Outcomes and Measurements Project: Interview with Multiple Disadvantages Senior Support Worker

This is an interview with someone who works as a Multiple Disadvantages Senior Support Worker exploring a series of questions about outcomes and measurements aiming to get nuanced views from people about the bureaucracies they face in their job roles.

Below is a transcript of the conversation which has been anonymized.  Special thanks go to the person who took the time to talk about their thoughts and experiences.  This is a part of an action research project which examines the impacts and effects of outcomes and measurements culture on complex jobs and the lives of people: https://www.raggeduniversity.co.uk/outcomes-and-measures/

Alex Dunedin: so these are a series of questions which I’ve asked everybody and you’re welcome to take the conversation wherever you feel it’s necessary okay and if you’re uncomfortable with anything you don’t need to answer so this is your chance to…

Participant: …In exchange I will have to say that I cannot guarantee any wisdom okay

Alex Dunedin: okay so can you talk about your role in relationship to care work ?

Participant: I am a, officially, that’s my remit, I am an average worker for people who face severe and multiple disadvantages or other people call it multiple exclusion homelessness; this, obviously they are service names and terms basically for people that they have trouble in quite a few areas of their life and they’ve been struggling for some time, in simple terms.

Alex Dunedin: Can you talk about what successes you have had ?

Participant: Is sometimes laughing with my colleagues I say ‘the outreach project – the project that achieves nothing’, ummmm, success is difficult in this line of work. Success is not something you see as a discrete category; you can see change, you can see a change in direction; you can see some improvement, you can see people feeling happier maybe sometimes, feeling safer and feel more motivated; however I think our ideas of success in this line of work needs to be – this needs to be questioned.

I think there is been an inflation of the kind of stories that they are well – ‘I was struggling a lot and now look at me’ – you know what I mean – ‘I run the bank of scotland’ – or you know what Im trying to say….and [Organization they work for] has been a bit guilty of this kind of of of idea

You know, the the only thing I can say is that in this job you don’t see success immediately, it’s only after a few years when you bump into people maybe in ASDA or whatever when you see how people have changed. So you don’t see immediate…it’s like a kind of an intervention but it may have or may have not some positive effect on the future of people

Which funnily enough most people don’t thank you when you are helping them; they they thank you when they find you in ASDA three years later for your help and you don’t even remember how you help them. You know, I am losing the plot here but I am trying to say success is, it’s quite difficult, you need to be careful with the idea of success because sometimes we may select people in terms of our own terms of what we think success is or we may force people to become the ranks of the sorted middle class, acceptable middle class and this is what we think of success

I don’t know, I don’t know; I think it’s an idea that I am very careful with. Is that okay just tell me a little bit more, a little bit less, so…

Alex Dunedin: Absolutely…this is about you having the space and freedom to use the language and change the questions as you see fit

Participant: Yeah, in basic terms you know I will say, when we talk about, do you know many services, when they start at the beginning the first question they they put on the table is how success will look like except when that was put to me in the services and say I don’t know and actually I don’t care you know what I mean because I dunno you’re just there to struggle with people beside them to go wherever they need to go even when they don’t know where the hell they are going.

Alex Dunedin: You mentioned in there inflation, the inflation of the idea. So can you explain that a little bit more

Participant: Well there is a sense that many services for people that they are struggling – I mean I am talking of the point of view of this project starts working with people they are seriously struggling with many basic things in their life and there is always the idea that services they are there to fix somehow people; so people won’t be broken anymore, you know, they will function perfectly as like an old well oil machine….

…um and that is an idea that I think is perverse in many ways you know. People, you know, you don’t really fix people; people do things broken, people do things better broken, people they find some happiness broken, you know

So yeah this is this is because I think sometimes it’s perverse because they have the idea that service when they say, ‘how success will look like’ would be okay, the job is finished, you are sorted, you are cured, okay

You don’t have… I don’t know… have a health condition, your leg is not broken, anymore you know what I mean…that is not the kind of things we are encountering, you know or what all jobs will be about

Alex Dunedin: Do the current systems of administration help you achieve what you’re trying to achieve ?

Participant: By assistance of administration you mean ?

