shaped to down the concept
empower our service users. into relatable and
practical terms.
This guide aims to promote empowerment in practice by breaking down
the concept into relatable and practical terms. It is hoped that this guide
can be used as starting material to catalyse further conversations and
practice amongst practitioners so that you can further develop the ideas
which are relevant to you. We are all at different stages of understanding
what ‘empowerment’ means in terms of practice and application.
I encourage those among you with experience to step forward and
share your empowerment journey with others. It is only by sharing,
encouraging and inspiring one another will we learn more about what
empowerment means. Taking an empowerment approach is not easy. It
takes commitment, time, effort and resources but it will be worth it.
I sincerely hope that you find this guide useful for your empowerment
journey and I look forward to us taking a step closer to fulfilling our
vision of every person being empowered to live with dignity in a caring
and inclusive society.
Ms Anita Fam
President, National Council of Social Service,
Singapore
1
Chairman’s
Foreword
In deciding what to write about the importance of being empowered, the saying
“Use it or lose it” kept intruding my mind. If you do not exercise at all, your
muscles will progressively weaken to the extent that you will need assistance in
executing the simplest task. You are only used to carrying out orders, you will
over time, be fearful of making your own decisions. You become dependent
on tools and devices all the time, you will quickly be incapacitated when you do
not have access to these tools or devices – classic examples are our inability to
remember contact numbers with the reference to your phone list, or navigate to
a destination without the aid of a GPS map. Because of the myriad of tools and
devices introduced to make our life, apparently, better, we have progressively
disempowered ourselves. Deviously we have become dependent on external
inputs even though we are well equipped to function without their aid. It is the
dependency which disempowers us. Instead of using tools and devices as aids we
allow ourselves to be dependent on them.
To be empowered
To be empowered to me means being allowed to exercise independence, make
and learn from mistakes, to grow from one’s experience. To live a life of merely
to me means being
complying turns one into a mere robot and eventually we become nothing more allowed to exercise
than just a living organism, inferior to a well programmed robot which does independence,
not need any rest and through updates in its programming become more and
make and learn
more capable. With Artificial Intelligence (AI), the robots will eventually beat an
average human in the thinking processes too. from mistakes, to
grow from one’s
Even organisations can become disempowered when regulations become experience.
too prescriptive. It is worse when organisations adopt self-censorship and read
more than what the regulations require.
Like the tortoise, one must stick out one’s head to move along. Empowerment
leads to individuals and organisations taking responsibility and having the
courage to experiment and grow stronger.
To empower individuals in an organisation requires observing certain
protocols. The intent of empowerment is not to nurture mavericks (although
having a couple of mavericks properly managed can be an advantage) but to
grow individuals within the organisation, making the organisation stronger
and sustainable.
Be empowered and grow into the person or organisation you are destined to be.
Dr Gerard Ee
Chairman, Agency for Integrated Care
Singapore
2
Message from
Sree Narayana Mission
Empowering individuals, their families and communities
to live with dignity in a caring and inclusive society is
a noble vision. To give this vision impetus, NCSS has
identified ‘empowerment’ as a key strategic thrust in
its 4ST roadmap.
To help SSAs translate this strategic thrust into actionable
plans, NCSS has developed this very practical guide on
empowerment. It is a timely and laudable initiative.
Sree Narayana Mission (Singapore) is privileged to be
part of NCSS’ Empowering Seniors initiative. Today 1 in
8 Singaporeans is aged 65 years and above. By 2030 the
ratio will be 1 in 4 (or 900 thousand). Singapore society
comprising individuals, families and communities will have
To lead purpose-driven
a distinctly different ‘look and feel’. The reality of the lives is everyone’s
not too distant future means we need to relook how we birthright. Empowerment
perceive ageing and break away from existing paradigms
is the keystone.
to create an ecosystem which empowers seniors to
contribute and live purposeful lives.
To lead purpose-driven lives is everyone’s birthright.
Empowerment is the keystone.
I am confident that all SSAs and all who serve in the social
service sector will find this guide a very useful tool.
S. Devendran
CEO, Sree Narayana Mission
Singapore
3EXECUTIVE SUMMARY
Understanding Empowerment:
The ‘What’ And ‘Why’ MY
TH
What?
• Increase a person’s ability to participate in and
influence matters that affect his or her life
• Be characterised by strength, choice, ability to
make decisions, control and dignity
• Own issues and take charge of one’s own life
Why?
• Increases independence which leads to improved
quality of life
Myth 1
• Increases perceived quality of services received
SERVICE USERS MAY NOT WANT TO BE
• Reduces costs (less need for institutional support) EMPOWERED
• Promotes sustainable change (decreases reliance • One’s lack of resources and inadequate choice-
on external resources) making infrastructure discourages a person’s
motivation to express views, set goals and take
How? charge.
• Provide an environment that facilitates service
users’ understanding of their role, knowledge Myth 2
and skill acquisition EMPOWERMENT IS A PROCESS THAT PRIMARILY
HAPPENS AT THE INDIVIDUAL LEVEL
• Accept service users’ definition of the problem;
• Empowerment entails individual and collective
help them articulate clear personal goals
change; change is necessary at structural and
• Build on service users’ strengths community levels as the larger environment can
• Co-produce with service users undermine opportunities and participation.
State of Empowerment
Where are we as a sector?
From NCSS’ Social Service Sector Survey (2018),
more than half of SSAs are of the view that they are
to some extent practicing empowerment:
• 71% of the sector strongly agreed/agreed that
they provide options to service users.
