http://home.gedde-dahl.no/fflh/dialog/S5109-08oeksnes.html

Klipp fra PLAnytt 29: S5109.08 Foss Nina, Aune Liv. PLA as a tool in participant process-oriented evaluation in the field of drug prevention psychiatry in Norway. P32-36. Mer samlet om evalueringen av Øksnesprosjektet som nå avsluttes som prosjekt mens måten å arbeide på fortsetter og begynner å spre seg til andre områder i kommunen . Arbeidet er før nevnt i PLAnytt nr 6, 20 og 25. ------------------------------------------------------------------------------------

Vi har nå fått lov å legge inn et utkast som er som er litt lengre og mer informativt. Det ble mottatt 20/5-00 pr e-post fra Nina Foss (noen stavfeil er retta): En beskrivelse på norsk av Øksnesprosjektet blir å lese i en bok med PLA-erfaringer i Norge. Den kommer fra Kommuneforlaget høsten 2000.

PLA in Norway has developed mainly the last five years, initiated from people who knew PLA ways of working in the south. The experiences with the empowerment abilities in PLA from various contexts in the south, made some of us want to look into the attitudes and tools, and try it out in the fields where we worked, far north. PLA in Norway – as far as we know - has mainly been used in the fields of health, community, education, and work with young people. PLA-work is still on a rather small scale, and rather few people are trained – but PLA ways of working together with people creates a lot of interest e.g. among health workers and educators. The growing interest runs parallel with strong governmental directives towards participation and empowerment from the patients ("users") in the health and community sectors, and towards more processual and creative learning throughout the educational system. Our experiences with PLA in these fields has so far shown great potentials for both creative learning , dialogue and empowerment.

As I live and work in the northern, coastal part of Norway, I am most familiar with PLA in processes in this part of the country. The example of PLA in Norway, is a PLA-process facilitated by Liv Aune and myself.

 People of course still live in concrete places, also in Norway, but more and more have their social relations connected to work and close family – and often also to some people who live far away. We connect to others who we experience as similar or equal to ourselves, not necessarily to people living close. Much time and energy are connected to the professional life for both women and men. Elderly people tell that television also has minimised social relations and the care for each others in the community. So the sense of belonging and responsibility is changing; from being of use and responsible for others and community – towards responsibility for ones own life and the ones who are close (e.g. Gullestad 1998, Foss 1994). We also put strong identity and a lot of effort into professional life - where the demands for effectively is escalating in our society.

So when working with PLA in Norway, we face ways of living together and thereby kinds of problems that differs from the south. As stated by Mincher in the invitation to this issue – also a different kind of poverty. We share, however, the need for empowerment in a lot of areas ; attitudes and tools that can help us facilitate dialogue, analysis and choices for action with and between people.

The way of working described in PLA-literature from the south (do you want references here?) – PLA-run developing projects with whole communities, does not fit well into to the Norwegian reality nowadays. If you invite inhabitants in a community to "peoples meetings" – e.g. for discussing the future of the community, a very small amount of people will show up. The people who gathers in these settings, are mostly the ones that have special interests, are educated or are known to be very active in the community. The people who usually do not speak up, will not participate to get their say.

When we started working with PLA processes, we then applied it into fields where people experience common problem- or interest-areas. In every field we will find "uppers" and "lowers". Our aim has been to facilitate bottom-up processes, to empower the lowers and create dialogue between groups in some fields.

People who strive with drug abuse combined with psychiatric problems are a group of people who "fall between two ( or more) chairs" (Norwegian expression) in the health care system. They cannot easily be put into one category, but belong to both the drug-helping systems, to the psychiatric health care and to the social services. The helpers in all these systems find it very difficult to relate to – and help- this group of people. The "users" often experience mistrust and bad relations towards the helpers. It is a group characterised (from one of the participants) as extremely vulnerable in social relations. Many strive with anxiety and loneliness, and have problems with relating to others when not doped. They often withdraw and use drugs when relations get difficult. The relations between the helpers and the users are characterised with mistrust from both sides, and often by avoidance strategies from the helpers.