Alex Dunedin: The paperwork you’re obliged, that you find…

Participant: No no no no. Categorically no. You know we were lucky enough to get some funding to try things differently okay. There seems to be a classical approach to this which is quite a technical and rational in itself; and it’s based in most of the services in the third sector that are offered to people and they are basically ‘okay we are going to take just one aspect of your life – just the one’….

…we are going to put a series of sessions, okay, and we are going to put you through a series of processes which we are going to monitor and then we are going to see how did that work from a baseline okay – so it’s classical.

The problem in an average project with people who are homeless and find it hard to engage for a number of reasons – who have experienced narrative experience of services, or that even starting to communicate that get up in the morning

…we are a kind of a fluid service; people don’t just enter in the program and it’s taken through a process and they finish in a different way they started
In this project people come in/out, they give up, they come back, they meet with you they may not and in that sense we take any kind of engagement as valid you know. So such flexibility it doesn’t fit extremely well with a set of boxes and/or a particular paperwork or evaluation methods.

In fact it seems a kind of professional psychosis to think that people with complex needs which you are called to work with, they have severe and multiple disadvantages; they are chaotic they are going to fit into tiny tiny paperwork processes…

…provided you are said to do something different but at the same time they are going to fit with your monitoring boxes – which it doesn’t obviously. So as you know, one has been, you know, studied a number of times or you made them fit which it means that paperwork is not neutral.

You work in a way that people will fit in your paperwork or the other way around or you lie, blatantly, covertly… [laughs – maybe you want to erase that]… you know, or you lie, or you work in a way that whatever you are writing in this paperwork is of no importance whatsoever for what you really do and here is the question….

…if, most of the monitoring things, they are not important for my clients and they are not important to me; one is trying to see who are they important for ? Particularly in services which call themselves ‘person centered’

Alex Dunedin: Can – you well this leads on – can you talk about the difficulties of measuring the outcomes of your work ?

Participant: Yeah first of all because there is a tradition, again; when you have a structured service – the service we have is more restructuring than structure. The idea is that, you know, you are going to help people to have some sort of structure themselves – to develop that…

So it’s not a structured program which you help people to get through, that you know where they start work – they should start to be able to benefit from the service and you have an idea what do you want them to end; so we don’t have any of that in this service okay.

Take your time; so we don’t have any idea of that so first this is an approach to help people manage their life better, so there is no specific outcomes we are looking for – I think that’s the first problem. We are not just there to get them a house we are not just there to solve their benefits although it may include this

Again, first, there is no specific outcomes. The outcomes will be decided by the person in any case and often the person they are not very sure what outcomes they want to achieve – you know, at the beginning. It will only become apparent after a bit; after working together it will emerge where they want to go. Many people you meet, they are not very clear they don’t have a plan, they do not know how far they can go or indeed if this is what they want.
Many of them they haven’t seen that so they don’t know if they want to, you know. It’s like, the second the problem with outcomes is they tend to be very discreet like you know, ‘got a buspass’ or a flat

You know many important answers for people they are not discreet at all, you know, they are progressive in a way; they are very difficult to cut where they start and when they finish. Second for people they struggle a lot

Gains, they are they are quite precarious; the fact you achieve something that doesn’t matter then maybe you had hoped it and you may have to try and try again. So you may be achieving the same outcome for a while which is fine until there is an instability

Did you know because this is a project that assumes that things are difficult and that people will need to fail quite a bit in order to learn, in order to even decide that it’s not worth pursuing what they were trying to pursue. So this is the difficulties with the concept of outcome.

Another thing I found I struggle with outcome is that it forced you to be quite invested in achieving something particularly when your job, the money you are given, your funding depends on particular outcomes you are forced to force people to achieve that or to do things for them, you know, because you need to achieve that – you need to show your achievement, you know, and that’s problematic.

Another problem with outcomes in those terms, understood in those terms is that – ahhhh, and this is the old story and it’s a kind of a disease that services will cherry pick those people that they are going to give them the outcomes they are looking for, particularly the more structured services…

…the more structured a service is; we look for the best possible baseline to start with which it means people are more sorted, they are more modulated, more secure, blah blah blah, so they will give the biggest chance to succeed. Perfectly okay since from a point of view of scarce resources and targeting, but of course that leaves a huge population without a service that can help them progress…

…and the more structured services go, the more targeted they are, the more evaluated they are, the more monitored they are, the more kind of population we left behind which they would benefit from something else

Um, second, sometimes, as a concept I tend to say that sometimes my clients they are so poor that they don’t even have outcomes to give me, you know; so they are rejected because they are not going to make me look good as a worker or as a service. They are not going to do that and I think we need to learn that my clients are not going to make me look good.