• 58% of SSAs strongly agreed/agreed that they
At a collective level, NCSS has promoted
co-create services and programmes with service
empowerment through Public Education and worked
users.
with ecosystem partners to offer person-centered
• Almost half of the SSAs expressed a desire to services. For example, the Beyond The Label and
improve in co-creating solutions and programmes See the True Me public education campaigns,
with service users, particularly the multi-sector Peer Support Specialist and Empowering Seniors
and eldercare agencies. project.
Executive Summary 4C
A B
EXECUTIVE SUMMARY D
The Process
A. Do A Self-Assessment Co-Production is…
Ascertain to what extent service users in your agency A relationship where professionals and citizens share
have been participating in the design & delivery of power to plan and deliver support together, recognising
that both partners have vital contributions to make
services. in order to improve quality of life for people and
communities. - Nesta, 2012
Where am I?
Consider to what extent the 6 principles of
co-production are practised: Co-producing • Equal relationships
Doing
• Voices are heard &
With
1. Assets: Seeing people as equal partners rather acted upon
than passive recipients Co-designing
• Capabilities are valued
2. Capabilities: Building on what people can do and
supporting them to put this to work Engaging • Participation exists but
Doing
3. Mutuality: Reciprocal relationships with mutual remains shallow
For
responsibilities and expectations • Involvement limited to
Consulting
4. Networks: Engaging a range of networks, inside consultation
and outside ‘services’ including peer support, to
transfer knowledge Informing
5. Blurred roles: Removing tightly defined • Service delivery is
Doing
boundaries between professionals and recipients Educating treated as a ‘cure’
To
to enable shared responsibility • Service users are
passive
6. Catalysts: Shifting from ‘delivering’ services Coercing
to supporting things to happen and catalysing
other action Source: Slay and Stephen (2013)’s adaptation of Arnstein (1969)’s Ladder of Participation
B. Identify Barriers To Empowerment The Individual… Or The Organisation?
& Actions To Overcome …both. Successful empowerment requires changes
Identify the barriers specific to you and your within the individual and organisation. Belief
organisation so that you can take actions to systems, structures and processes are key enablers
overcome them and make progress. to empowering practice.
Common barriers Description I can…
Inadequate Policies • Empowerment not mandated in service • Share candidly with policymakers on the
models; lack of strong policy drivers ground challenges faced to shape policies
A General Lack Of • A need for more operational definitions for • Use templates & guidelines; share resources;
Understanding On What better actualisation at all levels speak to peers
Empowerment Means • Empowerment not embedded in the • Ensure senior leadership buy-in for
organisational culture, resulting in lack of/ empowerment to be structured in a way that
uneven application becomes ‘everybody’s business’
Resources • Insufficient resources that reduces • Share resources across organisations;
agencies’ capacity and/or lead to trade-offs Demonstrate co-production results
Accessibility • Service users experience barriers to • Co-produce format of meetings for
participation e.g. language, inaccessible accessibility; train staff to produce “Easy
formats, difficulty getting to meetings Read” documents; leverage on digital means
Executive Summary 5EXECUTIVE SUMMARY
C. Design Your Solution & Implement
How?
Stage Description Tools
Needs Assessment Service users identify their • Problem and Solution Tree
on service users needs and challenges • Future Workshop • Focus Group Interviews
(early stage)
• Backpack method • Kitchen Talks
Service Design Stimulation of new ideas for • Theory of Change
(after needs assessment) social services or adaptation of • Business Model Canvas
existing services • Double Diamond
TOOL 1: TOOL 2:
PROBLEM & SOLUTION TREE THEORY OF CHANGE
When to use? When to use?
When understanding problems and their causes. When activities that contribute to desired impact
need to be identified.
How to use?
Participants are put into small groups to discuss How to use?
problem, causes and consequences. Participants map out goals, logical steps towards
change, measurable effects and key assumptions.
What does it do?
Visualise how causes and problems are connected. What does it do?
Outlines steps to achieve goal; make connections;
spot risks; alignment to a larger goal.
Peers in the sector
SINGAPORE ANGLICAN COMMUNITY SERVICES ALZHEIMER’S DISEASE ASSOCIATION
Empowerment at Organisational level Empowerment through Voice
• Empowerment as purpose of the organisation • Encouraging service users to step up and speak up
• Staff mindset: Recovery model embraced by as self advocates to reduce stigma i.e. Voices for
majority of staff Hope programme
• Hiring practices: Ensure staff’s motivations are • Building networks of persons with dementia and
aligned and believe in empowering the vulnerable caregivers who are confident in public speaking to
individuals be a spokesperson
RAINBOW CENTRE
Empowerment through Community
• Tapping on strengths of Persons with Disabilities
(PwDs)
• PwDs and families are included and connected
with resources in the community through
community connectors
• PwDs are socially connected and supported
within their own communities
Executive Summary 6EXECUTIVE SUMMARY
D. Review Your Solution Some common
Evaluation is a useful process of reflection, indicators…
improvement and learning.
• Skill development
• Self-worth
Step 2
How will Step 3 • Competence
Step 1 we know? How will
What needs Outcome we do it? • Self-efficacy
to change? Indicators Inputs,
Visioning processes, • Willingness to participate in
Outcomes outputs
EVALUATION…AS collective actions
PART OF WORK CYCLE • Community connectedness
Ide • Control over decisions and resources
nt
ifi Step 5 Step 4
ed How useful Are we
ne doing it? How do we know which to adopt?
ed was it & what
did we learn? Monitoring
Evaluation • The World Bank’s Measuring Empowerment
Framework explains the factors affecting
Source: CDX. (n.d.) Empowering evaluation: evaluating empowerment. empowerment.
