Friday, June 16, 2023

The importance and challenge of the service user voice in sexual abuse research, policy, and practice

By Kieran McCartan, PhD

This week, I attended a workshop as part of a research project that I am working on related to evaluating trauma informed practice with young people across the Bristol, South Gloucester, and North Somerset area (Project Vanguard). For those who may not be aware, “service user” or “a person with lived experience” are the preferred terms in the UK; the most common term in the North America would probably be “client.”

The well-run event was developed by a leading UK-based child-protection charity and was led by two ex-service users who talked about their experiences of being in the child protection system and the impact that this had on them at the time as well as afterwards. The aim of the workshop was to invite professionals and researchers to hear the voices and lived experiences of service users and to think about how these influence the attendees’ daily work and the feed into the ongoing research project that the event was linked to. The research project in question, which the workshop was designed to support, focuses on young people, trauma, informed practice, and professional engagement; so not sexual abuse specifically, but it raised some consideration and challenges for the sexual abuse field. 

The UK’s increasing multi-disciplinary and cross-agency approach to understanding, preventing, and responding to sexual abuse is resulting in interesting conversations about what evidence looks like and how we conduct and implement that research. Nowhere is this approach more prominent than in the growing intersection between public health, health, and criminal justice. In many ways, health and justice agencies are miles apart, as discussed below, especially in terms of data, data collection, and outcomes. This presents an opportunity to collaborate and expand our evidence portfolio. 

Currently, there is work taking place that looks at health outcomes for criminal justice programs and interventions. This includes how health outcomes are measured and what this means in terms of prevention of offending behavior, especially in the context of a changing police and criminal justice environment (i.e., the move to preventive policing and better police training).  Among the most important, and sometimes challenging, research tools starting to be incorporated in health outcomes, the service user voice. 

Research in health care generally includes a service user or a service user panel, which is a group of people with lived experience (i.e., have the health condition in question or use the service being evaluated) to give their feedback and input about the research. Over time, this has evolved into co-production, whereby the service user or people with lived experience help to design the research together so that it is seen as fit for purpose and responsive to service user needs. Co-production has a rich history in the social sciences, especially in childhood? research. It is seen as both essential and the gold standard in health research. However, in criminal justice research this is not always the case and there are pockets of good practice regarding co-production, but these are often limited to victim’s research, young people’s research and often prison based research. 

In the field of sexual abuse research, we often research people convicted of sexual offenses, but they are not involved in the co-design of the research, they are merely the researched. This poses a question about the validity of the research design and question: are we getting to the core of issue from the person with a lived-experience perspective or are we solely basing our understanding on past evidence and researcher considerations? Our assessments of the needs of these individuals are by no means always accurate. This is illustrated in a recent article on the terms we use for persons who have sexual interests in children (Jahnke, Blagden, & Hill, 2022). This showed that the handling of person-first language received feedback worthy of consideration from minor-attracted persons, feedback that we should take into regard in our research and clinical practice.  If we want to have a solid view of the service-user perspective, then co-production is a serious consideration for our field. Of course, there are challenges, including getting access to people with lived experience who are willing and able to participate, managing risks posed by the research and those with lived experience, research ethics challenges, researcher bias, the capacity of the researcher to be swayed by the person with lived experience, and the impact of broader social contexts. 

In considering co-production, our field has started to look to people in prison, on probation, or in community treatment; however, the question remains as to whether these are always the most representative service users for co-production? After all, many are in need of treatment but have not been impacted by incarceration, treatment, and rehabilitation programs. Research has also used the internet to engage with people with lived experience who may not have been in the criminal justice system or who at risk of committing an offense; but the issue with this approach is that one is often unsure of the validity and representative of comments from generally anonymous participants. 

Currently, there is no easy answer to the debates around co-production in the field of sexual abuse, but there is a recognition that it is important and needed. This means that we should be having the conversation, that research funders should be encouraging it, and that ethics boards should be aware of it. The event that Kieran attended this week really drove home the importance of co-production not only in terms of hearing the service user voice, but also in making sure that the research tackles all the issues at stake and is fit for purpose. Co-production can be a trauma-informed way to engage in research to benefit policy and practice.

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