The Oeksnes area has a population of 2500, in the coastal region of Vesteraalen in northern Norway. The community is built on fishing and fishing industries. According to surveys, problems with drugs and alcohol are increasing. There is also a group of approximately 15 persons categorised as having severe drug/psychiatric problems in the community. The project in Oeksnes is aimed at specifically reaching out to people with combined drug/psychiatric problems, although also wanting a wider reach. The project had initially two aims: 1. creating participation and empowerment among the users. 2. creating more flexibility and co-operation within the health/social services. The project started in 1996 and ended as a project – but not as a process - in December –99. The national department of health has mainly funded the project. There has been one project leader, Mr. Lahti, working throughout this period. He worked in the health care system in the community several years ahead of the project, and took the initiative to start the project in 1995.

From the analyses and evaluation made by users, health care and social services workers and administrative personnel connected to the project, the project has been important in the following ways. The findings are drawn form reports from PLA-run evaluations in 1996, 1998 and the last one from spring 2000 now in the making:

1. The users, with support from Mr Lahti and two more helpers, has created a meeting place which they consider their own place. The project has some kind of relation to about 30 persons. Most of them attend the meeting place on a more or less frequent basis. Here they experience to feel free to be themselves and meet friends – when not doped, when feeling good, and when feeling more down. Periodically here has been conflicts between the users, and also between some of the users and the helpers – which they reasonably successful, have sorted out by themselves. They feel safe and equal in this social setting
2. It has become more easy to get help when you need it. The helpers in the project are available at the meeting place. They function as mediators between the users and the rest of the helping system.
3. At the time of the midway –evaluation about 20 of the users were in some kind of work or school – most of them still on social services (I don’t know the word in English). 9 of these was employed as a direct consequence of their participation in the project. (the numbers from the 2000-evaluation are not yet ready). Several of the users have got help to get their own house.
4. The meeting place has after the project period moved to another locality. It is now a permanent meeting place in the community. Users organisation for drug-users, psychiatric patients and so forth meet here.
5. People in the administration and helpers system of the community have accepted less control in this project than they normally do. Their evaluation is that this try has motivated them to work for more user-participation and -empowerment in the future. The people working close to the users during the three years, however, have experiences with more nuances. They feel that user-participation, work for more equality and negotiation with the users is very demanding and challenging – but still the only way to go forward.
6. The social welfare office reports a lowering of costs towards the user-group, which more than covers up the costs of running the project. The police reports clear decrease in arrests among the group during the project period.
7. The project has been very influential in giving directions to the new organisational model

for the public services in the community. Flexibility within and between the services, and

more participation from the inhabitants are central aims in this ongoing process. The

former project leader now has a central role in the reorganising process.

8. Difficulties has occurred on different levels. There has been fluctuating conflicts between user- groupings. The helpers have had disagreements on if, how and when to intervene among the users. There has been opposing interests within the health/social services, not everybody supporting the project and the project leader.

This has never been a "PLA-project". PLA has been included in the project to facilitate processual, participant evaluation. The evaluations have been organised as action research –aiming at facilitating the participants own analysis, planning and ongoing evaluation of the process. PLA-tools has been used in three faces of the evaluation: Evaluation of the pre-project phase, evaluation mid-way and finally by the end of the project period.

Attitudes also central in PLA-work, has strongly guided the way of working within the project. The professionals in the project tries to hand over the stick, to sit down, listen and learn, and have a belief that people can do it, to site some of Chambers utterances. Right from the start, the users have been central in planning and developing the processes. The first planning group, organised in spring –96 , consisted of four persons; the project leader, to participants with long histories as users of the health care system, and one former drug- addict who is now working in the social services. Two of them were in addition active in the local users organisation for people with drug/alcohol problems. Persons with experiences as users dominated in numbers the planning group. I underline this, because power-asymmetry in the relations between helpers and patients (the knowers and the not-knowers of the patients own good), have through our social democratic history been strong. The standard way of user-participation in e.g. health planning in Norway nowadays, is letting one or two user representatives into a majority of professionals. In this project, one has tried to make the relations more equal by letting the users outnumber the helpers. Later in the process advisory group to the psychiatric system has been organised, here the helpers and users have been equal in numbers. The organising of the project start had a strong empowering focus.

