Is there an ideal model?

Is there an ideal working model that ensures sound, maximal, meaningful peer involvement?   No.  Each context, each community and each collaboration has different opportunities for meaningful involvement.  Any type of participation has the possibility to support someone to take responsibility of their life and to add to its quality.

The Good Practice Guide on HIV and drug use from HIV Alliance

distinguishes three characteristics of good meaningful involvement:

  1. people who use drugs participating in decision-making about programmes and services
  2. recognition of, and respect for the expertise of drug users who know about drug-use patterns
  3. people who use drugs implementing services or programmes as peer educators, evaluators, carriers and programmers.





The more the better?

It is tempting to believe the more power, the better;  that people do benefit from climbing the ladder of participation;   the higher you get, the better it is;   and that reaching the top (complete power) is the aim.  Liberating, justifiable and honourable in spirit and approach though this is, the concept has some serious limitations in daily reality. Climbing the ladder does not necessarily correspond with the ideas and/or capabilities of individuals.  Critics argue that there is no ‘one size fits all’ and that not all individuals are interested in full participation.

Tritter and McCallum describe the complexity of human development that cannot be represented in a one-dimensional model that leaves out the individual’s different motives, aspirations, capacities and limitations.

Some people want to be in control, some don’t and have different aspirations or priorities. Some have the capacity to take full control, others haven’t. That said, they may be very happy with a smaller, achievable improvement in their lives.

“By solely emphasizing power, it limits effective responses to the challenge of involving users in services and undermines the potential of the user involvement process.” Tritter and McCallum

It could be argued that focusing on one end result (total power) actually limits effective involvement of users in services and undermines the potential of the user involvement process.  This focus may reduce and limit other kinds of meaningful involvement, instead of enhancing them.  In daily reality, incremental steps - small steps forward - might be a more realistic alternative:  aiming for options lower down the ladder of participation may sometimes lead to considerable improvement of a person’s engagement with peer support programmes.





Empty participation

We must be careful to avoid the dangers of what can be called ‘tokenism’, where peers become mere ornaments in a consultation or communication process.

One of the best-known theoretical descriptions of different forms of participation is the participation ladder of Arnstein, devised in the heyday of the provoking 1960s.  She ranked various forms of citizen participation, in which she distinguished a number of levels of involvement.  She also identified the concept of ‘empty’ involvement.

Arnstein’s ‘ladder’ of increasing participation is :

  1. Information: Being provided with information is the first step in the entire participation ladder
  2. Consultation is another step in the right direction, but there is no guarantee that anything will be done with your opinion.
  3. Placation: advice can be given by those being consulted, but the power-holder retains the right to judge the feasibility or legitimacy of the advice.
  4. Partnerships: power is redistributed through negotiation and planning and decision-making responsibilities are shared.
  5. Delegated power: a majority of citizens hold seats on decision-making bodies and have the power to make decision.
  6. Citizen control: the former ‘have-nots’ have all power (planning, policymaking and managing) in their hands.






Meaningful involvement

* partly based of paper of Katrin Schiffer peer involvement (in press)

In general, we prefer to focus on genuine involvement and maximum implementation of ‘meaningful’, rather than to lose focus by discussing the minutiae of the technical terminology surrounding the level of peer involvement.  This section will focus on the concept of ‘meaningful’.

As mentioned earlier, the methods applied to engage peers vary considerably. Some forms of peer work focus on straightforward education and apply very similar methods to formal tutoring, such as whole-class teaching in group discussion in youth centres.  Other methods include very informal tutoring in unstructured settings, one-to-one discussions and counselling.  Other methods have more ambitious aspirations and focus on empowerment and emancipation processes.

Which method is adopted depends to some extent on the intended outcomes of the project, whether it be passing on information, behaviour change, skills development or community development.  Some projects include a variety of methods, whilst others keep to only one.

Pretty (1995) identify 7 different types of participation:

  1. Passive participation. Professionals have complete control of the programme, the planning, the organisation of activities.  The target group is only informed about what is going to happen.  Example:  drug users in methadone treatment.
  2. Participative information-giving, in which the target group is participating by answering questions from researchers, services or policymakers, without having influence on decision-making.  Example:  research settings.
  3. Participation by consultation, where the target group can express its views and needs.  Their feedback can influence the process and the decision-making, but there is no obligation by the consultants to incorporate it.  Example:  policy and civil society consultation processes.
  4. Participation for material incentive includes that the target group participates by providing specific resources such as labour in exchange for money or other material incentives.  They can influence the work setting, but not the process and the strategies being used there.  Examples:  social reintegration projects for drug users.
  5. Functional participation means that the target group participates by contributing to predetermined objectives (usually not from the very beginning of the project).  Control and responsibility are still in the hands of the professionals.  Example:  peer workers in HIV/AIDS prevention initiatives.
  6. Interactive participation is the cooperation between the target group and the professionals, working in partnership using interdisciplinary methodologies.  Knowledge is shared to gain understanding and develop common actions.  Example:  Action Research.
  7. The highest level of participation is self-mobilisation. Professionals remain in the background or do not play any role at all.  The target group makes its own choices and decisions and has complete control of the planning and implementation of activities.  Example: drug user organisations.