A Review of Social Role Valorisation (SRV)

Author: Nan Carle Beauregard

Normalisation and Social Role Valorisation (SRV) remain relevant but controversial theories to our thinking about how we live together as equals. For many leaders in the movement to challenge institutions and help people live lives of meaning they played a pivotal role in shaping policy and practice. Here, Nan Carle, one of those leaders, reflects on the strengths and limitations of SRV from her perspective.

I am going to stroll down memory lane from my own experience of Normalisation and SRV. I will discuss some key factors that continue to be relevant to me and why I think that SRV has not had staying power from a practice point of view. I like to think that as a manager I have been a ‘reflective practitioner’ – studying, reading, writing, learning and acting as I moved through large systems of care. A few times I have made a difference in someone’s life. Many people have made a difference in my life.

In the days of the arc (1980) when I was writing my dissertation I was not permitted to reference “Normalization” as an academic theory. I was able to talk about social psychology as an emerging theoretical construct but not Normalization. My dissertation was on the perceived differences in rating Adaptive Behavior between parents and teachers. The last line of my treatise – and the most important to me – was, “Adaptive Behavior is whatever we allow it to be.” Simply put, if we think that kids can learn to cross the street or to dress by themselves or to make decisions - large and small – than we will more likely set the conditions for such to happen. If we do not think kids will learn, they won’t.

Now, 36 years on, that is still my fundamental belief. All people can learn. It is up to us to put into play that which will make learning happen. And I continue to believe that “all means all” – including older people and those approaching life’s end.

What does this have to do with Normalisation or Social Role Valorisation? 

Everything. Expectations, learning, teaching, being responsible agents of change are all tenants of the developmental theory on which Wolfensberger and others based their work. I thrived in my early professional life in participating in and team leading PASS and PASSING Workshops then later to be involved with John and Connie O’Brien’s Framework for Accomplishments. It helped that I was in my early 30’s and was right about just about everything. There was no grey, no incremental steps to change. It was all or nothing and everything NOW. It also helped that I was working at Guys Hospital where everyone else knew they were right. Arrogance was the cultural and professional norm in a Teaching Hospital.

Now in my 60’s, I am fully aware that I really don’t know much about anything. I find myself in the same conversations day after day, year after year, decade after decade. For example, recently a staff person was talking to me about how parents didn’t really understand their son’s needs and abilities. i.e. Staff know better, care more… an age old arrogance that crafts a wedge between people with disabilities and their families - the people who care about them body, mind and spirit. In March a support worker was telling me that when she got to work she was given a set number of sheets of toilet paper so she would not use that of the people living in the home. Really? I used to photograph toilet paper in the 70’s (or lack there of). That toilet paper is still a front line issue today is… well… humbling in the extreme.

So what worked and what is missing from an SRV, Normalisation perspective in today’s human services? 

Common language - The study of Normalisation and participation in PASS and PASSING Evaluations gave us a common language that helped make clear distinctions about what we were seeing in our human services. This common language meant professionals could talk to each other about important issues of social justice and service change. We were able to discuss key aspects of social integration, individualised support and comprehensive service policies.

We bonded - The training opportunities created by Alan Tyne gave us a place to hone our voice. The open space that David Towell created at the Kings Fund Centre was a vital ingredient for plotting and planning in the name of Normalisation and Ordinary Lives.

In the early days of developing services in Lewisham and Southwark, the gift of a distinct language gave me clear reasons to ‘say no’ to acquiring large homes, to be careful about who lived with who, to fight for decision making that was based on multidisciplinary teams and to create staffing policies that were directed at ‘the best person for the job’ – not just nurses. 

With PASS manual in hand, I was also able to work with our finance department to develop individual based budgeting – yes in the mid 1980’s. This ensured that we had good documentation about the costs of our services and were able to promote a positive reputation about our services within the budget formation process within Lewisham and North Southwark Health Authority (i.e. Guys Hospital and arrogant doctors…). This understanding of our finances also led to more positive negotiations with social services about joint working and thus to creating organisations like the Southwark Consortium, now Choice Support.

A disciplined sense of change - PASS and PASSING were evaluation tools that helped us take a disciplined look at the rights and wrongs of human services. We aimed to walk in the shoes of those individuals who were using the services and to better understand their needs and experiences. I used the analogy that it was like standing on the top of the Post Office Tower (today's BT Tower) and looking out from each window to frame a specific part of London. As we stepped around each of the 50 (or 42) windows we obtained a clear set of distinctions about what we were seeing – AND it was all about London.[1] If we stood at the very top of the tower we could get the Gestalt of London – or the Model Coherency of what was and was not there:

Are the right people doing the right things in the right way to meet the people’s real needs? 

Each of the ratings in PASS and PASSING offered important nuances about what we were doing and how we could rethink quality of life questions and service responses.

This disciplined approach to reviewing the quality of our work has been the single most important asset to my career as a service provider and to my personal life as a human being. They remain part of my everyday experience of communities and the services we put into play for people with needs for support.

There were a couple of principles imbedded in PASS and PASSING that were core to our work and that seem lost in translation in today’s service structures and policies. It feels important to me to list a few of them here.

Conservatism Corollary -  “The more impaired, devalued, or otherwise at risk of social devaluation a person or group is, the more important it is to add value to that person or group and at the very least avoid doing anything which would even slightly harm the person’s or group’s image or competences.”[2] This corollary is at the heart of ‘devaluation’ and demands important roles for those who work in our support systems.

It remains the case, that people with labels, and particularly those who enter the service system, are at risk of being institutionalised and divorced from their natural family and friends. Institutions might look different these days but we still hear staff talking about someone ‘going out into the community’ even when they live in their own home and are already IN the community. Language is telling. It’s an institution.