The first planning group agreed on creating a good meeting place as the important thing . They worked on finding a nice place to stay – preferably not in the health care buildings. They wanted it to be physically and socially their own. At the same time they worked on how and who to recruit into the project. The discussions in the groups had many nuances and took time, as the participants knew the vulnerability and also the relations among this users-group. Initially they chose to invite few people into the meeting place, and from there build on the networks that already existed. This way of working, extended the user-group, as several of the users brought acquaintances with them. Till now it is a flexible and open place, that some of the users go to every day, and others in periods or only seldom. They have two open evenings every week, and open daytime during week-days. There has been conflicts - people have withdrawn for long periods, some have quit, but others have come back. The meeting place has been the nerve of the project throughout the project.

Liv Aune and myself was asked to take responsibility for the processual evaluation. We accepted, with the premise of trying out PLA as away of working. Mr. Lahti and one of the other participants had joined us in a three days PLA-course, so they knew about PLA, and also knew us. We had little experience, but were inspired, though a bit nervous, when we started. We had read that PLA was developed specifically to get dialog and analysis with people who usually do not speak out, people at the bottom of local hierarchies. The group of people we were going to work with, was definitely not the ones that normally sets the agenda in the local community – they were in trouble, and stigmatised as difficult, hopeless and unstable.

The first round of evaluation we did the following.

1. march – may: Telephone conversations with Mr. Lathi
2. May: participant observation in the planning-group. Visiting the new locale together with them
3. August: PLA-meeting with the planning group (4 hours)
4. August: Participant observation in the meeting place

The first report was mainly built on the PLA-meeting with the planning- group. We asked the open question (planned from readings and conversations with the group), and used visualising tools to inspire discussion, analysis and priorities. The evaluation was intended to sum up what had happened so far, and make analysis and priorities for the future work. The report was to be used in applies for money to go on with the project for a three year period.

As facilitators we initially wanted to arrange a PLA-meeting for all the participants at the meeting place. The planning group insisted that this was too early, people had just come to the meeting place, and they feared that an evaluation/planning meeting this early would scare people not to come. We agreed instead to come to the meeting place one evening, just be there, drink coffee and talk to people – to get an idea of the people and the place, and so that people should know who we were and what we were doing.

The PLA-meeting was organised as follows, all tools gathered from Pretty et. al. (1995):

1. Hopes and fears connected to participating in the project (Hopes/fears – Delphi).

2. What has happened so far? important events, persons involved (Historical timeline)
3. Aims for the project (Matrix-scoring)
4. Who participates in the project, co-operation, influence (Venn-diagram)

5 How do you want it to be in the future (Venn-diagram)

The report came up with documentation of the work done, priorities for future work in aims and influence – all done by the planning group. Weight was put on the participants personal development (getting oneself back into life, as one of them formulated it), to create a flexible meeting place and equal relations among the participants. Before finishing up, the report was sent back to the participants in the meeting place and planning group for discussion and comments. The project got funding for a three year period.

When we came back to facilitate the midway evaluation one and a half years later, our main aim was to create a discussion among the users of the meeting place. In addition we wanted discussion among the original planning group, and among the now formalised ruling group for the project. This ruling group was part of the organisational structure demanded as part of the funding. It consisted of representatives from the health care system, the administrative side, politicians and users. Besides from PLA-meetings in all three groups, we conducted open interviews with users, helpers and participants in the public social/health system. From our point of view, this evaluation was the most important for the process. It should sum up, analyse and if necessary redirect the ongoing project primarily from the users point of views, but also from the people on the professional side.

