Overview of this Session

1. Doing Community Psychology Research With People and For People, Rather than On People: Challenges and Ways ForwardWorkshop for Annual General Meeting of the Community Psychology Section of the BPS, 16/12/2013Dr. Glenn Williams

2. Overview of this Session • Asking the right questions • The three ‘lenses’ • Number-crunching Post-Positivism • Constructivist • Critical, challenging and transformative • Commissioning, planning and implementing community psychology-based research • A case study of a community arts programme • Key considerations for doing research and development with marginalised and disempowered communities • Sharing of experiences and of good practice

3. The Blind Men and the ElephantJohn Godfrey Saxe (1816-1887) “It was six men of Indostan To learning much inclined, Who went to see the Elephant (Though all of them were blind), That each by observation Might satisfy his mind…”

4. Foundations of Community Psychology Research: Asking the Right Questions Homelessness Pupils who drop out of school Some of your ideas follow…

5. Why does a person become homeless? • Money shortage • Disruption at home (divorce; domestic violence, parental conflict)/thrown out of home • Family difficulties/conflict/dysfunctional • Victim of abuse/neglect • Discrimination • Never had a home • Because we live in an unequal society • Because they are trying to leave an even worse life/easier than staying in their home (less dangerous) • Because they have lost their way in life emotionally • Human distress/Despair/feeling inadequate/unbearable distress and trauma • Lack of secure attachment/attachment difficulties • It’s a choice in some cases • Not enough affordable homes • Benefit problems/their benefits stop and they can no longer afford it • Council purchasing land • Reluctance to seek help • Alcohol/drug problems (inadequate coping) • Life events/crises like death of loved ones and feeling bereaved • Job loss/lack of employment • Mental health problems • Poverty (getting caught up in a cycle) • Social injustice/capitalist society • Adventure turned sour • Council purchasing of land/property • Bad luck • Not being aware/feeling like they don’t have rights • Lack of options

6. Why do so many people become homeless? • They have been let down • They don’t have skills society wants • They are marginalised for being different • Greedy bankers • Low pay • Unemployment/ineffective employment system • Relationship breakdown • Health problems • Lack of housing/too expensive • Insufficient welfare system • Ineffective economic policy • Eviction • Inequality • Transcultural migration • Environment (austerity) – not making mortgage payments etc • Addictions? (drug and alcohol) • Mental health deficits impacting on employability • People running away from violence and exploitation • Absent support systems • Proximal (school/family/friends) vs. distal (state/voluntary sector) • Lack of opportunities • Maladaptive coping strategies • Circumstances • Cumulative entwining of social and material exclusion processes • Social deprivation • Domestic violence

7. Causes of pupils dropping out of school Why does a student drop out of school? • Frustration if there are Special Educational Needs not recognised/supported • Problems at home • Lack of relevance of the curriculum for the student; thus, lack of engagement • No support or little support for the student • Being a victim of bullying Why do so many students drop out of school? • Different ways of learning not assessed and supported • Others’ needs take priority • Bullying • Money pressures • Peer pressures • Lack of hope/prospects • Lack of positive role models • Bullying (mentioned several times) • Poverty • Over-large classes • Family stresses • Behavioural challenges

8. The moral? • Questions guide the focus • Questions can be individualised and can potentially blame the victim, which is akin to conventional psychological analyses of social problems • Questions can be systems-focused, potentially less stigmatising, and better able to deliver on second-order change, rather than superficial first-order change delivered at the individual level (see Jason, 2013 for differentiation between first-order and second-order changes) • Community psychologists can look at individualised and systems-focused and can undertake interchangeable shifts in focus – research can be better informed by a focus that aims to get a better picture of the ‘elephant’…

9. What if you don’t know what question to ask? Serendipity… “One morning as we made rounds, we saw a very talkative patient, who had multiple complaints to tell the doctor about – all sorts of aches and pains, and unusual events. I could see that no one was taking her very seriously, and on the way out, one of the students said, “Boy, she’s really a crock!” I understood this, in part as shorthand for “crock of shit”. It was obviously invidious. But what was he talking about? What was wrong with her having all those complaints? Wasn’t that interesting?... So when Chet called the patient a crock, I made this theoretical analysis in a flash and then came up with a profoundly theoretical question: “What’s a crock?” He looked at me as if to say that any damn fool would know that. So I said, “Seriously, when you called her a crock, what did you mean?”

10. So… what is “a crock”? “He looked a little confused. He had known what he meant when he said it but wasn’t sure he could explain it…I got all the students interested in the question, and, between us, with me asking a lot of questions and applying the results to succeeding cases [of patients who could possibly be seen as ‘crocks’], we ended up defining a crock as a patient with multiple complaints but no discernible physical pathology.” (Becker, 1993; pp.31-32). Follow-up questions could be: • What to do with that new definition? • What do clinicians actually do with this implicit definition? • What could be changed?

