Visions for K319

The K319 course team met this morning. Each course team member had been asked to prepare a 10 minute presentation about their vision for the course.

(K319 is going to be a third level 60 point course, covering both health and social care and with a particular, but not exclusive, focus on older people. Its holding title is ‘Health and Social Care with Adults’ but that is unlikely to remain its title)

N.B. Disclaimer: what follows is in no way a statement from the course team – it’s just my personal vision.

I decided, rather than doing the now traditional PowerPoint presentation, to illustrate my ideas with items from my children’s toy basket:

(Somewhat noteform, for speed of posting)

Coming from working intensively on K101, another broad general course (although that covers the whole lifespan), what will be different about K319? Because it’s third level, I would like to see a more explicit foregrounding of  the research evidence base for practice. I would like us to hone students’ skills in assessing research evidence. I want to help equip them with a sophisticated understanding of the evidence-based practice movement, in order to enable them to critique it as well as use evidence in their practice. I’d like evaluating and thinking critically about research evidence to be a visible thread throughout the course, like the stripes in the Guatemalan purse (middle left)

I’d previously suggested that we should try to come up with a question that the course is answering (not necessarily a student-facing question, but one that will help us work out what we need to cover). My suggestion is:

• How do we know how to improve care for adults?

Since you need to know what’s going on now before you can know how to improve things, this might mean our (?)two Readers fall into:

1. what’s going on at the moment in adult care?
2. how might it be improved?

(Students dot about between the two Readers, directed by the Activities)

This might contribute toward my vision for the Readers, which is that I want them to be:

• exciting, cutting edge and coherent as books in their own right
• extremely well written – clearly expressed but sophisticated ideas
• contributors to include some big names
• but also some newer scholars who write well
• attractive and reasonably comprehensive, just like The Baby’s Catalogue

I want the course to make good use of new technologies. Ideally we’d find something quite exciting and shiny, that allows us to do something really good pedagogically that we wouldn’t otherwise be able to do. (My illustration for this (plastic thing, middle, 3rd from left) would have worked much better had the batteries not run out. How apt as a lesson in the perils of technophilia).

As a pedagogic strategy, K101 has left me a big fan of the detailed examination of particular issues (the magnifying glass), especially through case studies. I think these work really well to involve students and to move them from the particular to the general.

But it’s very important that these build up systematically to the bigger thematic issues, creating a tower of knowledge and skills (building blocks), but not an ivory tower

Three specific topics I’d personally like to see covered (not necessarily as detailed case studies, although obviously I’d favour that):

1. Domestic violence – symbolised here by that notorious perpetrator of domestic violence Mr Punch (Mr Punch attacks Rag Doll).
2. LGBT issues in care (Rainbow flag)
3. Older people portrayed as complex, rounded, varied individuals, not as stereotypical sweet old ladies or dirty old men, and including as sexual beings (This Mr Punch dates from at least the 1940s. He kisses the rag doll)

I want the course to avoid the various monsters (Purple Cthulhic glove puppet) lying in wait for course teams. Particularly the one that is preying most on my mind at the moment – understaffing.

I want the course to end up:

• Improving the lives of adult services users
• Making a major impact on the field of adult care
• Placing the OU back as a major player in gerontology

If we achieve all this, it will be cause for celebration (cake hat)

For the love of three Bookstart books

My almost-toddler had a routine Health Visitor checkup today. I was trying to work out why I took him along. I have no worries about him and felt no need to have my lack of worry validated by a Heath Professional. Taking him along risked getting sucked into surveillance practices that I know from previous experience can be very unhelpful. It was quite inconvenient to attend – I had to take time off work and he missed a nap.

I have, like most parents, considerable investment in being seen to be A Good Parent, and attending routine check-ups is one of the ways modern parents can do this. But I have sufficient theoretical traction on that to give me the resources to refuse it head-on. And sufficient articulateness and socio-cultural privilege to deal with the Health Visitor had they bothered me about it. I know my Health Visitor has targets to meet about getting parents to bring children to check-ups, but I don’t care enough about her to attend just to help her statistics.

