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Approaches to Participatory Research in Children’s Mental Health
Or: How I Learned to Stop Worrying and Love Participatory Research
Mike PullmannUniversity of Washington School of Medicine
Public Behavioral Health & Justice Policy
Grand RoundsSept 20, 2010
What is participatory research?
• Present some examples of participatory research
• Describe the theoretical context of Participatory Action Research
• Describe a framework of knowledge and power
• Examine how current children’s mental health research fits into this context and framework
Goals for this presentation
Example 1: The “Custody Problem”
• Anecdotal reports of custody relinquishment to obtain MH services
• No national or state estimates of the problem• Three reasons custody relinquishment occurs:
– Financial– Treatment issues– Legal liability
• Partnership with family organization for legislative change
• “Voluntary Child Placement Agreement” vs. “Voluntary Custody Agreement”
Caseworker knowledge
• Interviews completed with 127 randomly selected caseworkers who may have to use the VCPA
• Questions about when it is appropriate to use a VCPA
• 25% reported not having enough knowledge of VCPA to be able to answer any questions about it
3 caseworkers responded correctly to all 6 situations
6 caseworkers responded correctly to 5 situations
23 caseworkers responded correctly to 4 situations
Example 2: Family participation in systems of care
research• The impact of the System of Care grants
(Children’s Service Program or CSP) is widespread and will continue for decades
• Since 1993: 126 communities funded at a total cost of $1.1 billion
• Family involvement at all levels is a guiding principle
• CSP requires participatory evaluation but researchers may not be trained or experienced
• Family participation in evaluation evolved, it was not begin as a community based participatory process
Family participation in systems of care research
• In a qualitative study of “exemplary” researchers at system of care grantee sites:– Over half reported having no academic
training on family involvement in research– Over 2/3rds reported that they learned about
participatory evaluation on the job
(Jivanjee & Robinson, 2007)
Historical and theoretical context
Grassroots family advocacy groups promoted family involvement in research
Federally mandated family participation at all levels of
the system of care
Family evaluators in systems of care
Professional evaluators dedicated to Participatory
Action Research
Empty ritual? Empty ritual?
Or real power?Or real power?
“The Ladder of Participation” Arnstein, 1969
Applied to children’s mental health services by Turnbull, Friesen, and Ramirez (1998).
“Authentic” participation
• Serves the interests of the community
• Is not exploitative
• Participants have real influence and power from start to finish
Why would participation be
“inauthentic” or manipulative?
“Inauthentic” participation
• Instant participation: Just add families and stir• May emerge from:
– Blatant exploitation and manipulation– Researcher inexperience with participatory
approaches– Differing goals, values, and cultures of traditional
research and family-based research (Koroloff and Friesen, 1997)
– Difficulty in “scaling up” from local projects to national projects
– Communities’ lack of desire to be involved in research– A mismatch between the type of participatory
approach and the type of system that is being studied
“Inauthentic” participation
• What about the system of care?– Evaluation largely planned by experts on national
evaluation team– Evaluation generally focuses on developing a
traditional body of knowledge– Evaluation assumes cooperation and collaboration
among various parties– Evaluation assumes that decision making is data-
based and rational– Most grantee communities focus on meeting federal
requirements for data collection rather than utilizing data locally or developing a comprehensive local evaluation
Two broad classes of participatory approaches
The Utilitarian Tradition– “Northern,” “Collaborative Participatory Research”– 1919: Chicago Race Riots/Charles S. Johnson– 1940’s: WWII, Kurt Lewin– Participation as “added value”
The Liberatory Tradition– “Southern,” “Radical”– Marx, Freire, Bud Hall– 1960’s and 70’s: Vietnam, social unrest, popular
education– Participation as system transformation
Two broad classes of participatory approaches: Ideology
Views and assumptions
Utilitarian tradition Liberatory tradition
Decision making
Open, rationalClosed, based on politics and
power
StakeholdersNon-hierarchical,
roughly equal resources and power
Hierarchical, inequitable distribution of resources and
power
Problem solving
Cooperative and consensual
Conflictual: powerful and powerless are opposed
Role of researcher
Discover facts and create knowledge to
use in decision making
Advise and assist the less powerful in creating their own
knowledge for advocacy, network building, and
reflection
“One of the biggest challenges to successful
partnership between families and evaluators—to real family engagement in evaluation—are issues of
power.”