You know, that’s a kind of thing you have to be careful of because I think success, outcomes… do you know there is a role for these kind of ideas but we need to be really careful how we use them; we have to be critical with them.

Of course everybody wants to have positive outcomes for people, t will be ridiculous to think otherwise – that you are there to do damage although that may happen as well but we need to be careful how we go about that.

I tend not to think of the outcome and not to care because at the end the outcomes belong to the person; they don’t belong to me. I can do my best, people achieve/no achieve; they decide they don’t want that; that’s fine, you wouldn’t be the first person that we managed to find a flat for them which is a huge outcome after 10 years of homelessness and then decide that after all didn’t want the bloody flat

‘This is not for me’ – you know what I mean; that’s fine, that doesn’t mean that I done something that is not useful for the person; it’s an example.

Alex Dunedin: Can you think of helpful and unhelpful examples of bureaucracies in relation to your work

Participant: Well, I have to say first that after three years of struggle I’ve been given quite a lot of freedom in [Organisation they work for] and it needs to be recognized. Sometimes scarily so, but when I started here, yeah, it was clear that there was that process to go through you know…

…like, you probably will know this you may have – sorry I shouldn’t have referred to you there – you know, okay, we need to do a baseline where you are, we need to do a plan, you know. I wanted to do ways to meet to find out how well you are doing, you know, um and you are not relating to people, you are processing people you are taking it in through a set of processes

You know, for which at baseline people they are not just stable – nobody is in a baseline – everybody is in some sort of trajectory moving around – I don’t know. I’ll ask you today the baseline will look different if I ask you tomorrow. This is a social thing, it’s not a medical thing; I cannot take your blood pressure as a baseline – you know – this is a construction of people’s lives

Planning what can we say about planning ? You know… my biggest surprise, educated in a traditional approach is that you need to this planning with people and by planning with people I mean the smart planning with these processes is that people apparently knew on their first meeting – what was my surprise ? That when I offer planning in a very centred way as an option most people said that they didn’t want a plan

They didn’t say they didn’t want help; they didn’t say they didn’t want to try things. It’ just they didn’t want a plan. Of course in many services that would have been enough for the workers to say ‘if there is not a plan, I cannot present a plan, I need to present a plan because if I don’t have a plan I am a very bad worker and we don’t get the money so I cannot work with you because you don’t have a plan.

Which is basically the issue you are trying to address through your work. You know, um, and then there is a thousand small bureaucratic processes like – my personal favorite about bureaucracies is as an outtreach worker is, obviously I need a bus pass.

Of course [Organisation they work for] pays for my bus pass but every month I have to declare where the hell I’ve been with the bus pass. So that takes, it will take if I do it – which I don’t – two hours of my life just putting down what the hell I did, which I dont remember…so just between you and me, I know I’m getting; I just put the same places I was two years ago – I am still going to the same places

I’m finding that, this not being very important for me to record this because after two years nobody has come back to me and said ‘hey, you are putting the same places… you are going to stick to those same places after three years’. What I am trying to say is that you shouldn’t record anything that is inconsequential; it’s not useful – nobody cares – nobody noticed. You know, it’s like a collection of information from clients. I always ask, ‘okay I’m collecting that information – what do you want it for?’; ‘what do you suppose you are going to get out of it ?’

You know, workers instead of helping people they are becoming more collectors of things – monitors. This they seem to be doing rather than helping, you know.

They are seen to collecting and monitoring how well you are doing but the person is coming to you is saying ‘well I need help’; so I… because monitoring I’m pretty sure it really means etymologically just watching. So you know, apparently workers they are called to watch more rather than do things with people, you know.

Um yeah, bureaucratic – there is big ones and there is a small annoying ones, yeah, like the buspass one but justthis example of something you should be doing is extremely important and I’ve been lying for three years and nobody has called me on it because it doesn’t matter and still I am called to say that, to do that when it will be very simple to say ‘listen I am outreach worker, I work full time, give me a bus pass every month and that’s it, don’t make me explain’.

