Describe and evaluate the essential elements of a ‘Quality Service’ in a health or social care setting of your choice. You may illustrate your answer with examples from practice.
Since the implication of the NHS and Community Care Act 1990 providing quality has become a key issue in the field of health and social care. How quality is defined is relative and may vary from person to person, at its core quality is about meeting agreed goals and objectives in relation to individual needs.
Service delivery has become more “customer” focussed, although service users may have limited options. Stakeholders, such as perspective service users, family members, other professionals, employees etc will have an interest in the quality of service provision.
The health and social care setting that I have chosen to evaluate and describe is Cathays and Central Youth Provision (CCYP) based at Cathays Youth and Community Centre. This youth provision consists of an open access youth club, open three nights a week for varying age groups, DJ and breakdancing sessions on the weekend and a thriving music project. Also this youth provision runs regular holiday schemes, predominantly focussed on young people with learning difficulties.
Although the provision is based in Cathays the young people who attend come from a wide catchment area; this is to do with the demographics of a condensed student population in Cathays and a high school that has an intake from all over Cardiff.
The youth provision is funded and run by Cardiff County Council but the building and other functions of the community centre are the responsibility of a voluntary management committee. The organisation is a registered charity and is funded by rental of the building space and small grants.
Young people are a diverse client group with specific individual needs; therefore stakeholder perceptions of quality service may vary greatly. The Youth Work Curriculum Statement for Wales and “Extending Entitlement Document” advocate “the promotion of equal opportunities to ensure that all young people are able to take advantage of youth provision, based on local and individual needs”. (National Assembly Wales 2004, online)
Cathays Youth Provision aims to meet individual service user needs by providing a variety of activities and opportunities which are age and ability appropriate. Youth work should develop through voluntary relationships with young people and, as stated in the Youth Work Curriculum for Wales, opportunities to learning should be educative, participative, empowering and expressive.
A measure of quality youthwork is how much young people are involved with decision making processes within activities offered. (John, M, ed. 1996) Roger Hart’s “Ladder of Participation Model” is a good example of a framework tool used to measure the involvement of young people. At the bottom of the framework/ladder is token involvement moving up various “rungs” to decisions initiated by young people
Stewart and Walsh put forward the theory that quality can be assessed by using three dimensions. These three dimensions are the “core” service that is being provided i.e. does the service do what it was set up achieve? The service environment, such as the physical surroundings, i.e. do the surroundings enhance delivery of service? Also service relationship, do service providers have a good rapport with service users and stakeholders?
When these three dimensions are applied to Cathays Youth Provision it may be said that the core service is set up to achieve a positive interaction with young people in which the fundamental principles of youth work are applied.
The service environment however is inadequate; the building is nearly one hundred years old and was originally set up to be a roller skating rink. Although it manages to pass fire, health and safety inspections etc the building is a constant concern and drain on depleted resources. However, there is currently a drive to improve the building through a re-development programme, plans have been shown to stakeholders, including youth club members, and service users and stakeholders have been consulted via questionnaires and surveys.
The service relationship with young people should be one of partnership between the youth worker and the young person:
Youth workers have become concerned with “empowering” young people, helping them to develop skills, knowledge and the disposition necessary to become society’s active participants, rather than its passive victims (Roche and Tucker, 1997 p.249)
The service relationship at Cathays is based around an open access policy; it is delivered via a voluntary relationship between the service user and youth worker. It could be argued that the voluntary nature of young people’s attendance at the provision is in itself a measure of quality service provision.
Because of the informal nature of youthwork and the transient relationship with service users quality outcomes are often difficult to define. The Community Education Officer, currently based at Cathays Youth Provision was asked whether he thinks that there are any reliable methods of researching and measuring quality of service delivery. He stated that:
“This depends on the type of service being delivered, for instance OCN, photography, cooking and other “practical” activities can be practically assessed. Other aspects of service delivery, such as putting into place anti bullying strategies are harder to quantify as a decrease in bullying may be due to other factors.
Youthworkers may have a unique standpoint which enables them to put an alternative interpretation and value on situations, for instance a development of trust between a youthworker and young person may enable the youthworker to identify significant character development. By getting to know young people as individuals, youthworkers are able to perceive subtle changes that are difficult to measure. Although measurable targets are useful in some situations the benefits of some activities may not be immediately apparent.”
Ivan Illich stated that “personal growth is not a measurable identity; it cannot be measured by any rod or curriculum”. Given that youth provision is primarily concerned with personal growth reliable measures of service delivery are difficult to quantify. ( Illich, 1971)
However, in recent times there has been a drive to document and record activities involving young people. The Youthwork Curriculum for Wales 2002 states that “Youth work in Wales is delivered through a voluntary relationship between young people and youth workers working within their own organisation and in partnership with others”. (WAG 2002)
However some youth clubs are not allowing young people to access their provision unless they sign up for accredited awards. Some sections of the youth service believe that this could be seen as discrimination against young people who do not want, or are unable, to sign up for this award. Accreditation is often used as justification for funding but many feel that this approach goes against the core ethos of youthwork:
Once the youth worker adopts a curriculum, other than in exceptional circumstances, they break with the historical mode of practice that has given them a unique place in the tapestry of education. (Tony Jeffs, 2004)
The disagreement within the field of youthwork about whether service delivery should be informal or curriculum based illustrates how the ethos of “quality service” can be defined in different ways. The community Education Officer for Cathays feels that “The days of opening doors to anyone are running out due to justification of funding”.