A practice sharing report from CDX
Measuring Empowerment Framework
An empowered person has the capacity to make Guiding Questions:
effective choices, that is affected by: (i) Agency • Are there opportunities to choose?
(ii) Opportunity Structure
• Are choices actually made?
Opportunity • Does the choice made bring desired outcome?
Agency
Structure
Consider Domains:
State (political participation), Market (credit, labour,
Degree of goods), Society (family, community).
Empowerment
Consider Levels:
Macro (National), Intermediary (between national &
Development
Outcomes residential), Local (residence)
Source: Figure 1 in Alsop, R. & Heinsohnn, N. (2005).
Empowerment Framework
Domain/ Contributory Level
Subdomain Factor Macro Intermediary Local
State – Justice, i. Agency Degree of Empowerment
Politics, Service ii. Opportunity i. Presence of choice
Delivery Structure ii. Use of choice
iii. Effectiveness of choice
Market – Credit,
Labour, Goods
Society – Family,
Community
Executive Summary 7What Is This
Guide About?
8The journey to empowerment
is a collective effort.
Let us begin this journey together.
What does it mean to empower individuals, their This user-centred guide on empowerment is iterative
families and communities? While we understand its in nature as there are always new discoveries and
broad underlying intent to promote ownership in perspectives gained through social service practice.
issues and independence, where do we begin? What We therefore encourage readers’ active participation,
are the practical steps we can take to start, grow and voice and contributions for the guide to remain
influence others on this journey to empowerment in relevant to users.
the social service ecosystem?
The journey to empowerment is a collective effort,
This guide is for you if you relate to those questions. let us begin this journey together.
Although primarily targeted at social service
practitioners, this guide is also useful if you are a
funder, researcher, advocate, or just someone with
a curious mind, as you can play a part in advancing
empowerment in the social service ecosystem. Legend of
Symbols in Guide
The contents of this guide were drawn from
observations of practice both locally and overseas, Reminder
as well as from evidence-based research. It is Things to keep
intentionally curated to address some of the in mind
challenges made known to National Council of
Social Service (NCSS) in the past 4 years of catalysing
Tools
empowerment under the 2017-2021 Social Service Practical resources
Sector Strategic Thrusts (4ST). you can use
Specifically, we have heard that Social Service
Agencies (SSAs) are experiencing difficulties Case Studies
Overseas practices
operationalising empowerment. In this guide, we
that you can learn or
translate this feedback and ideas into action by feel inspired from
breaking them down into practical initiatives. Here
you will find concrete steps to take in order to begin
your journey. We encourage you to use this guide Ideas
and provide us feedback. Ideas that you
can try
What Is This Guide About? 9I am empowered to
take hold of my life!
some
#awe
“Voices for Hope (VFH) is a
very interesting, wholesome
and enlightening programme for
participants living with dementia,
like myself. I am given many
opportunities to intermingle, to openly express
my feelings, desires and hopes. Like the others,
I feel important, needed, useful and accepted.
Through its activities, I got to understand more
about dementia and how to handle it without fear
or feeling unduly downhearted. Most importantly,
I am empowered to take hold of my life, to look
at the present situation together with what I am
endowed with and take steps to ensure that I can
progress satisfactorily and happily into the future”.
Thomas Ong
82 years old
Graduate from Voices for Hope Cohort 5
10Understanding
Empowerment:
The ‘What’ And ‘Why’
11What Is And Why
Empowerment?
Empowerment is the expansion of assets
and capabilities of people in vulnerabilities
such that they m ay participate in, negotiate
with, influence and hold accountable
institutions that affect their lives.
World Bank, 2002
EMPOWERMENT IS TO… 1 OPERATIONALISING EMPOWERMENT
• Increase a person’s ability to participate in and MEANS… 5, 6, 7
influence matters that affect his or her life • Changing mindsets by seeing service users as
• Be characterised by strength, choice, ability to participants and contributors rather than passive
make decisions, control and dignity recipients of care
• Own issues and take charge of one’s own life • Providing an environment that facilitates service
users’ understanding of their role, knowledge and
EMPOWERMENT BECAUSE IT… 2, 3 skill acquisition, and participation
• Increases independence which leads to a positive • Accepting service users’ definition of the problem
sense of well-being and improved quality of life and helping them articulate personal goals clearly
• Increases service users’4 perceived quality of • Identifying and building on service users’ strengths
services received • Co-producing with service users as it contributes
• Reduces costs as it increases contributions from to change in relationships that come with
service users and lessens the need for costly empowerment
institutional support
• Promotes sustainable social change through
self-responsibility and ownership which decreases
reliance on external resources
1 Poverty Reduction Group, World Bank. 2002. A Framework for Empowerment: Summary.
2 Rogers et al., 2010. In Cyril, S. et al, 2015. Systematic review of empowerment measures in health promotion. Health Promotion International, 31: 809-826.
Cyril, S., Smith, B.J. & Renzaho, A.M.N. (2015). ‘Systematic review of empowerment measures in health promotion’, Health Promotion International, 31,
809-826.
3 Alpay, L.L., Henkemans, O.B, Otten, W., Ing, A.J.M.R. & Dumay, A.C.M. (2009). ‘E-health applications and services for patient empowerment: Directions for
best practices in The Netherlands’, Telemedicine and e-Health, 16, 7, 787-791.
4 ‘Service users’ in this guide refers to people who are directly receiving service support from a social service agency. It is aligned with the terminology
adopted in the Social Service Sector Strategic Thrusts.