11. And, yet, language can still imprison • “Linguistic entrapment” (Crawford, et al. 1995) • Once a patient is labelled, the professional looks for information to confirm this label. Contradictory information is ignored or discredited (Edelman, 1974) • “On being sane in insane places” (Rosenhan, 1973)

12. And it can also liberate… Finding hidden ‘gems’ and new insights, which lead to new questions… • Interviewee called ‘Vince’: “I have NF. NF does not have me. So that’s as simple as I can put it and I just live with it. I guess I look at is as if I were a dwarf, I’m still a human being. Matter of fact one of my co-workers is a dwarf – now that guy is a cool dude.” (Dheensa, 2008) Follow-up questions: • Does social comparison help to liberate and empower? Is identification of similarities crucial for this empowerment and liberation? Or is embracing uniqueness better? • How can others in similar situations exercise the power to challenge labels or to get some distance from the label or the labellers?

13. Key Concepts Underpinning Community Psychology Research • Ontology – “the nature of being, existence or reality” • Epistemology – “the nature of knowing or understanding reality” • Axiology – “concerned with the study of values” • Methodology – “tools that researchers use to understand reality” Nelson & Prilleltensky (2010) – p.273

14. Three ‘Lenses’ for Community Psychology Research & Action • Positivist/Post-Positivist – • Came from logical positivism with emphasis on one external reality/truth • Constructivist – • Sees reality as relatively shaped by people’s perceptions of their worlds • There can be many ‘truths’ (e.g. see post-modernist approaches to inquiry) • Transformative – • Developed from Marxist and critical theorist approaches to social phenomena; • Emphasis on external reality that historically shaped by social, cultural, political, gendered, economic and ethno-racial factors. • Based on assumption of inequalities being present and there being dominant/subordinate groups

15. The Positivist/Post-Positivist Paradigm • Ontology: • Positivism = goal of the development of generalisable laws that can apply to behaviours (e.g. Skinnerian approaches to reinforcement); • Post-positivism = some laws of behaviour might not be applicable everywhere and with everyone. Understands need for contextualising. • Epistemology: • Positivism = ‘researcher’ and the ‘researched’ being very separate. Need to eliminate bias. Should be value-free. • Post-positivism = might be a relationship between the ‘researcher’ and the ‘researched’ but objectivity should still be the aim. • Axiology: • Positivism = ‘Facts’ and personal values are treated as separate. • Post-positivism = values do intrude but in background. Upholding the status quo is key. • Methodology: Surveys; epidemiological data; correlational analysis; qualitative methods used to generate hypotheses.

16. An Example of Positivist/Post-Positivist Research • Tsemberis, et al. (2004) – “Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis” • Longitudinal design. Work done in New York, USA. • 225 people with mental illnesses and who were homeless. • Control group = Housing allocated depending on receiving treatment and being sober (Continuum of Care default model). • Experimental group = Being housed without prerequisites. • Interviewed every 6 mths over 24 mth period. • Measured alcohol and drug use and psychiatric symptoms and housing retention rate. • Conclusion: Should not have treatment requirements as pre-condition for housing. Full article via: http://tinyurl.com/9pac3vr

17. The Constructivist Paradigm • Ontology: Draws from social constructionism (e.g. Gergen, 2001). Argues that there is no unitary reality but instead many constructions of ‘truths’. Realities can be co-constructed. • Epistemology: Looks to monism/holism (Montero, 2002). Researcher and researched are interdependent. Language conveys constructions of these multiple realities. • Axiology: Epitomised by relativism. No single value system reigns supreme. • Methodology: Usually analysed via qualitative data. Dialogue, reflexivity, discourse, texts.

18. An Example of Constructivist Research • Boydell, et al. (2000) – qualitative study of 29 homeless people in Toronto, Canada. • Used symbolic interactionism to see how sense of self and the homeless person’s social context interacted. • Main finding – the homeless persons in this study were motivated to maintain a retrospective, positive sense of self. The current sense of self was commonly affected by perceptions of: • Stigma • Isolation • Shame • Feeling inferior to others • “I felt disgusted with myself, you know, that I messed up. I felt bad, you know, like I was nobody” (p.31) • Aim of this study was not to generalise to all homeless persons, but to understand their phenomenologies and constructions of their realities. Full article via: http://tinyurl.com/9mpfar9

19. The Transformative Paradigm • Ontology: Rooted in German critical theory, feminism, Marxism and strives for social justice and change. Proposes external reality (like post-positivism). However, this reality is based on shared social histories where inequalities and misuse of power are salient. • Epistemology: Inter-relationships between researcher and researched. Researcher is working in solidarity with the oppressed and marginalised (e.g. Freire, 1970/1993). • Axiology: Has moral & political stance. Has values of justice, respect for diversity, inclusivity, empowerment, and accountability to those being oppressed. • Methodology: Reflexive and critical. Uses participatory and action-oriented methods. Disadvantaged people are included in the setting for the research agenda, executing the study, disseminating findings and deciding what to do afterwards.