Our austerity policies and budget limitations have multiplied the importance of going the extra mile to enhance the image and competence of people supported. Staff must be both mindful and aggressive about promoting positive reputations through their actions and interactions. One of the advantages of the PASSING instrument was that it articulated a distinction between competency and image enhancement. I fear that this distinction has been largely lost in today’s policy and practice.

Intensity of Relevant Programming - In my mind one of the most important PASS ratings is Intensity of Relevant Programming. First is there programming at all? Second is it even relevant to the individual’s needs and third is there any intensity in what is on offer? Does the programme challenge the person based on state of the art technology and knowledge? Or is it just good enough…

We know so much about teaching technologies, motorized and computer aides and basic behaviour enhancement so why are we not using it? Are people really supporting people to have meaningful community participation and loving relationships – regardless of the nature and severity of their disabling condition?

I despise the laissez-faire attitude that is ever present amongst providers. I have been having the same conversations about choice for over 30 years. Based on the work of Fred Emery and Russell Ackoff I posit that Choice is a function of what is familiar to the person and what they have access to.[3] So exactly what are we doing to increase what people know about and what they can access because they have knowledge, money or proximity – or advocacy? Then talk to me about choice.

The developmental model that we profess to advocate requires rigorous action. It requires staff at all levels to have high expectations about what is possible. Expectations do not cost anything and free training is equally present. There are no excuses for our low expectations.

Change and No Change - Of course we have made many many positive changes since the 1970’s and 1980’s. So why has Normalisation and Social Role Valorisation lost its footing? John O'Brien has offered some very cogent reasons. But I would also suggest that the very strength of its common language has been and continues to be its downfall.

Most people I know who use services do not want to focus on deviancy, devaluation and the language of ‘lack’. The PASS and PASSING instruments focused our attention on all that was wrong with a particular service or a whole service system. And whilst that naming of what needs to change is an important first step – it is even more important to envision a better present and future with a way to get there. Over time we got better at offering feedback but my main experience was PASS and PASSING reports sitting on shelves long after they were delivered. We asked too much.

We were in our ‘heads’ much of that time and failed to take the hearts and minds of others with us. We created an ‘us and them’ clique – the very thing we professed to oppose. I blame myself and others in my clique for continuing the divorce between individuals and their families in the name of “Age Appropriate Interpretations and Structures”. I had no idea that our arguments would have the consequences of recreating strained family relationships akin to psychiatrists telling parents to “let go” of their sons and daughters and send them to institutions. Anger and arrogance is all right for a 30 something but heaven forbid our social policies would remain stuck in that developmental age.

Framework for Accomplishments - It is my experience that it has been the work of John O’Brien that has created the most sustained and long term change in our service systems. John and Connie’s development of the Framework for Accomplishments refocused our attention on visions of possibilities – of how to find even the smallest positive action and build from there. Planting people – all of us - deeply into our neighbourhoods and communities - is at the heart of his work. The language is inclusive and demands change from inside our being. It is not business as usual. John’s efforts to create images of possibility for valued living especially with people who most challenge us - is a living and breathing example of positive and sustainable change. It’s possible and we can do it!

John has certainly been a thoughtful and heart filled agent of change. He described himself as a good listener. I consider John to be a brilliant architect – crafting elegant structures and safe spaces where we could explore our ideas and live into our better selves. It is his work that has and will stand the test of time.

As part of John’s network, I met John McKnight in 1984 who added language and structure for thinking about the community aspect of Framework for Accomplishments. McKnight’s work on Asset Based Community Development helped articulate a vision for a new role for paid support – and for the service systems as a whole. His latest work on Abundant Communities with Peter Block is seminal. As we move deeper into a world of terrorism and trauma these distinctions about community become extremely important.

Another major contributor to communicating our work was David Sibbet. His work on Team Performance and Group Graphics was a fabulous addition to getting beyond spoken language and teasing out the assumptions that lay just beneath the surface of our words. Sibbet’s work enabled people of different professional and cultural language groups to understand each other – and therefore to solve long standing problems. “I see what you mean!” was more than just a workbook.

The last person of note is Margaret Wheatley. Her work on leadership and community building has influenced me greatly. I have especially liked Walk Out Walk On as an inspiration for local change in very troubled areas around the globe. I carry her small book Perseverance when I travel as it keeps me grounded.

You will gather that whilst the work of Normalisation and Social Role Valorisation has much to offer us in the world of human policy and practice I would not support it as a way forward to thinking about serving our elders. I think there are better more inclusive ways to think, work and be. As a growing elder I want to be surrounded by love, community and a gentle touch.

For me, the bridge between value based theoretical constructs and citizenship is community. It is community where we need to focus our attention during these very troubled times. Community is where the work belongs.

I will end here with Margaret Wheatley’s new work on Warriors of the Human Spirit:

Warriors for the Human Spirit
are awake human beings who
have chosen not to flee.
They abide.

They serve as beacons of
an ancient story that tells of
the goodness and generosity
and creativity of humanity.

You will know them by
their compassionate presence.

You can identify them by
their cheerfulness.

When asked how they do it
they will tell you about discipline,
dedication, and the necessity
of community.

References

[1] The PASS instrument had 50 ratings and PASSING had 42 ratings.
[2] PASSING: Normalization Criteria and Ratings Manual (2nd Edition) (1983). Wolf Wolfensberger and Susan Thomas Alphabetic Glossary of Special Terms. Pg 16.
[3] Active Adaption: The Emergence of Ideal-Seeking Systems, Fred Emery in The Social Engagement Social Science: A Tavistock Anthology Volume III, edited by Eric Trist, Fred Emery and Hugh Murray. (1997)

The publisher is the Centre for Welfare Reform.

A Review of Social Role Valorisation (SRV) © Nan Carle Beauregard 2016.

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