5 World Health Organisation. 2009. Patient empowerment and health care.
6 Masterson, S., & Owen, S. (2006). ‘Mental health service user’s social and individual empwerment: Using theories of power to elucidate far-reaching
strategies’, Journal of Mental Health, 15, 1, 19-34.
7 Busch, N.B., & Valentine, D. (2000). ‘Empowerment Practice: A focus on battered women’, Sage publictions, Inc, 82-95.
Understanding Empowerment: The ‘What’ And ‘Why’ 12Common Myths
About Empowerment
Myth 1 Myth 2
SERVICE USERS MAY NOT EMPOWERMENT IS A PROCESS
WANT TO BE EMPOWERED THAT PRIMARILY HAPPENS AT THE
Service providers wonder if empowering practices INDIVIDUAL LEVEL
are imposed when they observe silent, passive and While empowerment entails changes at an individual
reliant behaviours from service users. level where self-confidence, efficacy and responsibility
are acquired, it also involves changes at social and
Before drawing such conclusions, we should collective levels for genuine empowerment9.
investigate the reasons behind such behaviours.
Empowerment is influenced by a person’s ability This means that structural changes are necessary
to make meaningful choice and the context within so that individuals with their acquired power can
which he or she makes these choices8. effectively influence their outcomes and not be
withheld by systemic limitations.
The root issue could lie in either the lack of resources
to allow choice-making or the inadequacies of Besides laws and policies that affect the exercise
choice-making infrastructure, therein discouraging of these, services play an important role in that it
participation and ownership. can be designed to give service users greater choice
and control.
In other words, without the capacity to envision
change and a conducive envionment to express In considering their strengths and availing resources,
views, decide and set goals, a person’s motivation service users are equipped to define their own
to participate and take charge reduces. situations and set their own agenda in care plans,
instead of being limited within the parameters set
This gives the misperception that one might not by service providers and policymakers.
want to be empowered.
Change is also necessary at community levels,
where collective action is facilitated by services and
MY professionals to alter social stigma in vulnerabilities
TH
(e.g. mental illness, disability) that may undermine
service users’ opportunities and participation.
Practitioners should encourage individuals to join
activities led by local groups and communities.
8 Alsop, R., Bertelsen, M.F., Holland, J. (2006). Empowerment in practice:
From analysis to implementation.
9 Masterson, S., & Owen, S. (2006). ‘Mental health service user’s social and
individual empwerment: Using theories of power to elucidate far-reaching
strategies’, Journal of Mental Health, 15, 1, 19-34.
Understanding Empowerment: The ‘What’ And ‘Why’ 13Society
(Laws, policies)
Community
(Services, community
groups)
Individual
(Individual
attributes -
confidence,
responsibility)
Empowerment takes
place at all levels
Understanding Empowerment: The ‘What’ And ‘Why’ 14State of
Empowerment
15Where Are We At
As A Sector
“Empowering individuals, their
families and communities” was identified as
one of the key thrusts to achieving the vision
of “every person empowered to live with
dignity in a caring and inclusive society”.
In 2016, NCSS co-created the Social Service Sector At a collective level, NCSS has promoted
Strategic Thrusts, a strategic roadmap, with social empowerment through Public Education and
service partners in the ecosystem. ‘Empowering working with ecosystem partners to offer
individuals, their families and communities’ was person-centered services. To share a few:
identified as one of the key thrusts to achieving
the vision of ‘every person empowered to live with Public Education campaigns:
dignity in a caring and inclusive society’. • Beyond the Label movement was co-created
with persons in recovery to rally the support of and
From the Social Service Sector Survey10 conducted encourage the community to be more accepting
by NCSS in 2018, more than half of SSAs are of of persons with mental health conditions.
the view that they are to some extent practicing • See the True Me that positions persons with
empowerment: disabilities as individuals with abilities and
passions and encourages social inclusion.
• 71% of the sector strongly agreed/agreed that
they provide options to service users.
Person-centered services:
• 58% of SSAs strongly agreed/agreed that
• The Peer Support Specialist programme,
they co-create services and programmes with
implemented by mental health agencies with
service users.
the support of Institute of Mental Health (IMH),
• Almost half expressed a desire to improve in trains Peer Support Specialists to use their lived
co-creating solutions and programmes with experience to inspire, empower and support
service users, particularly the multi-sector and those in their recovery journey.
eldercare agencies. • The Empowering Seniors project, in
collaboration with SSAs and Agency for
Integrated Care (AIC), is a compilation of
resources for those who wish to increase user
participation in the delivery of senior services.
How can we grow more of such empowering and
person-centred practices? As a service provider,
you may ask – where do I begin?
10 Executive Directors, Presidents and Board members from 241 Social Service Agencies.
State of Empowerment 16“When people have a
voice to their
own solutions,
it’s empowerment!”
#aweso
me
“Having the Peer Support Specialist (PSS) in our
organisation gives us the opportunity to be their partners
and supporters in their recovery journey.
We see how PSS value add to our work as they could share
their lived experiences and instill hope of recovery to our
existing members. Their living examples of progressing from
being a member to a staff, a receiver (Service User) to
a giver (Service Provider) is strong evidence of hope
in recovery.
PSS also acts as a bridge which connects the staff and
members by helping staff to better understand members’
perspectives and struggles. This has helped members’ voices
to be heard and facilitate their rehabilitation process”.
Ms Rebecca Moh
Senior Manager
Anglican Care Centre
Simei, Singapore
17The
Process
C
A B
D
18A. Do A Self-Assessment
WHERE AM I AS A PRACITIONER/ORGANISATION?