In the end, I concluded that I went because I wanted the Bookstart books you get given at this check-up, and the handy sturdy canvas bag they come in.

That set me thinking about the role of trivial incentives in health and social care settings and in recruiting research participants.

Children often get given stickers by dentists and practice nurses these days. It doesn’t seem to encourage or reward my children significantly, but I guess it must do some children, or it wouldn’t have become such a common practice. Or is it, perhaps, not an evidence-based intervention?! Is is perhaps performed just to make practitioners feel they are doing being good with children?

Pregnant women in my area get given a pseudo-book ‘Emma’s Diary’ at an early antenatal appointment. I found it too irritating and patronising to read. I wonder whether it does improve pregnancy outcomes. Then there is the whole Bounty Bag Full of Nothing phenomenon. If you have a home birth you often end up not getting the post-birth bag – serves you right for bucking the system?

It is becoming increasingly common practice when doing academic research to reward participants with something like a £10 M&S voucher. I’ve always had rather mixed feelings about this. On the one hand, yes, it’s nice to symbolically give something in return for participants’ time, energies, insights and experiences. But on the other hand, £10 seems a woefully inadequate response given how crucial people’s participation is to academic research. And as vouchers-for-participants becomes more of a norm, it becomes more difficult to undertake unfunded research. And there’s an argument from the service-user movement that participants in research ought to be properly paid for their time if their contribution is so important.

I’ve often wondered whether the £10 is significant to research participants, or just to researchers, so that they can do being a good (ethical) researcher. But perhaps my own willingness to inconvenience myself suggests that trivial incentives can work.

Learning to assess: Assessing to learn

(Image nicked from studenthacks.org/2008/01/29/conclude-essay/)

Last week the K101 course team had an all-day meeting to discuss the assessment questions for the next couple of presentations of the course. Each person who is responsible for a Block (about a month’s work, a sixth of the 60 point course) had produced suggested questions and guidance for students and tutors for their material. On this occasion we each produced 4 continuous assessment (TMA) essay questions and 1 exam question. We pretty much spent all day discussing the draft questions and their guidance in fine detail. It’s very much like the process of constant critcism and redrafting we used to produce the materials in the first place, although with considerably fewer iterations.

Exam and assessment questions are much harder to write than you might think – it’s very easy to set something misleading, or unsuited to students of varying ability, or insufficiently related to the course materials. And because this is basically the same material presented over many years, you quickly run into the danger of repeating yourself. It’s very important to avoid that when you know people sell past essays for your course on eBay!

I value very highly the co-operative and collegial atmosphere in which these sort of discussions (mostly!) happen. It’s not easy having your work torn to shreds, but people mostly seem to accept that it is done with good intentions and that the end result is immeasurably better for it. I was particularly impressed with the good grace with which a senior and very experienced colleague accepted having to go away and rewrite almost all of their questions. I like the way it seemed we were all focused on the end product and not on our egos or pet interests.

Assessment is of course vitally important in any educational context since, famously, assessment defines the de facto curriculum (Rowntree, 1977). But it’s particularly important in an OU context because feedback on essays is one of the main vehicles of individualised teaching. Students (usually!) get very substantial comment on their work and suggestions for how to improve it. And tutors get regular feedback on their marking and how to improve the ways they teach through marking. The feedback chain does come to a stop with the people who give the feedback to the tutors (Monitors), since we are not assessed, but we do get trained specifically in being a monitor.

One of the course co-Chairs, Anthea Wilson, had produced a paper to help us design the questions (with, I think, some input from Andy Northedge, who was the course Chair while we were producing the course). With her permission, I’m reproducing parts of it here, both so I can find it next time I come to write assessment questions and in case it’s useful to any of my readers (some of it is specific to the pedagogy of K101, e.g. the centrality of case studies, but other points are more widely applicable). I’ve added some notes of my own at the bottom.