It’s just a small example of these things but these things in my organization they can absolutely go crazy in terms of recording things that have no use, that have no value to the life of the worker or the person or the organization for that matter

Alex Dunedin: So in terms of maybe the printed word what do you find helpful ?

Participant: I think you don’t notice when you meet with people; yeah, that is useful to gather your thoughts and to have some sort of guide of what was going on and it’s quite useful to see what discussions you have at the beginning and what discussions you have in the middle and what discussions you have at the end, you know um…

So that I find it useful, like because I work as well to put things on in some sort of paper, give it some objectivity, get it out of themselves; that I find it really useful, I find it really useful in terms, if in terms of monitoring, for the kind of population I work – I’m not saying in other kind of services that they should be more structured. This, I don’t care, you know what I mean; you are here, you started somewhere, I try to capture the best you can using your words and at some point whatever is needed will do the same – it doesn’t matter – this is what I said to my boss about what do you want to do

I’ll tell you how they are now, you know, uh that, I find it really useful personally. At some point to stop and say okay; but that’s something which you do regularly with a person you know. I said ‘what do you think we are ? You seem to be a bit lost’ – you know…

That in terms yes. The human process, give it some sense to do what is a human process you know and if it needs to be at some points, you know; this is where the process is at the moment – this is what we have achieved, this is where we are stuck, this is the reasons we believe we are stuck, this is what we are trying, and that’s it. Like life basically

Alex Dunedin: how often do the funding administration systems change and do they have continuity

Participant: No, no, that’s a big, that’s a big problem okay

Alex Dunedin: So that’s no to they don’t have continuity

Participant: no no actually I want to find an example of this and I have to say I am very happy with our funders because it has allowed us a great degree of freedom to try different things; they are different from the traditional approaches even when we were in a discussion about if the funding will continue I only find out one month before the money was given

So for many workers you don’t know if it is going to continue, are you going to have a job ? Are you going to be relocated to another part of the organization you may hate and actually do some damage and…you know… that’s problematic. Then from the clients as well, many of them didn’t know if this will continue

Um and that happens in many services; continuity in funding is… it’s always been an issue. You know that’s actually part of social care management in many ways

Alex Dunedin: So do the funding administration systems change frequently in your opinion and in your experience

Participant: Yeah I have colleagues, they have they they made their job out of… my colleague [Name], you will know I think his job is made of three different streams of funding in three different monitoring systems; three different set of outcomes for the same population (laughs) you know what I mean…

…which by the way clients have no interest in this – no interest whatsoever, you know but yes, that happens. In my case I am, as I say, I am quite lucky but there is some people that it is a real nightmare.

Alex Dunedin: Do the funding structures allow you to plan long term ?

Participant: No, no but I want to talk about my role; my other colleagues they have funding for some long-term – they have that possibility. My project is a pilot project, it was a pilot project for three years so that’s fine

It’s a pilot project for three years, good funding for another three years to try to find out more and that’s acceptable – it’s three years to do a specific thing. So it’s not.. my project is not that kind of project that is just interested in service delivery

Of course if your main goal is service delivery, you need longer funding because you know if you don’t have it you are no…not going to be easy for you to try to implement changes. You know what I mean; only in the longer term you can have the security to try something new or try something – do you know what I mean…

If you are just, year by year, you just, go by, you know; you have to make it do. That’s a problem of course and for services that are being well established and they’ve been considered to be in the first sector, they’ve been considered being positive blah blah blah… under the threat of funding being stopped, yeah, funding is a problem. There is no two ways around that I am afraid.

Alex Dunedin: do you feel you have the latitude to implement the policies you feel are important

Participant: Again I am privileged because the money doesn’t come from the statutory service, the government, the council – comes from a foundation so it gives us a lot of freedom and actually the money is actually to do the opposite that in other services…

…is try to do things differently so my experience differs enormously for some of my colleagues, you know. Um and yes although even when we did have this – this is curious – even we did have some freedom even inside [Organization they work for] they were limiting themselves to the traditional approaches

Even when, even… this is it’s an ideology, some managerial ideologies, the new public service management ideology; and this ideology is so ingrained that even when I was telling in [Organisation they work for] ‘why do we need to do that again ?’ and it was because that’s how things are done but actually this is why they give us the money because how things were done – they are not working

So it was very difficult; it was very difficult to communicate that it was just an ideology this is how the things are done. That may be exactly the problem we are having with people they are no accessing services as they are difficult to engage with people you know with complex needs. So that was quite surprising that it was difficult for people to say ‘oh no, so you are not interested in outcomes’.