20. An Example of Transformative Research • Paradis (2009) A little room of hope: Feminist participatory action research with “homeless” women. PhD thesis. University of Toronto. • April 2005: >50 women experiencing poverty, homelessness and isolation attended a workshop on human rights at a drop-in centre in Toronto. • 15 months later, these women had attended weekly workshops on social and economic rights and learned methods of reacting to, and resisting, homelessness. They were able to give testimony to their experiences and their group sent a representative to the United Nations Committee on Economic, Social and Cultural Rights. • Conclusion: “homelessness is not only a material state, but more importantly a social process of disenfranchisement enacted through relations of harm, threat, control, surveillance, precarity and dehumanization” (p. ii). • Project acted at multiple levels including at the macro level. Available via: http://tinyurl.com/8vdk5x8

21. Methods Used with the 3 Paradigms

22. Commissioning, planning and implementing research: A case study Goal: • To assess the impact of a pilot programme of 12 consecutive weeks of participatory arts sessions on health, well-being and quality of life. Programme is a possible scheme to be accessed via Personal Budgets funded by Local Authorities. Objectives: • For the evaluation of this pilot, these were to: • Assess, through the use of standardised and validated measures, participants’ health, well being, and quality of life upon entry into, and upon completion of, the pilot of the participatory arts programme • Evaluate processes and products that emerge from these participatory arts events through using qualitative methods.

23. Methodology Participants: • Inclusion criteria: • having an ongoing physical or mental health problem, • having the capacity to give informed consent to take part, • and being aged 18 years or older. • 4 pilot sites: • District general hospital (n=12, average of n=9 participants) • GP-led health centre (n=7, average of n=4 participants) • A well-being centre for people with ongoing mental health difficulties (n=21, average of n=11) • Clinic for those recovering from mental health problems (n=16, average of n=6)

24. Implementation Methods – Art and Health • Consultation with stakeholders • Pilot (January – March 2011) and drop-in sessions (May 2011 – present) • Weekly group sessions – Initially, artist demonstrates an art form to stimulate thought and creativity; Link Coordinator helps facilitate. • Integrating the evaluation process • Celebration of Achievement (Arts Trail in Nuneaton)

25. Evaluation – Art and Health Pilot Sessions Integrated Sessions Interviews with 9 participants (4 of whom were pilot project participants) and 4 artists and link-coordinators Diary data from artists and link-coordinators (i.e. sessions 11-32, sessions 35-38, sessions 44-56). Diary data related to sessions using a variety of art forms: mono-printing, stone painting, group production of music, clay work, pinhole photography, Russian dolls • 20 semi-structured interviews with stakeholders (i.e. participants, service providers, artists, link coordinators) • Pre-post measures: • At entry and finish of 12 weeks - Short Form-12 for quality of life; Life Satisfaction Scale • At start and end of each session – Positive Affect Negative Affect Schedule • GHQ-12 – before each session to reflect on week beforehand • Flow State Scale – to reflect on flow experience states after each session

26. Findings from 12-Week Pilot Programme Quantitative Trends Qualitative Data Themes included: Positive impact on well-being Labelling of the Programme Perceptions of support from service providers Dynamics of being inclusive and participative Difficulties with the evaluation Making transition from the Pilot to the Drop-in Sessions • Mental Ill-Health symptoms significantly reduced from weeks 1 to 12 (as measured by GHQ-12) • Quality of life for mental health – significant increase (as measured by SF-12)

27. Quantitative Findings #1: Mental ill-health symptoms A related t-test showed that the difference in the reduction from week 1 to week 12 of GHQ-12 scores was statistically significant, t (17) = 3.74, p = .002.

28. Quantitative Findings #2: Quality of Life (QoL) for mental mealth • A difference was found in overall QoL for mental health at the beginning of the pilot (Mean = 40.61, SD = 13.23) versus at the end of the pilot (Mean = 47.36, SD = 8.92); a mixed two-way Analysis of Variance showed this difference was statistically significant, F (1, 17) = 5.53, p = .03.

