Co-design: finding ways to walk alongside our communities

"We've all got knowledge, it's just different knowledge." Wales Chief Medical Officer Dr Ruth Hussey focused on the value of 'co-production' in her address this week to the Population Health Congress in Hobart.

In this article below, Michela Clarkson examines the theory and practice of co-design, which she says 'starts with an open question of need and recognises the limits of professional assumptions'.

It was originally published in the latest edition of Insight, the Victorian Council of Social Service (VCOSS) member magazine and is based on the Walk Alongside report by the same author, also recently published by VCOSS. 

Kylie Swartz, a grade 3 teacher in the United States, wanted to find out how she could better support her students who were predominately experiencing poverty and disadvantage.

In a simple written exercise, she asked them to finish the statement: “I wish my teacher knew…” They responded candidly:

“I wish my teacher knew that my reading log is not signed because my mum is not around a lot.”

“I wish my teacher knew that I don’t have pencils at home to do my homework.”

“I wish my teacher knew I got bullied on the bus and it made me feel sad.”

“I wish my teacher knew how much I miss my dad because he was deported to Mexico when I was three years old and I haven’t seen him in six years.”[i]

This anecdote was published internationally as a 'good news' story and was not directly associated with what we know as co-design in social policy planning. It does, however, serve as a clear example of co-design thinking, which starts with an open question of need and recognises the limits of professional assumptions.

Co-design takes a ‘ground-up’ approach to finding solutions to social problems. It respects individuals as partners in an initiative for change and looks to create a system which is truly responsive to the people it intends to serve.

What is co-design?

Co-design involves coming alongside people who experience vulnerabilities, to work with them in creating interventions, services and programs which will work in the context of their lives and will reflect their own values and goals.

This involves letting go of professional assumptions about a group’s perspectives and experiences and actively learning from what people say and do. Expertise, professional knowledge and research can then considered in relation to group input, to add colour to the possibilities of approaching social problems with specific groups.

This is different from traditional feedback methods, which ask user groups to comment on their use and satisfaction of services that have already been planned or implemented.

Co-design begins with the people – their experiences, perspectives, values, challenges and understandings.

***

There is growing recognition among community sector organisations that we need to work more closely with people experiencing vulnerabilities, in order to deeply understand their needs and make a significant impact in resolving complex social problems.

A recent report indicated that 1.5 million Australians are experiencing chronic disadvantage, despite two decades of sustained economic growth.[ii] Children born within disadvantaged households are more likely to experience disadvantage throughout their lifetime, and approximately a quarter of people who find their way out of poverty return again within two years.[iii] We are challenged by pervasive issues of mental health and substance abuse, poverty, affordable housing and homelessness, violence and abuse, Indigenous disadvantage and unemployment. To compound these issues, Australia faces the threat of a diminishing tax base, possibly reducing resources available to tackle 'wicked' social problems in future.[iv] We need to make sure that the services and programs we implement to address these issues accurately and effectively targets need.

Finding the right way to approach social problems involves partnering with the people who experience them firsthand.[v] This is because their perspectives and living realities will largely determine whether an initiative will actually be effective in context, and how far it will go in meeting their needs.

Unfortunately, traditional feedback methods only ask for target group input after a program or service has been planned or implemented. At this point, practitioners have already formed a clear idea of the problem and the range of possible ‘solutions’ which follow on from it.[vi] Organisational and resourcing factors have been ordered or cemented around these assumptions, meaning they are difficult to drastically shift in response to emerging insights. Program effectiveness is also measured by existing user satisfaction, though people experiencing significant vulnerabilities are less likely to access or continue their use of services.[vii] By commonly characterising these groups as ‘hard to reach,’ the problem is inferred to exist with the people, rather than the capacity of services to engage them.[viii]

Co-design: where is the process?

Often, instructional guidelines and tick box protocols are used to give us a sense of security. We feel safe in knowing that we can correctly follow procedure, that we can order our actions against a validated framework, and that we can be accountable to where we are at in each stage of the process. In many areas of our life, this approach works well – when we are baking a cake, when we are assembling Ikea furniture, when we are operating complicated machinery. Unfortunately, or perhaps fortunately, life is not so linear or predictable. Honouring the precision of a step-by-step guide can prevent us from being responsive to people and the complex problems they face in real time.

In co-design, the methodology will vary in the same way that people, problems and organisations do. The focus instead is on our working mentalities as the primary tools for social change. These are described by IDEO, a not-for-profit organisation designing solutions for poverty alleviation, through a set of Mindsets and Design Spaces[ix]. The seven Mindsets of social design are termed as: embracing ambiguity, empathy, creative confidence, learning from failure, 'iterate, iterate, iterate', optimism and 'make it'. The three Design Spaces within which social designers work are termed as: Inspiration, Ideation and Implementation. These will manifest differently at different times and for different projects. What is key is that they enable practitioners to stay grounded in the needs of the people who are impacted by social problems. They form the basis of a social designer’s thinking and responsive action throughout.