Now people here are understanding what I was trying to say but at the beginning they really look at me like someone who obviously was not well. That caught my attention that even when you are giving freedom to try something else still that ideology is so powerful that it affects the way we see things
Like paperwork is not natural, the ideologies in which we work are obviously no neutral have an effect so what i’ve been doing these last three years is a kind of trying to detoxing from that ideology from that way of of doing things and trying to do things differently. By the way funnily enough most of the learning has come from my clients. Most of it

Alex Dunedin: can you elaborate a little on that

Participant: yes, in simple terms, as I told you before, you are used to people entering services where you are assuming that you have to do a baseline, a planning and you are not even given a choice; however personal centered in your leaflet you are saying you are you are not doing the basic person-centered thing that is – ‘are you interested in doing this ? do you think that will be helpful to you ?’ and when I started giving people the choice most of the people say that they didn’t want to

They didn’t want to be monitored and of course why should we ? Nobody wants to be monitored; it doesn’t sound nice. You know because whatever you want to say about this it’s just, the client is not understanding they’re monitoring the service and is the service do well but they are understanding – and rightly so – you’re monitoring their life and probably their possible failures and their possible shortcomings and you’re documenting that

So you can understand how, you know, they don’t want that; they may want to try things and feel free of trying things not getting on – whatever. Um, so you I learned that really really clearly – people say no, but they didn’t say I don’t want help and of course you can’t say ‘oh of course’ if you have that disease you say to the person ‘No, no, no, you have to do it because this is how we are person centered to you’; and you will impose that in a very person-centered way

You know what I mean. I learned from a particular client that will remain nameless at the moment – when he told me ‘listen [Name] it would be for some people it’s more difficult; it would be as difficult to move from where they are homelessness addiction blah blah into success that for you coming into homelessness and addiction, from where you are now,- that was you by the way, okay

Okay that made me think enormously and actually I called you with her name because they don’t know who you are and I told someone, a young young lady, which by the way she want an offer of a flat, she wanted a flat in this case. I think may change her mind, you know, as we say

um I say, ‘you know what a client told me ?…’…..there has been many things many things that I assume, I took for granted, I was full of service ideology, professional ideologies that weren’t useful to the people; a language that it wasn’t useful -i t didn’t make sense for the people and I still I still haven’t fully detoxed, obviously you know but I think that there is some hope for me.

Is that ok, is that okay what I am saying ?

Alex Dunedin: Wonderful.

Participant: Can I say something ? To the very same person I say – because this is something which I learned myself … of course she’s going to go to a flat; it’s in Wester Hailes and I cannot support them as much as I can so we referred some tenancy support just to get her settled.

I said – Oh I dont know because all the workers I have, they are a bit jumpy or they judge me or …-kind of I say to her, come within those stairs and I say ‘let me tell you a secret; don’t tell anybody. Support workers are stupid….and I was expecting her say no no …

…she said ‘I know’ [laughing] she looks at me and I says I know you didn’t mean it that way.

Of course they are and I said to her, you need to educate them, they mean well most of them, some of them are psychopaths clearly but they mean well but it’s up to you to say ‘well this is the way it needs to be, this is helpful, this is not and that’s it …

…but it surprised me that it actually took it as a fact of life that support workers are stupid, you know um, so I learned that as well that we are stupid most of the time

Alex Dunedin: Are you able through existing structures to forge the connections with outside organizations that you think are important

Participant: Well this is a very interesting question. Okay particularly for people who are on Complex Needs that services they are finding it difficult to cope with. What’s happening in complex needs people they may displays what is called challenging behavior or hard to engage is that in the first sector is that these people they are dumped from service to service and it becomes a game of musical chairs with the client which the client at some point obviously give up about

Okay so when we started the service we put reference on there saying we were a severe multiple disadvantaged service and of course we were dumped with everybody that a service – not necessarily because of the condition; they thought they were too hard to work with and they dumped the person on to you.

