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HOSPITAL SEVERO OCHOA, DE LEGANÉS (MADRID)

In document TRIBUNAL DE CUENTAS Nº 589 (página 120-129)

CAPÍTULO 3. ANÁLISIS DE CUMPLIMIENTO EN LA GESTIÓN DE

3.10. HOSPITAL SEVERO OCHOA, DE LEGANÉS (MADRID)

Across the literature there are a small number of frequently referenced texts that I would suggest capture some of the substance that other accounts then seek to build on. These include Hart (1992), Shier (2001), and Fielding (2001) within the field of education; and if this is broadened to include parallel work that was

exploring understandings of children as social agents within a participation context, then Prout (2000; 2001). These accounts put forward persuasive arguments for understanding participation in all its forms as part of a socio-cultural dynamic that needs to recognize issues such as power and responsibility; the role and

conceptualization of individuals within a context; and the benefit of appropriate and differentiated methods as a way of enabling participation within the context of relationships and explicit intent.

One of the ways that the participation agenda has been taken forward is the

Students As Researchers (SARs) approach. I initially struggled with the idea of this

as it seemed to me to offer only ‘the few’ an opportunity to experience participation and in quite contrived ways; a perspective acknowledged by Hart (1992). He

argues however that if one truly wishes to involve young people in decision making then it is necessary to involve them in the design of how something is to be

reflection around what is revealed, which he argues is a definition of ‘research’. Hart goes on to describe what he refers to as Participatory Action Research which stresses the need for research and action to be carried out by the same people. He argues that involvement in successful research and action encourages more of the same.

When talking of participation within a context, Hart asserts that one must speak of encouraging the participation of all, with the shared goal of improving the whole of society. These ideas of children being active agents within society is also promoted by Prout (2001) who in reflecting on a large scale project focusing on children as social actors identifies five areas that he felt were important to reflect around. These were:

i. Children as research subjects;

ii. The documentation of ‘children’s standpoint’; iii. Children as strategic actors;

iv. Children’s exclusion;

v. The construction of children’s voice.

The idea put forward by Prout is essentially that voice should be understood as a constructed identity that comes about through the interaction or alliance of different actors, and through the intersection of different practices. He suggests that we need to examine the practices that do or do not produce and elicit it. Prout claims that this takes us beyond children’s own practices, though these remain very

important, to the settings, practices and relationships that can enable or disable the production of voice. A key focus therefore must be given to what he describes as the generational relations between the children and the adults involved. Prout (2000) identifies a tension between the rights of children to be recognized and involved, and public policy and practice as marked by an intensification or control, regulation and surveillance of children. This tension is considered in relation to the

constitution of children in the public sphere as human capital and therefore as a means of controlling the future.

Across the literature there is a recognition of the desirability of children’s

participation, often for different reasons such as to uphold their rights, to fulfil legal responsibilities, to improve service or decision making, to enhance democratic process, to develop skills, or to empower and enhance self-esteem (Sinclair and Franklin, 2000; Bragg, 2007a; Cleaver et al., 2007). The issues and tensions above are often acknowledged but rarely resolved either conceptually or through the adoption of particular methods. There is in this sense a gap between how we claim to be viewing this area, and what we are actually doing. In terms of the doing, Hart’s ladder of participation (1992), Shier’s alternative model which extends from this (2001), and Fielding’s 9 questions and four fold typology models (2001) offer frameworks for both planning and reflecting on practice.

Hart’s model was designed to serve as a beginning typology for thinking about children’s participation in projects. The ladder metaphor was borrowed from

Arnstein’s (1969) article on adult participation, though new categories were added. An original image of the model is set out in Figure 1 (p.26).

Figure 1- Hart's Ladder of Participation3 (1992)

The rungs on the ladder provide a continuum from non-participation where children do or say what adults suggest, or take part in ways that do not enable them to really understand the issues or choose how they express their views; to children being independent in having ideas, coming up with projects, and bringing in the involvement of adults by invitation. Shier’s model (2001) does not have an

equivalent to the non-participation rungs of Hart’s ladder, and creates a five level model for participation that considers the level of commitment adopted by an individual or organization to empowering the child. At each level three stages of commitment are described in terms of openings, opportunities, and obligations. A simple question for each stage of each level is offered to allow reflection of both the current level of operation and also how it may be possible to move to the next level- see Figure 2.

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Figure 2- Shier's Pathways to Participation Model (2001, p.111)

In discussing his model Shier makes a number of interesting points. He observes that to achieve level 5 requires an explicit commitment on the part of adults to share their power; but that there is no obligation under the United Nations

Convention for adults to share their power with children. Decisions about how or when to share power he suggests must be based on the risks and benefits of doing

so, i.e. it is conditional on a range of other unspecified factors. Shier stresses the need at levels 4 and 5 of sharing not just power but responsibility for decisions.

Hart also recognizes the potential repercussions on lives of allowing participation without some checks and balances being brought to bear. Defining the conditions under which this can be done safely and appropriately is not specified by either Hart or Shier. Hart does state (op cit., p.11) that it is not always necessary for children to operate at the highest rungs of the ladder. Different children may

participate at different levels and at different times. An important principle of choice is asserted, the challenge becoming that of creating opportunities in which the child can choose to participate at the highest level of their ability.

Fielding (2001) proposes a nine question interrogatory framework for the

conditions necessary for pupil voice practices; and a fourfold typology of what he envisions pupil voice to mean. This model, developed primarily out of experience within the educational context and an explicit Student as Researchers perspective, is intended to allow professionals to examine arrangements and practices which seek to acknowledge and promote pupil voice. The typology distinguishes between:

 Students as data sources  Students as active respondents  Students as co-researchers  Students as researchers.

The similarity with Hart and Shiers’ models can be seen, and the questions offer a process through which awareness can be raised and reflective decisions taken- see Table 1:

Table 1- Questions for Evaluating the Conditions for Student Voice (Fielding, 2001, p.110)

As noted by Morgan (2007), while useful these and the others models outlined do not specifically relate to practice at a classroom or everyday level. More

importantly, I think, this raises another question in relation to who is constructing these models, and how they might look were they to be developed by professionals and young people within the contexts in which it is or is not operating.

2.4 Problematizing the Agenda

In document TRIBUNAL DE CUENTAS Nº 589 (página 120-129)