TMA Essays

• Does it lead students into exploring and thinking through a key aspect of a Unit of the Block?
• Does it give the student enough scope to draw on case material?
• Does it give students enough opportunity to engage with key ideas and debates?
• Is the scope of the question focused enough to help students to understand how to limit their answer?
• Does the task/guidance fit with the writing skills development strategy of the course?
• Does the guidance guide the writing just enough to still leave a significant challenge for level 1 students?
• Is there scope for high-end students to extend themselves?

Exam questions

• Does it give students enough opportunity to engage with key ideas and debates?
• Does it give the student enough scope to draw on case material from the course?
• Is there enough contextual information in the question to enable students to think their way quickly into a productive line of answering?
• Is there enough scope in the question to enable a Level 1 student to write a substantial answer? (E.g. the addition of such wording as ‘and how may these issues be addressed’, or ‘and what are the arguments against’ will often legitimise and guide students towards providing a fuller, more rounded answer.)
• Is there enough relevant material in the related unit(s) to enable a Level 1 student to write a substantial answer? (E.g. A short subsection of a unit is unlikely to offer enough – and there needs to be clearly associated case material.)
• Is there scope for high-end students to extend themselves?

My additions

If you’re not sure whether you’ve got the question right, try writing the student and tutor guidance for it. If it’s not going to work, that quickly becomes apparent when you try to tell the students how to approach it and the ALs how to mark it. In K101 the tutors are given a list of key concepts which come from the course material. For most of my questions I had about a dozen concepts, of greater and lesser relevance. I discovered that for one question I had set I could only come up with 3 key concepts. That made me realise that the question wasn’t really one that could be answered from the course materials, even though it was otherwise a good question.

Slightly journalistic questions can work well – ‘Is this the case?’, ‘Does this work?’ – but they usually need an additional sentence like ‘Discuss in relation to the course materials’ or ‘Illustrate your answer with examples from…’. This helps to ensure that students don’t get seduced into ranting on the basis of their own opinions or poorly theorised personal experiences.

Try not to get distracted onto your own pet peeves or interests.

Questions of the form ‘General issue question. Illustrate your answer with reference to 2 case studies from the course material’ often work well. The general questions helps to keep a focus on the theoretical issues and the case study bit helps to keep it focused and grounded on practice and the complexities of real situations. 

And finally, remember to allow plenty of time to draft the questions! It always takes longer than you think.

Rowntree, D. (1977) Assessing students: How shall we know them? London: Kogan. 

Cyberspace still patriarchal shocker

I’ve just been to a meeting of the OU’s Feminist Reading Group. As always, I almost didn’t go, because it doesn’t feel like an essential part of my day-to-day job, it feels like a self-indulgent luxury for when I’ve plenty of time (which is never). And as nearly always, I’m so glad I did.

The paper being presented was itself interesting – Andrijasevic, R. (forthcoming 2009) ‘Sex on the move: Gender, subjectivity, and differential inclusion’ Subjectivity, 29. Special Issue on ‘Conflicts of mobility: Migration, labour and political subjectivity’. A topic on which I knew nothing and now feel as if I know something, and can see some interesting connections to my own field and theoretical concerns.

But, again as often, we had a really interesting conversation beforehand. One of the things we talked about was the experience of receiving pornographic spam on your blog, and how upsetting and malicious that can feel. I was particularly struck that one senior academic, an experienced blogger, was thinking of closing one of her blogs because she found the amount and content of the spam she was receiving so distressing.  As we commented, this perpetuates the exclusion of women from cyberspace, but at a personal level it can be too much psychic cost to be worth the battle.  It linked in my mind to this interesting post by an acquaintance of mine on similar issues.

This blog is too new yet to have received any spam, but I will bear this in mind as it ages (hey, that’s like the opposite of real life – broadly, the older you get as a woman, the less likely you are to be catcalled in the street, due to the prevlance of the view of older women as asexual. But the younger your blog is, the less pornographic spam you get because nobody’s found it yet. Well, it’s a bit more complicated than that in both cases, but I couldn’t resist bringing it back to later life sex.)