Of course, you are only one person you are likely to fail and the game becomes me dumping it into someone an unassuming one which straight away will dump it into a third one. So this is because we started taking breakfast from the homeless practice because like us, and we wanted to mirror that, they say they are CPNs and doctors that work with homeless people and no matter what they do, no matter how compliant they are or not they still treat them and they do so and they have very, they are very tolerant in their approach as they should be for the kind of population

So since I started working with them things are better because at least we can reinforce with each other that they do the clinical part and we do the social relational part and that seems to be working for people they need these two sides you know

It’s a kind of socialize-humanize: humanize the clinical part and brings a little bit of the clinical into the social stuff you know mainly to overcome the experiences of many people with medical approaches you know – it gives a little bit…

…there is a long way to go with that, okay, to get these two parts to work together for the person but that’s that’s quite positive yeah. As I say I said to my boss the other day we need to move to a project that doesn’t take referrals as such – it sounds a bit corny but just consider or accept offers of working together with someone to help someone to avoid just dumping

Say okay you are working, you’re struggling with that person, I will come and help for this person okay; so we take offers of working together and when we refer we do the same we’ll call other people and we’ll say ‘okay, we need some help here but we will still be committed to this person’; okay, so we are not just leaving them’. Is that okay ? I talk too much, I need to go for a cigarette

Alex Dunedin: Wonderful

Participant: yeah, you are going to love that and that would give us an excuse to meet again to talk about that. I will be back in five.

[Brief interval]

Alex Dunedin: Sorry see that again so most.

Participant: Important as we say itself is that we make sure that we don’t do further damage to people; they’ve been damaged quite a lot.

Alex Dunedin: …and you can see that being a possibility with people engaging with services they are engaging with.

Participant: Oh yes, yes, services they are completely unaware of the possibility of the damage they can do themselves to people. There is no such a thing in any risk assessment. There is never a risk that is considered that one risk could come from our engagement with you, from us – and that is from professional services there is a lack of awareness of that

Alex Dunedin: very interesting

Participant: I’m not saying that services…but I think there should be awareness of any intervention in people’s lives to be treated carefully

Alex Dunedin: Do you feel the language used in administration outcomes and measures adequately represents you

Participant: No. No and I don’t know, what to say. I mean, it’s just, it’s no how I see my work; it’s not, it’s something that is very apart from my work, it is like a virtual reality that is constructed based on a reality that is complex, it’s messy, it’s confusing, it’s ambivalent, it’s paradoxical; the rest is some sort of surrogate language so services can digest; which again I don’t know how much they learn about the real world through that language. Again, I dont know what is to say.

Alex Dunedin: Is the sector adequately funded and resourced

Participant: Well that’s a question that goes beyond my remedy Im just a humble support worker in a project I don’t know. My feeling is that no one – you just have to read the newspapers – of being around when try to refer services and then you find out that they don’t exist anymore

You know, it’s like a casualty you know what I mean – that’s, that’s, yeah, that’s probably no but I don’t have the the white, you know, understanding that you know that it’s just my experience you know that – we have services in here but yeah their potential is much more and they are understaffed and they cannot take more people because just there is no money and that’s just in [Organization they work for], you know. So, yes, the answer would be yes, around me without going any further.

Alex Dunedin: What role should broader society play in facilitating your work

Participant: Oh help me now. See here is is another psychotic thing about it. I mean you you may want to to get rid of some of my comments. You know this is this is the funny thing when you say, this is the virtual reality we live in

So we have someone who has a very difficult life has, you know, a lot going on in their life and you are trying to help and then you are monitoring if your intervention has done anything good but it’s hardly considered what these people are confronting, how society conspires to make matters worse for people or interventional work if we monitor in those terms

Will will absolutely this regard what society does to people; their social barriers, the stigma, the exclusion, you know…and this is the problem I have with many monitoring tools that they forget absolutely the context in which our clients live

They just take the person how they are, the intervention, absolutely initiation of what is going on

You know, like people they should become in a neoliberal society entrepreneurs of their lives, you know, and just is, yeah if this is a very simple question if I put it to my boss or to my colleagues or to whoever and I ask them, how do you think society is organized, in a way geared up to help people to get back into society, to help people to integrate it, to help my clients I mean and the answer will be No !

The opposite. It is organized in a way that reproduces the exclusion of certain groups in society and obviously that’s a big monster to find.