One way to ascertain how much you practise empowerment is to consider: to what extent
are service users in your agency participating in the design and delivery of services.
This will be useful as research has shown that participation predicts empowerment11.
Slay and Stephen (2013)’s adaptation of Arnstein (1969)’s Ladder of Participation helps
to facilitate this thought process.
Doing With (Advance):
Doing With
Co-producing
• Service user and professional relationship
has
become equal and reciprocal.
• Service users’ voice are not just heard but acted
Co-designing upon. Service users are enabled to run the services
that they have contributed in designing, and their
assets and capabilities are recognised, respected
and valued.
• These roles can take the form of peer support,
Engaging
Doing For
mentoring, running daily activities or decision-
making in the running of an organisation.
Doing For (Intermediate):
Consulting • Service delivery starts to involve service users,
but participation remains shallow and within
the parameters set by professionals.
• Although professionals design services w ith
Informing well intentions, service user i nvolvement
is limited to consultation a nd users still
lack power to ensure theirviews shape
Doing To
decision-making.
Educating
Doing To (Beginners):
• Service delivery is in the most coercive
manner, a form of ‘cure’ so that service
Coercing users keep to norms.
• Service users are passive and supposed to
agree that the services they receive are beneficial.
11 Christens, B.D., Peterson, N.A., and Speer, P.W. (2011). ‘Community participation and psychological empowerment: Testing reciprocal causality using a
cross-lagged panel design and latent constructs,’ Health Education & Behaviour, 38, 4, 339-347.
The Process I A. Do A Self-assessment 19A precise way of assessing where you are (be it at individual level, project or
organisation) practising empowerment is to consider to what extent your practice
embodies the 6 principles12 characterising co-production from the table below.
Co-production, intrinsic to empowerment, is defined as:
A relationship where professionals and citizens
share power to plan and deliver support together,
recognising that both partners have vital contributions
to make in order to improve quality of life for people
and communities.
Nesta, 2012
In short, it refers to stakeholders, characterised by equal partnerships, making something together.
A REFLECTION TOOL FOR PRACTITIONERS:
Not There Yet Basic Making Progress Excellent
1. Assets: People are seen as Contributions by People are asked The experiences,
Seeing people problems to people in achieving what they like to skills and aspirations
as equal be solved. outcomes are do & what they of the people
partners rather recognised and are good at. Staff (and their families
than passive valued. support people to and carers) are
recipients use their skills within viewed as integral
the service. to the service.
Your Score 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Project 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Organisation 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
2. Capabilities: Professional skills, People’s People’s People’s
Building on qualifications, contribution is contribution is contribution is
what people expertise have restricted due fostered through vital to success.
can do and status. Specialist to regulations & tailored approaches. Activities are
supporting knowledge is institutional risk Contributions are shaped to fit skills
them to put delivered to client. management. determined by what & responsibilities
this to work People are trained roles the service of everyone
by staff to perform needs. involved. Personal
volunteer roles. development is
expected.
Your Score 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Project 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Organisation 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
12 Source: New Economics Foundation (2010)’s Co-production Self-assessment Framework here: https://www.seemescotland.org/media/7287/co-produc-
tion-self-assessment-framework.pdf
The Process I A. Do A Self-assessment 20A REFLECTION TOOL FOR PRACTITIONERS: (CONTINUED)
Not There Yet Basic Making Progress Excellent
3. Mutuality: Assumption that People’ views are People’s ideas shape People play an
Reciprocal professionals are heard but staff are service design. active part in
relationships paid to provide responsible for Their skills are initiating, running,
with mutual service and delivering services. sometimes built into evaluating, directing
responsibilities therefore, should Some informal the services where & delivering projects.
and not expect to need/ give & take occurs appropriate. There They work alongside
expectations ask for help. as a result of staff are opportunities social service
values/ways of for recognition & professionals and
working. reward. their views/ skills
hold equal weight.
Your Score 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Project 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Organisation 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
4. Networks: Friends, family and Staff appreciate Informal mentoring/ Supporting peer
The engagement peer networks as the value of buddying takes networks that
of a range marginal influence; people informally place; encouraged to enable knowledge
of networks strengthing of supporting one invite friend/family transfer is part of
to transfer networks regarded another but to join activities. core work. Staff
knowledge as outside remit of infrastructure does Development of & people engage
- both inside service provider. not make this easy new friendships in activities that
and outside to achieve. encouraged, connect to local
of the service although networks networks beyond
(including peer mostly valued when remit of service.
support) they directly support
service.
Your Score 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Project 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Organisation 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
5. Blurred roles: Professionals seen People are ‘Expert by People & staff own
Removing as ‘authoritative encouraged experience’ roles the project; share
tightly defined voice’; 1-way to volunteer exist; reciprocity responsibilities
boundaries transactions from informally; training between staff to run it well.
between expert to lay person. usually required to and people are Expectations of
professionals increase familiarity encouraged mutuality are
and recipients with service and and activities of discussed; wide
to enable professional service delivery are range of skills and
shared knowledge. beginning to be experience valued.
responsibility shared.
and control
Your Score 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Project 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Organisation 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
The Process I A. Do A Self-assessment 21A REFLECTION TOOL FOR PRACTITIONERS: (CONTINUED)
Not There Yet Basic Making Progress Excellent
6. Catalysts: Community Staff invite people Opportunities The purpose of
Shifting from members expected to contribute time, created for people interactions is to
‘delivering’ to comply with ideas and seek to to play leadership/ support people
services to ideas set out by develop services to delivery roles; to live a good life.
supporting professionals meet needs. services are Staff roles focus on
things to co-designed & connecting people
happen and co-delievered but to networks &
catalyzing other reach is restricted resources, removing
action by objectives of the barriers where
organisation. necessary and
developing skills &
confidence.