We had been in contact several times with Mr. Lahti during the period, and had a fairly good idea of what was going on in the project. The planning was conducted together with him. Still, we had the main responsibility for planning the questions and the meetings, he had responsibility for the practical solutions to get things going during the two days we would be there. We made a timeline for the two days – which included a pre-meeting with the planning group to discuss our suggestions for the meeting-place session.

In good PLA-spirit, we wanted to organise a common meeting between the users and helpers, but the planning group considered this to be premature: Now the users were ready to meet with us, but still the relations to the helpers-system as they saw it, was characterised by distrust. If professionals – apart from the three close into the project came - they feared we would loose the users. The vulnerability among the users and in the project guided the way we conducted the meetings.

The meeting took place in their meeting-place, on one of their scheduled Tuesday evenings. None of us knew how many would show up, and we were happy when as many as 14 people came (including the three helpers). After one to two hours of chatting, smoking and coffee-drinking, we started the more formal PLA-session. We split into two groups – working together with one facilitator separately throughout the meeting, but with the same questions and tools. This time we asked:

1. What is the project? What activities goes on – and who participates in what? Including activities that has ended, and activities you want to start (Activity-sun)

2. Who is participating, influence, overlap (Venn-diagram)

3. Aims for the project now (matrix-score)

The most striking with this meeting form my point of view, was the atmosphere, the analysis and involvement in discussions among the users. They found it interesting to visualise and see for themselves how varied and how may things they were actually engaged in. They went into good discussion on the aims for the project, and their own involvement in it. People compared the visualisations, and asked for explanations by each other. The project leader commented that people here normally do not sit down and go into serious discussions. They easily get restless, and leave out of situations. Now people were able to engage in the tasks for 4 hours – it was extraordinary. So our belief in PLA-ways of facilitating dialogue and empowerment was strengthened.

The report is quite detailed – in 35 pages, but I will try to sum up some of the central themes. The discussions showed a project which facilitated things from informal socialising, trips evening courses, adult schooling and workplace – with about 30 people involved in different ways (visualisation 1). They analysed the project as being heavily influenced by the users, though knowing very little of what was going on in the healthcare/social system connected to the project. The most important aims were to keep the ("being together, caring for each other" - help with translation!)) going between people, to secure the continuation of the processes in the project after the three year period, and to better the quality of life for the participants.

We also conducted a PLA-meeting with the ruling group – participants mainly from the administration and health care system. Here we worked on their evaluation on how and to what degree they experienced influence in the project. We asked one of the same questions as in the user group; who participates in the project, who has got influence, and who co-operates with each other. The tool was Venn-diagram as in the user- meeting (Visualization2 &3: Venn-diagram from the users and from the ruling group). Both diagrams showed a project where the users had much influence, but the last diagram showed a detailed illustration within the professional system, and less detail on the user side. In comparing the diagrams – the participation and power from the users in the project was evaluated as important – but each of the groups actually knew quite little of the other side.. The discussions showed a project that was clearly two-sided, one part working into the user-group, and another part aimed at changing attitudes and ways of working in the helpers-systems. From both sides the project leader came out with heavy influence, as the information source and mediator.

We did not ask the ruling group to discuss the further aims of the project – this was exclusively done by the participants in the meeting place (including the three helpers there).

The open interviews was conducted mainly to triangulate the findings from the PLA-run discussions.

Throughout the facilitating process, our main aim was to empower the users as evaluators and planners. By asking them more questions, using more time and so forth. The group is however not used to this way of working – and some of them find it difficult to join into a process like this. Several of them did not show up in the meetings, and did not want to talk with us. We had problems in getting hold of users who were more critical towards the project. We have started wondering if PLA-tools (our maybe our way of using them) is creating more consensus than what actually exist in the groups.

"We need to evaluate ourselves forward" , one of the users told me in an open interview.

One of the common problems in evaluations are that they will evaluate what has happened, and not use the experiences made to think forward. A lot of evaluations are put aside once finished, and do not help to guide further process.