Alex Dunedin: Can you see a way which people and maybe institutions – I don’t know – where are there any things that come to mind or have come to mind in the course of your work but you think if people did this it would be easier

Participant: I think for the kind of population I’m working withI think there is two keys. Continuity, no matter what, as much as you can, keeping with the person, keeping with the people, staying with them – not necessarily you, whoever, you know, it could be different people; and cooperation…

Good communication between those that they are there to help. So continuity and cooperation I think they are key in the current climate funding the way we see services, fixing services, sorter services, crisis services. It goes different ways; there are fragmented services, sorter services, shorter view, narrow view and they don’t…

…despite all the talk of interventions and you know, working together, no, nobody has any incentive to work together in the sell sector precisely because of the outcomes thing, everybody has their outcome, fight for the outcomes, my outcome is my outcome, it is no use – you know – so these key things in the current landscape they are difficult to achieve and I think we will do better ,it will be an improvement if you can keep continually working with people through their difficulties at different stages and so it doesn’t have to be intensive work you know what I mean, it could be different, you can come in, come out, you have experience of this kind of service yourself. Any work people could communicate better, again this has been told a thousand times I’m not discovering anything

It’s just we don’t manage to do it if we have the person at the center of this, it wasn’t the outcome for the service, it’s for the person, but that seems to be the psychology of funding it is looking for something else and you know your remedies are remedies, your outcomes are outcomes

You know, yes, the whole system how it’s designed conspires against these two fundamental needs for people with complex needs okay. As you will read in there people are systems, complex systems; people with complex issues – they are complex systems; systems are complex, workers are complex.

So what the people needs to contract as a system as a complex system is another system that can take embrace and work with that complexity over a period of time; that’s the challenge

Alex Dunedin: How might clients and service users best support you in delivering support

Participant: Well it’s supposed it’s supposed to be, supposed to be that kind of service that the interest is not necessarily in the outcome but in the process, in a sense – you, you, you know – again a classic example you may find someone that is hopeless with little sense of self-efficacy, little confidence, very passive, so you may start having to do 90 percent of everything and then you can see people are doing a little bit work, cooperating with you on later stage and then taking control of the support at a later stage

You see, at the beginning, you need to follow them, ‘do you want to meet ?’, ‘oh, I cant be arsed, you know’, ‘have you done that ?’, ‘oh what’s the point’ – and by the end of it you will see people saying ‘can you meet me there and then because I need some help with this’.

You know, you see the difference, someone taking control of what they need to make things happen. You know and some people go through this process, some people they stop at this station as people to choose to exit no fight anymore, some people take a break; that’s the idea, but you know people always help you in some way

Of course there is people for fundamental psychological traumatic reasons in their lives that of course will work against you but you need to be aware of that. They will show us themselves, nothing will work and that is something to be aware and to be patient about and to recognize and discuss with the person, you know; that’s a perfectly reasonable response from where they are, you know

I think again at some level everybody is trying to help themselves, if they can or they are not finding their way, it’s a different matter but they are all trying to help themselves, you know. So that’s helpful for me as well of course. I don’t know if I am answering the question.

Alex Dunedin: Yeah, these are not necessarily answerable or finitely…these are prompts for thinking for talking

Participant: yeah of course

Alex Dunedin: What questions do you think are important in working towards greater understandings

Participant: Yes, yeah this is the question you should have sent me by email you know what I mean because this one is like wow… I think there are very simple questions. I’m not going to discover anything you know

What we are here for

What is my job with this person

In terms of system, what is yours, instead of saying, thinking first what is your contribution not to the solution but to the problem – how are we contributing to the problem so the problem it keeps continuing; we may be part of this fucking problem because this problem keeps carrying on you know.

I know we are nice people, all of these people are nice, I’m sure they are, the doctors, everybody, is nice. I’m sure, most of them, they mean well but they never think what is minimal contributions or things they are not better than they should be

I think it’s like the awareness of not doing damage is to say ‘what is your contribution to…’, you know, because if you don’t ask yourself this question it’s going to be very difficult to know the contribution you are going to have to the solution you know because it doesn’t solve the awareness of how you are part of the problem and we are part of the problem of course, you know. Is that fair ? I don’t have anything else. Thank you very much a pleasure I feel exhausted