Your Score 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Project 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
Your Organisation 0 Rate 1 to 3 Rate 4 to 6 Rate 7 to 9
HOW SHOULD I USE THE FRAMEWORK TO DO BETTER13?
Identify your score Reflect on your score Improve the framework
• Consider which • Plot your scores in a diagram • Adapt the framework to suit
statement most – this serves as a reminder of your service setting by:
closely relates to your current state. You may - Personalising the
your approach/project/ have 1 for your project, and language through the
organisation for all another for your organisation. description of your own
6 principles. Display it where you can see practices so that all other
• For each principle, this regularly. professionals can work on
provide at least • Review your performance what is recognisable to them.
1 practical example every 6 months. Think about - Asking those who are
based on your activities. what you can do to improve, engaged in service to
Avoid generic examples; or share your success so complete framework
if you have trouble other services within your as a check for your own
identifying, reconsider organisation can learn from assessment and
your ranking. your good practice. opportunities for open
• Keep earlier versions as discussions on how to do
they are valuable in tracking things better.
progress or any unintended - Applying this framework
consequences of changes to to your recruitment
infrastructure/personnel that process as these principles
might affect people’s capacity are crucial to making
to co-produce. co-production work.
13 Ibid.
The Process I A. Do A Self-assessment 22DRAWING THE DIAGRAM
STS ASSE Tools
LY
A • The Empowering
CAT
TS
Seniors Resource Kit
version 1.0 by the
Empowering Seniors
C Workgroup, (2019)
UR ROLEs
AP
shares tools and
ABILITIES
checklists on how to
take concrete steps
L
to increase user
B
participation.
• Co-production
Network for Wales
NET
TY
W (2019)’s tool.
LI
OR S M U T UA
K
• Ed. Mersey Care NHS
Foundation Trust.
(2015)’s A toolkit for
Outer Segment = Excellent coproduction.
Middle Segment = Making Progress
Inner Segment = Basic
Blank = Not There Yet
CASE STUDIES14
• Shared Lives Plus match trained Shared Lives • Routes out of Prison is a peer support project
carers with adults who need support to live for returning prisoners. Participants access
fulfilling lives. Participants are matched to life coaches who support them in linking to
ensure shared interests. services in the community.
STS ASSE ASSE
LY
TS
A
TS
CAT
YSTS
AL
T
CA
C C
UR OLEs
AP
UR OLEs
AP
ABILITIES
ABILITIES
R
R
BL
BL
TY
LI
M U T UA
NET
TY
NET
W W
LI
OR S M U T UA OR S
K K
14 Nesta. (2012). People Powered Health Co-production Catalogue. London: new economics foundation..
The Process I A. Do A Self-assessment 23
23B. Identify Barriers
To Empowerment &
Actions To Overcome
24To increase the practise of empowerment,
it is crucial to identify the barriers specific
to you and your organisation so that you
can take actions to overcome them and
make progress.
Reminder
Successful co-production requires
The Individual... practitioners to facilitate the involvement
Or The Organisation? of service users and an organisational
structure that supports such process.
Service users are at times cited as barriers
to empowerment, with their inability In healthcare context, Palumbo and Manna
to make choices, unwillingness to (2018) discuss the importance of health
participate, or not knowing what they literacy and organisational health
want15. This understandably takes a toll on literacy in reaping positive effects of
practitioners, as it takes effort to foster co-production.
meaningful participation.
This means that professionals actively
Successful empowerment therefore engage patients to increase their
requires the organisation as a whole to knowledge, skills, and positive self-efficacy
enable and make change at every level. It perception. Such practices require the
is the orgnisational culture and values that right policy, structure and managerial
form the system of belief to influence the culture to support such engagement.
identity and behaviour of staff, which in turn
affects the way services are delivered16.
Empowerment also needs to be
systematically embedded within structures
and processes such that it is taken into
account in workflows, resource allocation
and decision-making processes. Such a set-
up translates to non-hierarchical ways of
work that values critical reflection, dialogue,
negotiation and discovery17.
With the appropriate culture and structure
in place, practitioners will be better placed
to overcome the challenges encountered at
the service user level.
15 Interviews with Social Service Agencies on empowerment conducted in the period of July-Aug 2020.
16 Empowerment – Making it happen. A handbook on user involvement in social service design and delivery. (2019). Retrieved from www.sempre-project.eu/
handbook
17 Ibid.
The Process I B. Identify Barriers To Empowerment & Actions To Overcome 25CASE STUDIES
Social Care Institute for Excellence’s
‘whole systems approach’:
Culture Structure
Beliefs and values The way organisation
that define an is arranged to carry
organisation and out work
way it works
LTURE STRUCTURE
CU
PRACTICE REVIEW
Practice Review
How the organisation
Monitoring how
and staff carry
work is carried
out their work
out and outcomes
that result from
the work
Source: Social Care Institute for Excellence. (2019).
The Process I B. Identify Barriers To Empowerment & Actions To Overcome 26Actualising empowerment is a complex process.
Below is a summary of common barriers18 faced by practitioners and suggestions of small steps you can
take. Every effort counts! Below is a summary of common barriers faced by practitioners.
Barrier Description In our stakeholders’ words19 What you can do?
Inadequate Empowerment …it depends on the standards • Be candid and share
Policies is not mandated and direction set by the challenges faced on the
in service models government. ground with policymakers to
and there is a lack shape policies
of strong policy • Invite policymakers in the
drivers service design process
A General A need for more Empowerment is abstract; a • Use templates and guidelines
Lack Of relatable and big word… and provide feedback so
Understanding operationalisable that these resources can be
On What definitions so Not everybody wants improved (including this one!)