In this process we tried all three times to use as much effort on how to go ahead, as to evaluate what has happened so far. We do not know to what degree the meetings and reports actually has been used e.g. by the project leader, but the discussion concentrated both on past, now and the future. Anyway, all evaluation reports has got a focus on the users points of view – with additional and comparable information from other relevant groups.

The final evaluation-days in Oeksnes was conducted in April this year. The report will be finished and sent back to Oeksnes for review next month. We worked intensively for three days – facilitating PLA-meetings, interviews, visits. The users was asked to evaluate the aims, how far have we reached the different goals they set up in the midway-evaluation. Highest score was given to the work on "user-participation", and to creating a meeting place.

We also asked what had been most important for each of them – again there was weight on the meeting place, further to have found friends, and that helpers now were more available.

In open interviews most users told that the project had been important to them as persons. It was possible to come when you wanted, meeting people you knew, you could be yourself.. One could drop out in periods, and then be welcomed back. There were not helpers defining you all the time, but it was possible to get help when needed. Some were more critical towards the way of running the project – especially the way the helpers had met the conflicts between the users. Some were also critical about getting little information about what was going on in the helpers-systems. Many of the users have got some kind of occupation, three of them in connection with the meeting place. The meeting place has moved to new locales, same building and floor as the offices for the three central helpers in the process. This location is according to users not ideal, but means lower costs for the communities. That means that the meeting place can continue when the project-funding has ended.

The last round also showed that Mr. Lahti had put a lot of effort into attitude and behaviour change in the helpers-system. He had got funding to a row of seminars for professionals in different helper-positions (and some of the users), and was working with loosening up the lines between the different sectors. There was co-operation with police-department – evaluated as being of great help towards the users. The users now very seldom was put in jail for public drunkenness and rioting – the police would help in critical situations, but there was rarely need for more than that. The users could trust more the helpers in the project, and they would do the follow-up. As for the midway evaluation, the users had little direct knowledge of this side of the project – but evaluated that it was much easier to get relevant help when it was needed.

In this last evaluation, we also worked on getting more hard facts considering the economical side of the project. In Oeksnes there is now one group working to figure out numbers, costs and savings connected to the project. As far as we know, this empowering, flexibility –building process will show cost-reductions in the social welfare system on a long term.

One of the users criticised us for talking too much with the people higher up this time – a critique which is legitimate. We did spend more time with people higher up this last time, as we felt a need to get a clearer idea of what was going on in this side of the project. The project has as far as we can see had two development paths, with the project-leader as the only one with a full overview.

The users experience the meeting place, the contact with Mr. Lahti and the availability for help as most important. The helpers-side experience that users participation is necessary and possible and fruitful – though not easily achieved. The process has got a lot of publicity, as empowering project for a stigmatised group. It has also influenced direction for the ongoing reorganising of the administrative and political system in the community.

PLA has in this project been one of many ways of working. We feel that PLA has made possible a more user-participant analysis and evaluation of the processes. The attitudes that is important in PLA-work has also been at the bottom line of the work done in the total processes. So PLA has been used into processes, to stop up and think, discuss, evaluate and plan together with different participants. We as outsiders has had roles as facilitators – not being directly involved in the project work at any time. We have learnt a lot both form the users and from the helpers in the project. Not so much from failures, but rather from experiencing the potentials in this way of working together with user-groups.

The chance to facilitate processual evaluations over three years, has been important for our way of developing PLA into Norwegian contexts. We believe that PLA attitudes and tools has important contributions to empowerment processes in the sectors we are familiar with. PLA challenges our ways of thinking and acting towards people. We have just started here, and will continue experiencing and evaluating ourselves and each other forward.

??

– need for creating relations and support between people. A lot of problems are connected to feeling lonely and useless, not coping with everyday demands in professional and community life. Old structures of socialising and being together change - when working with groups of people who are on the bottom of the society – work to create places to meet others. From being alone in your house, except when drinking – to a meeting place that is ours. We can go there without drugging – can relax as the ones we are.