(Slaton, 2004)
Knowledge Power Example of oppression
Example of liberation
Representative Issues, facts, objective data
Advocacy Funding traditional power structures for
evaluation and research; research is
often blaming
Advocating through professional
leadership and issue-based argument
Relational People relating
and sharing perspectives
Organizing and
mobilizing
Nondecision making--Excluding
families from decision making in
research and evaluation practice
Organizing and mobilizing to demand
authentic participation in
research and evaluation
Reflective Awareness of a
problem and reflection on its roots and
context
Control over consciousness
Insidious blaming, shaming,
stereotyping of family members as
incapable and powerless
Critical reflection, awareness building
workshops, empowerment and
action
Note. This table borrows heavily from Williams, 1999 and Gaventa & Cornwall, 2001
Knowledge Power Example of oppression
Example of liberation
Representative Issues, facts, objective data
Advocacy Funding traditional power structures for
evaluation and research; research is
often blaming
Advocating through professional
leadership and issue-based argument
Example: The “Custody Problem” study • The effective use of representative knowledge to create social change requires:
• 1. A collective pursuit of knowledge based on the needs of the community
• 2. A place at the decision-making table
• However, power is often used to exclude communities from decision making
Knowledge Power Example of oppression
Example of liberation
Relational People relating
and sharing perspectives
Organizing and
mobilizing
Nondecision making--Excluding
families from decision making in
research and evaluation practice
Organizing and mobilizing to demand
authentic participation in
research and evaluation
Example: Family support and advocacy groups • Relating concerns to each other creates shared meanings and understanding of experience
• Data alone cannot create change; social change requires the organization and mobilization of the community
Knowledge Power Example of oppression
Example of liberation
Reflective Awareness of a
problem and reflection on its roots and
context
Control over consciousness
Insidious blaming, shaming,
stereotyping of family members as
incapable and powerless
Critical reflection, awareness building
workshops, empowerment and
action
Example: The “Custody Problem” study • Several frames of consciousness may have prevented the custody issue from being addressed, including blame, suspicion of caregivers involved in child welfare, and the American value of independence.
• Advocates and researchers successfully reframed the issue as a tragedy that happened to real families, and that the child welfare system was a rigid bureaucracy stuck in old policies.
The two traditions and power/knowledge
Views and assumptions
Utilitarian tradition Liberatory tradition
Role of research
Incremental system improvement
System restructuring
Knowledge RepresentativeRepresentative, Relational,
and Reflective
PowerData-based advocacy in open, flat systems
Advocacy, organizing, and education in closed, hierarchical systems
• Family evaluators report less involvement in data review and utilization
• Sites vary widely on the influence and decision making of family evaluators
• Family evaluators often feel tokenized• Family involvement in system of care
research often means training families to be more like professional researchers (representative knowledge)
Family participation in systems of care—conclusions from existing
research
Bates, 2005; Jivanjee & Robinson (2007); Koroloff, et al. (2010); Osher, van Kammen, & Zaro (2001)
Recommendations for the system of care
• 1. Train researchers and evaluators in principles of community organizing and adult education
• 2. Reduce the burden of the national evaluation and increase the expectation for a local applied evaluation
• 3. Place some of the funding authority for the evaluation into the hands of family advocacy groups
Questions to ask ourselves
• Is power shared among service providers, administrators, and consumers or families?
• Who developed the research questions?• How useful is the knowledge that may be
uncovered?– For who? How could it be used?
• Does the research have any organizing or mobilizing component?
• Do you have a plan for continual reflection on the research findings with the entire community?