Empowerment that people can empowerment. • Share resources with peers
Means better appreciate
• Proactively seek help from
and actualise Caregivers also need to
champion organisations
empowerment at understand empowerment.
all levels
Organisational Empowerment is Empowerment starts • Ensure senior leadership
Culture and not embedded in from within... buy-in for empowerment
Staff the organisational to be structured in a way
culture, resulting in Staff has to believe in it. that becomes ‘everybody’s
lack of or uneven Training can only do so much. business’
application • Involve service users and
caregivers in decision-making
• Include co-production in job
descriptions
Resources Insufficient funding It’s demanding in terms of • Share resources across
and resources manpower. organisations
reduces agencies’ • Demonstrate how
capacity and/or Current funding models do not co-production results in better
lead to trade-offs take into consideration the services and cost efficiency
“extra work” that might when done properly
be needed.
Accessibility Service users Service users don’t know what • Co-produce format of
experience barriers they want. meetings for accessibility
to participation • Leverage on digital means
e.g. language, lack Service users lack the mental
• Train staff to produce
of information in capacity to decide…
“Easy Read” documents
accessible formats
and difficulty • Allow time for discussions
getting to meetings • Make logistical arrangements
for persons with to improve accessibility
disabilities
18 Social care institute for excellence. (2019). Breaking down the barriers to co-production. Retrieved from www.scie.org.uk/co-production/supporting/
breaking-down-barriers
19 Interviews with Social Service Agencies on empowerment conducted in the period of July-Aug 2020.
The Process I B. Identify Barriers To Empowerment & Actions To Overcome 27“Thank you for
helping me
plan and work
towards my goal!”
#aweso
me
“I started the Connected
Community Services programme
in March 2020. Over the sessions,
I got to discover my Good Life
goals. We prioritised working on my budgeting
and traveling skills as I wanted to become
more independent. Previously, I didn’t see the
importance of savings; now I have come to realise
savings are important. It was fun learning these
skills as I got to enjoy places I enjoyed like
Chomp Chomp Food Centre, where I also shared
a meal together with my coaches.
I love kids and long to work with them too. My coaches
shared a childcare aide training opportunity and they
helped me prepare for the WPLN test and interview
required. I’m happy I’m now accepted. I am scared but
also looking forward to the course because I know my
coaches will continue supporting me. Thank you for
helping me plan and work towards my Good Life.”
Young Adult Service User
Rainbow Centre
28
28C. Design Your
Solution & Implement
Once you have identified the barriers, you are ready to In order to inspire and guide you on your journey
design and implement solutions that can propel you to empowerment, the end of the chapter will also
forward on your journey. share initiatives by local SSAs.
This guide will not be able to prescribe the ideal
solution to your problem because actualising
empowerment varies across contexts.
Every individual practitioner and organisation has to
undergo your own reflection, problem identification
and solutioning.
Reminder
That said, the guide is able to suggest some tools
Empowerment is contextual; it looks
that embrace empowering principles when used in
different across situations, cultures
the solutioning process. These tools allow service
and identitiesa.
users to actively participate and in doing so helps
a East, J.F., & Roll, S.J. (2015)
to build their confidence, knowledge and competency.
STAGE OF SOLUTIONING & USE OF EMPOWERMENT TOOLS20
Stage Description Tools
Needs Assessment Service users • Problem and Solution Tree
on service users identify their needs • Future Workshop
(early stage) and challenges
• Backpack method
• Focus Group Interviews
• Kitchen Talks
Service Design Stimulation of new ideas for • Theory of Change
(after needs social services or adaptation of • Business Model Canvas
assessment) existing services
• Double Diamond
20 Source: Empowerment – Making it happen. A handbook on user involvement in social service design and delivery. (2019). Retrieved from
https://www.sempre-project.eu/handbook. The guide will only elaborate on problem tree and theory of change. Please refer to the handbook for details on others.
The Process I C. Design Your Solution & Implement 29TOOL 1:
PROBLEM & SOLUTION TREE
When to use:
First phase when understanding problems and
their causes
Leaves:
Consequences
How to use:
Facilitator puts participants into smaller
groups to discuss the problem, causes and
consequences. Results are written down on
post-it notes and stuck onto a wall to create
a problem tree. Once these are identified,
focus shifts to ‘solutions’ that help to
achieve desired change.
What does it do:
Visualise how causes and problems are
connected
Trunk:
How does this promote empowerment: Problem
• Promotes sharing of responsibilites
• Focuses on solutions not deficits
• Helps to network and form alliances
for effective solutioning
Tip:
In Germany, a local
network used watering
cans for participants to write Roots:
solutions on. This promotes Causes of the
ownership & shared responsibility
problem
over the idea proposed - that they
would water a tiny plant
and watch it grow.
The Process I C. Design Your Solution & Implement 30TOOL 2:
THEORY OF CHANGE21
When to use: What does it do:
After problems are identified and when activities that Outlines the steps to take to achieve your goal.
contribute to desired impact need to be identified. Helps to make connections between your work
and the objective, spot potential risks, align
How to use: team members to a larger end goal and helping
Facilitators get participants to map out goals, logical them understand their role.
steps torwards change, measurable effects and
key assumptions. How does this promote empowerment:
• Helps participants, including service users, come
to a conclusion on the key common problems
• Promotes ownership in the activities to be done
What is the What are
measurable the wider
effect of benefits
What What your work? of your
What is your steps are work?
is the Who is What is the
entry needed
problem your key long-term
point to to bring
to be audience? change you
reaching about
solved? see as your
your key this
Measurable Wider goal?
audience? change?
effect? benefits?