Surprise! Domestic violence still gendered

I’ve just read this new piece of research on the gendered nature of domestic violence within heterosexual relationships:

Marianne Hester (2009) Who does what to whom? Gender and domestic violence perpetrators Bristol: University of Bristol and Northern Rock Foundation

It’s basically confirming what Women’s Aid have been saying for years; that women may sometimes perpetrate domestic violence against men, but it’s not the same. The violence is typically not as bad, it’s much more likely to be a single incident rather than repeat incidents, it’s not part of a pattern of coercion and control. Depressingly, she finds that women were three times as likely to be arrested as men, despite the fact that the main form of abuse women used was verbal abuse.

I recommend having a look at it, if you’re at all interested in these topics. It’s reasonably clearly written, only 19 pages, available as a pdf, and, for OU colleagues always on the look out for case study material, it contains several useful case studies.

Things that struck me about the findings include:

She found that over the course of her longitudinal study (2001 – 2007) the police became more likely to check whether they had identified the correct person as the perpetrator when the woman was originally identified as such. Some police appeared to be looking at the context and longer term pattern of violence and using that to identify a primary aggressor (or an initiator and a retaliator). I find this encouraging. It sometimes feels as if the new pressure to provide gender-neutral services means that all the feminist insights of the last 40 years of DV campaigning are being lost. This counterbalances my pessimism.

One of the case studies concerns a woman victim whose children had been removed by social services to live with their grandparents. She was reported to have said that

She doesn’t always ring the police because Social Services have told her if she has more domestics she won’t ever get her children back

I would be willing to bet a small sum that that’s not actually what the social worker said (at least, I very much hope not!). I imagine that they said something along the lines that the children were not safe because of her partner’s violence and that unless she could protect them from him, they wouldn’t be placed back with her. But you can see how that sort of response combines with the common notion that ‘social workers take your children away’ to mean that she heard it as a threat. It’s a real challenge for those of us involved in social work education to equip students to work in the context of that idea about their profession. It’s so tempting to just get annoyed with the idea that Social Workers Want To Take Children Away, but that’s a way of not really engaging with it. We need to help Social Workers to develop ways of actively countering that notion in the minutiae of everyday work.

I also took the paper as a salutary lesson in the merits of quantitative methods. It is so powerful to see the statistical patterns across a reasonably large longitudinal data set. Although of course I’d still want to interrogate the discourse in which I am inscribed which finds numbers peculiarly convincing and persuasive…

The changing nature of health advice-seeking behaviours

My pre-schooler is very partial to the counting rhyme Five Little Monkeys. For those not privileged enough to have encountered this little gem, it goes:

Five little monkeys bouncing on the bed
One fell off and bumped his head
Mummy called the doctor and the doctor said:
‘No more monkey business, bouncing on the bed!’

And so on, counting downwards until there are no little monkeys left.

Thankfully, no head-injuries have been sustained yet, but it always makes me think about the changed ways in which we interact with the NHS and health advice nowadays.  I don’t know when this ditty dates from, so I don’t know whether ‘called’ means ‘telephoned’ or ‘called in for a house-visit’ but neither is terribly likely to happen in my experience (although Swine Flu does seem to be mean that GPs are spending more time telephoning  patients rather than seeing them in person).

Here, instead, is my version of the health-advice seeking behaviours of the modern parent:

Five little monkeys bouncing on the bed
One fell off and bumped his head
Mummy called the doctors’ and the receptionist said:
Well, if it’s really urgent, you can see this trainee doctor with bad breath that nobody ever wants to see tomorrow, or you can wait a fortnight to see your own doctor.

Four little monkeys bouncing on the bed
One fell off and bumped his head
Mummy called the doctors’ and the practice nurse said:
Has he got asthma or diabetes and did you know you’re overdue a cervical smear?