29. Positive impacts on well-being “…this art group has been a healer. It’s helped to heal me and I’ve had companionship here and… there’s been no demands on me and I’ve been allowed to work at my own pace”.

30. Dynamics of being inclusive and participative • “…it’s all very seamless, it just flows, everybody’s helping each other, sitting down and enjoying it, there’s no sort of um, it’s not prescriptive, it’s very fluid and I think that’s what the aim of the project was from my understanding so that the people that come along didn’t feel under any pressure, they felt it was flexible, that they wanted to stay for 10 minutes or the whole session, that was up to – how they felt and most people, to be fair, once they’ve got into the artwork got engrossed and they’ve done more than one piece”.

31. What are the key issues? Indirectly touches on dynamics such as marginalisation and disempowerment. Sought to challenge participants’ experiences of these dynamics through collaborative working, skills development and confidence-building Works with the participants to meet their needs. Addressed inequalities in well-being by using ameliorativemethodologies to lessen the pain or discomfort cased by a social ill and by utilising transformativemethodologies to equip people with skills to rise above social inequalities or to work against these inequalities Helped participants to build up networks of support and social capital (Putnam, 2000)

32. Considerations & Implications • Resolving the tensions from meeting multiple agendas of: • funding bodies, • ethics committees, • participants, • service providers) (c.f. case study by Kagan, et al., 2011 on implementing arts and mental health projects) • Identifying the ingredients of the arts and health programmes that work • Sustaining these types of projects: • Who owns them? • Who can maintain them? • Who can continue to fund them? • How can it be appropriately labelled and targeted? • How to integrate these kinds of programmes with Personalisation agenda driven by Social Services? • What evidence do they need to purchase it?

33. Open Discussion What have been your experiences of conducting community psychology research and action? • Opportunities to share good practices and pitfalls to avoid • Anticipating issues regarding funding and programme sustainability • Analysis of the multi-level considerations and impacts: • Micro-systems (a family unit, a gang, a school, a work team) • Meso-systems (bridges between micro-systems; e.g. how Age UK may bridge the gap between the family unit and the residential home for an older person who is about to live in that new homesetting) • Macro-systems (e.g. legislation, societal norms, media portrayals)

34. References & Further Reading (1) Becker, H. (1993). How I learned what a crock was. Journal of Contemporary Ethnography. 22, 28-35. Crawford, P., Nolan, P. & Brown, B. (1995). Linguistic entrapment: medico-nursing biographies as fictions. Journal of Advanced Nursing, 22 (6), 1141-1148. Dheensa, S. (2008). The Psycho-Social Effects of Living with Neurofibromatosis Type 1: An Interpretative Phenomenological Analysis. Unpublished BSc. (Hons.) in Psychology project report. Nottingham Trent University. Edelman, M. (1974) The Political Language of the Helping Professions, Politics & Society, 4, 295-310. Freire, P. (1970/1993). Pedagogy of the oppressed. London: Penguin. Gergen, K. (2001). Social construction in context. London: Sage. Jason, L. (2013). Principles of social change. New York: Oxford University Press.

35. References & Further Reading (2) Kagan C.M., Burton M., Duckett P.S., Lawthom R., & Siddiquee A. (2011). Critical Community Psychology. Oxford: Wiley-Blackwell. Montero, M. (2002). On the construction of reality and truth. Towards an epistemology of community social psychology. American Journal of Community Psychology, 30(4), 571-584. Nelson, G. & Prilleltensky, I. (2010). Community Psychology: In Pursuit of Liberation and Well-being. New York: Palgrave Macmillan. Putnam, R. D. (2000). Bowling alone: The collapse and revival of American community. New York: Simon and Schuster. Rosenhan, D.L. (1973). On being sane in insane places, Science, 179 (4070), 250–258. Williams, G. (2012). Evaluation of the Integrated Participatory Arts Programme in North Warwickshire. Presentation at Warwickshire Arts and Health Network Event, St Nicholas Community Centre, Nuneaton, 8th November 2012. Available via: http://www.escapecommunityarts.co.uk/activities/arts-and-health/ Williams, G. & Zlotowitz, S. (2013) Using a community psychology approach in your research. Psy-PAG Quarterly, 86, 21-26.

36. My contact details for sharing any thoughts from this workshop • Email: glenn.williams@ntu.ac.uk • Mail: Dr Glenn Williams, Psychology Division, Nottingham Trent University, Burton Street, Nottingham, NG1 4BU • Tel: 0115 848 5980 • Via my academia.edu website: http://nottinghamtrent.academia.edu/GlennAWilliams • Or via the Community Psychology UK Ning: http://communitypsychologyuk.ning.com/