Within the youth provision at Cathays there are a number of evaluation processes. Nightly de-briefs amongst staff allow for discussion about issues arising during the session, these de-briefs are written up and kept for future reference if needed. Also staff can log any requests or concerns they may have about the provision.
Banks et al identify open, transparent dialogue as one of the key learning processes in professional practice. This dialogue should encompass all levels of management but professional status should not be of key importance. “Dialogue, within a team minimally encumbered by status differences, and motivated by a desire to establish valid and useful ideas or innovations, has the best chance of reaching quality conclusions” (Banks et al, 2003, p.99)
Within Cathays Youth Provision open dialogue is actively encouraged and professional status is not overly apparent. However, professional experience is utilised in particular situations with most staff having a particular area of expertise.
Also within the de-brief activity monitoring forms are filled in, these log any activities that the young people take part in. These forms also record a statistical breakdown of the young people into age range and gender, this can be used to assess which activities have been accessed and by whom and employed in future activity planning.
Staff undertake regular supervision and this enhances reflective practice, which is very much encouraged within the field of health and social care. Supervision with line management can be broken down into three main functions theses are administrative, educational and supportive (Kadushin 1992, online). The function of administrative supervision is to ensure good standards of work and adherence to operational policies, educational supervision is to make sure that supervisees’ personal and professional development is maintained. Supportive supervision ensures that the supervisee has a chance to air concerns and maintains the equilibrium of staff relationships. (Smith, M, 1997) 1
The inspectorate body for youthwork in Wales is Estyn, their strategic direction is set out by the Welsh Assembly Government, and they aim to deliver high quality inspection of training providers, education providers and other related services of which youthwork is one. They aim to raise the standards of service within these provisions and to inform the Welsh Assembly Government in the formulation and evaluation of training policies and education. (Estyn 2004 online)
Within Cardiff youthwork has moved from the department of Leisure and Lifelong Learning to Education. Many youth workers see this as problematic with youth provision being seen as the “poor relation” to schools services. This move may impact on funding and increase the trend towards curriculum based activities and projects within the youth service.
Banks et al indicate that quality assessment is particularly difficult in community practices such as youthwork. The definition of quality within youthwork is more problematic than within education which has a more structured outcome base and a stronger reliance on performance indicators.
Quality measures, within youthwork, may be difficult to quantify as initiatives evolve over time and outcomes and goals are flexible. As young people are encouraged to be a part of the decision making process youthworkers cannot pre-empt project goals. This does not mean that quality within youth provision is immeasurable but its boundaries are blurred. (Banks et al, 2003).
Measurement of quality service may be more difficult when the service user has communication difficulties or learning impairments. Strategies may need to be put in place for advocates to assist with the evaluation process. Within Cathays Youth and Community Centre there is a strong emphasis on inclusion (reflected in their policy documents) and each summer the local authority fund a four week teen scheme for young people with learning difficulties.
This scheme is provided in a more structured environment than the open access youth club, and has a higher staff to young person ratio. Quality outcomes are measured by primary carer evaluation sheets. The active participation of the young person filling in evaluation sheets is encouraged but they may need support in undertaking this task.
Professional practice is often underpinned by a code of ethics; this helps the profession to be accountable to its service users and stakeholders and provides a framework from which to base practice delivery. Historically youthwork has had no formal code of ethics, although there are professional guidelines and standards to which youth workers should adhere.
It may be difficult to hold fellow professionals accountable for their actions if a code of ethics is not in place. Also a code of ethics can help when maintaining and measuring quality service delivery: Codes of practice do provide a reference point – something for us to use to judge situations”. (Jeffs and Smith, 1999, p.3) There is currently an initiative within youthwork in Wales to develop a code of ethics by which all professionals involved in youthwork will have to be accountable to.
Throughout this assignment I have aimed to describe and evaluate quality service provision within the youth service, particularly within the provision provided at Cathays Youth and Community Centre. It has become apparent, that within the field of youthwork, quality service delivery is difficult to define and quantify. However, within Cathays there are service evaluation methods and frameworks in place which staff are encouraged to use.
Bibliography and References.
Banks, S, Butcher, H, Henderson, Robertson, J (Ed ) (2003) Managing Community Practice, Bristol. Policy Press.
Dunkerly, D and Thompson, A (Ed) (1999) Wales Today, Cardiff, University of Wales Press.
Estyn, (2004) (online) Estyn home page aims and objectives, http://www.estyn.gov.uk/home.asp, accessed 03.01.05.
Holmes, J (online) (2001) The youth service alternative to connexions in Wales. http://www.infed.org/youth work/extending_entitlement.htm accessed 03.01.04.
Ivan Illich, (1971) Deschooling Society, Middlesex, Penguin.
Jeffs, T, Smith, M, (1999) Informal Education, Conversation, democracy and learning, Ticknall, Education NoBooks.
John, M, (Ed) (1996) Children in Charge, The Child’s Right to a Fair Hearing, London, Kingsley.
Roche and Tucker (Ed) (1997) Youth in Society, London, Sage.
Smith and Smith (online) (2002) The Albemarle Report and the development of youth work in England and Wales, http://www.infed.org/youthwork/albemarle_report.htm accessed 22.12.04.
Smith, M (1997) (online) The Function of Supervision. http://www.infed.org/biblio/functions_of_supervision.htm, accessed 03.01.05.
Welsh Assembly Government (online) (2002) Learning Wales, The youth work curriculum statement for Wales 2002.http://www.wales.gov.uk/subieducationtraining/content/guidance/entitlement/annex%208-e.htm. Accessed 16.12..04