Three little monkeys bouncing on the bed
One fell off and bumped his head
Mummy called the Health Visitor and the Health Visitor said:
You’re rewarding him for bad beahaviour, you have to do controlled crying.

Two little monkeys bouncing on the bed
One fell off and bumped his head
Mummy called NHSDirect and the nurse there said:
Better take him to A&E just to be on the safe side.

One little monkey bouncing on the bed
He fell off and bumped his head
Mummy looked it up on the internet and the internet said:
If he seems fine and his pupils are the same size as each other, he’s probably fine.

ETA:  With thanks to Sara and Ina May’s Pinard, and in the light of my next post about social workers taking your children away (and with apologies to my social worker friends and colleagues):

No little monkeys bouncing on the bed
They’d all fallen off and bumped their heads.
Mummy called the doctor and the doctor said:
A clear case of neglectful parenting, we need an interagency referral to social services who will take them into care immediately, you’re an unfit mother.

Iatrogenic illness and the importance of listening to service users

A. A. Milne says it beautifully, 50 years before the emergence of the Service User movement:

There once was a Dormouse who lived in a bed
Of delphiniums (blue) and geraniums (red),
And all the day long he’d a wonderful view
Of geraniums (red) and delphiniums (blue).

A Doctor came hurrying round, and he said:
“Tut-tut, I am sorry to find you in bed.
Just say ‘Ninety-nine’ while I look at your chest….
Don’t you find that chrysanthemums answer the best?”

The Dormouse looked round at the view and replied
(When he’d said “Ninety-nine”) that he’d tried and he’d tried,
And much the most answering things that he knew
Were geraniums (red) and delphiniums (blue).

The Doctor stood frowning and shaking his head,
And he took up his shiny silk hat as he said:
“What the patient requires is a change,” and he went
To see some chrysanthemum people in Kent.

The Dormouse lay there, and he gazed at the view
Of geraniums (red) and delphiniums (blue),
And he knew there was nothing he wanted instead
Of delphiniums (blue) and geraniums (red).

The Doctor came back and, to show what he meant,
He had brought some chrysanthemum cuttings from Kent.
“Now these,” he remarked, “give a much better view
Than geraniums (red) and delphiniums (blue).”

They took out their spades and they dug up the bed
Of delphiniums (blue) and geraniums (red),
And they planted chrysanthemums (yellow and white).
“And now,” said the Doctor, “we’ll soon have you right.”

The Dormouse looked out, and he said with a sigh:
“I suppose all these people know better than I.
It was silly, perhaps, but I did like the view
Of geraniums (red) and delphiniums (blue).”

The Doctor came round and examined his chest,
And ordered him Nourishment, Tonics, and Rest.
“How very effective,” he said, as he shook
The thermometer, “all these chrysanthemums look!”

The Dormouse turned over to shut out the sight
Of the endless chrysanthemums (yellow and white).
“How lovely,” he thought, “to be back in a bed
Of delphiniums (blue) and geraniums (red.)”

The Doctor said, “Tut! It’s another attack!”
And ordered him Milk and Massage-of-the-back,
And Freedom-from-worry and Drives-in-a-car,
And murmured, “How sweet your chrysanthemums are!”

The Dormouse lay there with his paws to his eyes,
And imagined himself such a pleasant surprise:
“I’ll pretend the chrysanthemums turn to a bed
Of delphiniums (blue) and geraniums (red)!”

The Doctor next morning was rubbing his hands,
And saying, “There’s nobody quite understands
These cases as I do! The cure has begun!
How fresh the chrysanthemums look in the sun!”

The Dormouse lay happy, his eyes were so tight
He could see no chrysanthemums, yellow or white.
And all that he felt at the back of his head
Were delphiniums (blue) and geraniums (red).

And that is the reason (Aunt Emily said)
If a Dormouse gets in a chrysanthemum bed,
You will find (so Aunt Emily says) that he lies
Fast asleep on his front with his paws to his eyes.

A. A. Milne (1924) When We Were Very Young, Methuen & Co., London.