There are undoubtedly challenges for embracing co-design within traditional service systems. Entrenched structures and practices often do not leave room for innovative activity, and top-down hierarchies can pose an obstacle to ground-up problem solving. Cultural change within an organisation can also be painstakingly slow and current contracting relationships between government and community agencies may restrict innovation. There is no prescriptive solution to these challenges, though practitioners can be inspired to meet them through the same Mindsets which drive co-design practice. Optimism is a key tenant in this. It means we do not accept social dysfunction as hopelessly inevitable and instead see the possibility of doing things better. It inspires policy-makers and practitioners to look for new ways to approach issues which can be beyond the current limits of their professional knowledge and expertise.

Thriving families and communities

The Australian Centre for Social Innovation (TASCI) was engaged by the South Australian Government to devise a service solution for families at risk. The initiative sought to address two problems:

1. There are too many families who are stressed and without the right support.
2. Crisis services are overloaded with demand and have insufficient resources to respond.

To tackle these problems the team began with the question: 'How can we help struggling families to thrive?'

TASCI spoke with over 100 families, and spent time with 35 of them in their homes to learn about their lives, the main stressors they experienced, and how thriving and struggling families differed in their capacities to balance stress. They also found out about the kind of support networks families had, what networks were attractive to them, where they wanted to see themselves in a few years and how they felt they could get there.[x]

Through their work, the team identified ‘thriving behaviours,’ which were typical of families that were doing well, and they looked for existing programs which helped develop these. When they couldn’t find an appropriate model, they began generating their own ideas for a program solution. As part of this process, they went back to families to gain further insights, share ideas, and test program possibilities.

The program they designed is called Family by Family.[xi] Here, families who are 'struggling' link up with 'thriving' families who have experienced tough times and made it through. Thriving families receive training through camps and workshops to build on their strengths, and all families are supported by a local Family Coach throughout link-ups.

Family by Family was initially designed and rolled out in Marion (SA) and has now been adapted in other areas, including Playford (SA) and Mt Druitt (New South Wales). Its effectiveness was demonstrated in an independent evaluation, which suggested positive change was created by:

• increasing choice and control
• strengthening relationships between children and parents
• behaviour modelling
• goal setting
• accountability and reflection
• increasing reciprocity
• increasing practical assistance.

In another project, TACSI examined how services could improve progress for Aboriginal families in the Playford area. They identified the need for 4 shifts:

1. from being ‘culturally appropriate’ to being ‘culturally adaptive,’ where staff are flexible and responsive to what is important to different families
2. from expecting too little to expecting change, where staff are driven to see significant progress through their work
3. from seeing families as recipients of services to seeing families as a resource, where organisations support families’ capacity to multiply change through their own social networks
4. from focusing on getting by to focusing on goals, where staff seek to understand unique family objectives and measure progress along the way.

[i] K Gander, ‘"I Wish My Teacher Knew ..." Young students share their heartbreaking worries in notes, The Independent, 17 April 2015, accessed from http://www.independent.co.uk/news/education/education-news/i-wish-my-teacher-knew-young-students-share-their-heartbreaking-worries-in-notes-10185155.html on 20 May 2015.

[ii] Committee for Economic Development of Australia, Addressing Entrenched Disadvantage in Australia, 2015, accessed from http://adminpanel.ceda.com.au/FOLDERS/Service/Files/Documents/26005

~CEDAAddressingentrencheddisadvantageinAustraliaApril2015.pdf on 9 June 2015.

[iii] ibid

[iv] Australian Government, 2015 Intergenerational Report, accessed from: http://d3v4mnyz9ontea.cloudfront.

net/2015IGR_Overview.pdf on 9 June 2015.

[v] M Steen, M Manschot & N Koning, 'Benefits of co-design in service design projects', International Journal of Design, 5(2), 53-60, 2011.

[vi] T Brown & J Wyatt, 'Design thinking for social innovation', Stanford Social Innovation Review, 8(1), 31 -35, 2010.

[vii] Royal Children's Hospital Melbourne, Engaging marginalised and vulnerable Families, accessed from http://www.rch.org.au/uploadedFiles/Main/Content/ccch/PB18_Vulnerable_families.pdf on 30 April 2015; S Carbone, A Fraser, R Ramburuth & L Nelms, Breaking Cycles, Building Futures. Promoting inclusion of vulnerable families in antenatal and universal early childhood services, 2014, accessed from https://www.eduweb.vic.gov.au/edulibrary/public/beststart/ecs_breaking_cycles_best_start.pdf on 15 May 2015.

[viii] N Brackertz, 'Who is hard to reach and why?', ISR Working Paper, 2006, accessed from http://www.sisr.net/publications/0701brackertz.pdf on 20 May 2015; Royal Children's Hospital Melbourne, Engaging marginalised and vulnerable families, accessed from http://www.rch.org.au/uploadedFiles/Main/Content/ccch/PB18_Vulnerable_families.pdf on 30 April 2015.

[ix] IDEO, The Field Guide to Human-Centred Design, accessed from http://www.designkit.org/resources/1/ on 20 May 2015.

[x] C Lockett, S Schulman, C Vanstone, Going for the good life, 2010, accessed from http://familybyfamily.org.au/2010/08/going-for-the-good-life/ on 30 April 2015.

[xi] The Australian Centre for Social Innovation, A year In the life of Family by Family, 2013, accessed from https://vimeo.com/50653317 on 30 April 2015.