Key Assumptions
21 Nesta. (2013). Development impact and you. Practical tools to trigger and support social innovation. Retrieved from diytoolkit.org
The Process I C. Design Your Solution & Implement 31Peers in the Sector
Embracing Empowerment
As An Organisation
Singapore Anglican
Community Services (SACS)
To SACS, empowerment is a ‘recovery-oriented’
culture and practice supporting people with mental
health conditions. It is characterised by five domains:
• Person-centricity Idea: Encouraging empowerment at the
Executive Leadership level
• Strengths-based
The Executive Director had written a guide
• Holistic approach on ‘Recovery Oriented Practices’, to inform
• Eco-centricity – Enhance resources in the the senior management of the concept,
environment to better enable empowerment which focuses on:
of service users in the community by working • Co-creation – Working with service
with the different systems that surround the users to make the physical environment
service users more inspiring.
• Culture relevancy • Change of language – Using recovery
language (e.g. descriptive words to
How does SACS build an organisational culture inform experience rather than labels)
that embraces empowerment? to change the way of interaction and
SACS believes in being intentional when promoting communication internally and externally.
empowerment. Examples of these efforts: … “a visitor would be able to ‘sense empowerment
• Empowerment as purpose: Empowerment is practices’ when visiting the agency.”
reflected in SACS’ mission statement and linked
to the purpose of the organisation. It is a belief
that is continuously practised, and not taken as
transactional and time-bound.
• Staff mindset: Organisational leaders believe that
the majority of staff (i.e. 80% - 90%), regardless for members, peer befrienders’ handbook and
of functions, should embrace the recovery model. facilitate recovery and WRAP (wellness recovery
• Alignment with hiring practices: When hiring new action plan) support group.
staff, interviewees will be asked the purpose of • Recovery-focused committee: Formed a
wanting to join the agency to ensure motivations recovery-focused committee, where PSS together
are aligned and they truly believe in empowering with other professionals are appointed as
vulnerable individuals. recovery champions to drive recovery knowledge
and practices within SACS.
How does SACS co-produce with service users? • Co-run activities: Involved their members to
• Peer Support Specialists: Hired Peer Support co-run the Clubhouse activities, orientation
Specialists (PSS) to provide individual and group programmes and events (e.g. employability
work to support its members. The PSSes are also night), and revamped environment of their
involved in co-designing and co-delivering the residential facility to be more person-centred and
workshops and materials such as wellness plans recovery focused.
The Process I C. Design Your Solution & Implement 32Empowerment
Through Voice
Alzheimer’s Disease • Building networks of persons with dementia
and caregivers who are confident in public
Association (ADA) speaking to be a spokesperson
Based on research studies, ADA recognised that the
involvement of persons with dementia as co-designers Persons with dementia and the caregivers attend
and spokespersons is critical in reducing stigma and sessions that are planned, implemented and
improving community attitudes towards dementia. evaluated by persons with dementia, various
professionals and staff.
Prominent examples in the UK, Australia and Japan
also led ADA to believe that persons with dementia To date, participants have stepped up to talk
stepping up as advocates can improve quality of life about dementia and played meaningful roles
for them and their peers. by co-hosting programmes under ‘Memories
Cafe’ (activities and conversations that facilitate
The Voices for Hope programme was thus interaction in a café setting), co-facilitating of Voices
conceptualised and piloted by ADA in 2019, for Hope programme and supporting other peers
empowering persons with dementia and their with dementia.
caregivers by:
• Encouraging service users to step up and
speak up as self-advocates to reduce the stigma
of dementia
2
Creating
Familiarity
Participants
feel safe &
3
1 Cultivating
Outreach supported
Self-Advocacy
Persons with
dementia & Skills
caregivers are Participants gain
willing to public speaking &
self-advocacy
participate How is skills
empowerment
6 created? 4
Advocacy Building
Network Confidence
Participants are willing to Participants go
continue self-advocacy through coaching in
& are connected 5 speaking up & being
to other Step Up a contributor
self-advocates Participants
gain confidence
to speak up &
contribute through
meaningful roles
The Process I C. Design Your Solution & Implement 33Programme Structure
The programme structure includes the following elements:
1. Breaking the Silence (Creating Familiarity)
2. Advocacy & Change (Cultivating Self-Advocacy Skills)
3. Dementia and Me (Building Confidence)
4. Stigmas and Impacts (Building Confidence)
5. Living well despite Dementia (Step-Up and Advocacy Network)
In addition, there are two elements in Advocacy Network (i.e. Post Voices for Hope):
• Mentorship from senior advocates made up by persons living with dementia and caregivers
• Peer support for caregivers
The “Forget Us Not” campaign promotes
inclusion and empowerment of persons
with dementia.
A partnership between ADA, Lien Foundation and
Khoo Teck Puat Hospital, the “Forget Us Not”
campaign aims to raise awareness of the unique
needs of persons living with dementia and build
communities where they are empowered to live
independently and be treated with dignity.
More recently, the campaign supported an
overseas trip to Taipei, a first of its kind in
Asia. The goal was to prove that persons with
dementia can achieve anything they set their
minds to. The trip brought greater insight to the
condition and deepened familial bonds, which
outweighed the challenges of travelling with
persons with dementia. To witness the invaluable
expressions of joy, watch the video here.
The Process I C. Design Your Solution & Implement 34You can also read
