Reflections & future

Rodd Bond, Shared Learning Subject Matter Expert and Principal of Rodd Bond Innovation Services shares his thoughts on the project.

Who are you? What do you wish for? What matters to you? Can we help you open a way towards finding and meeting your goals and aspirations – whether clear or currently shrouded?

These are some of the core questions at the heart of the mechanisms of engagement between the 10 mPower project’s partner teams, and the hundreds of participants they served over the past 5 years. For a project committed to fostering the development of healthy and connected communities, through empowering its older citizens; these are not only questions for older people, from which to prepare personalised action and wellbeing plans, they are also points of cultural reflection for participating communities and stakeholders; to examine how they do this ‘mPower thing’, and if and how we might be able to do more of it, and do it better, in the future.

In this new and emerging domain of community enhancement, there are no experts yet, only people carrying the scars and wearing the tea-shirts of their endeavours to introduce innovations that might improve how communities work together to serve their older citizens. I cut my teeth in this area through my time leading the NetwellCASALA research centre for ageing, place and technology at DkIT, through helping introduce and shape the evolution of the WHO’s age-friendly cities initiative in Ireland, and through my work supporting ALONE in their journey of social innovation to support older people in Ireland. This does not qualify me in any academic sense, but it has heightened my awareness and sensitivity to some of the issues that might matter, as I’ve been able to journey alongside, and learn from, some of the wonderful people and initiatives that have helped make mPower the success it is.

The actionable breadth, yet singular purpose of mPower, warrants consideration from several disparate, though converging perspectives. The different coloured lenses of service design, health-oriented implementation science, inclusive place-making, community development, and personal wellbeing not only overlap and form a bright, white, sharply focussed light on the target of individual personal empowerment, but they also merge at a different and wider level, to form a more transcendent, warm glow that looks at people in relation, in communities and places, and the detail and working of these community partnerships, both physical and digital, that envelops them.

These personal reflections afford me an opportunity to take some liberties and to explode some myths and deceptions that have concerned me about community link work. The first myth is that the community is generally just fine, it’s just that some people have somehow found themselves dis-connected from it – and that technology can fill the gaps and mend or re-forge these dis-connects. mPower does more than connect isolated older people at the edges to a set of community-based services, supports or programmes – whether centred or distributed. It helps these disparate services to coalesce, to learn about each other, to identify and fill community service gaps, to forge their own connections and choreographies together. mPower enhances communities’ connectedness, it increases their reach, but more importantly, it can intensify and strengthens a communities’ coherence and resilience, it’s inner sense of place and purpose.

– What’s in a name

– What’s the art at it’s heart.

– The digital services heartbeat: beyond community arrhythmia

– The route less travelled: Pathways, forks, destinations and tacking.

What’s in a name

I was first introduced to this type of community response in the Trynwalden in northern Holland in 2005. The brokering role there was called an ‘omtinker’, in a local Fresian dialect it means to ‘reconsider’ – to look at again. Its local attachment caught on with our project team, and when we first shaped the role in our demonstrator project in Dundalk we called it ‘Cúltaca’ – a gaelic word for ‘strong support’ or ‘fullback’ on a football team – someone that would ‘have your back’!

Today, the mPower ‘community navigator’ name sits beside a plethora of names competing for attention – social prescriber, service broker, service coordinator, support coordinator, community link worker, case worker, well-being coach and more! Even within the ‘prescriber’ reference framework, we see differentiation with ‘prescription’ prefaced or qualified by whether it’s social, cultural and technological. There are stories and nuances behind all these role identities that both converge and differentiate, and it will be interesting to see if they tend to globalise and universalise, or localise and specialise over time. God forbid that we’ll need a glossary for semantic interoperability between them all!

Whatever about the name of the roles, a bigger challenge is classifying the label for the person to whom these roles and services are targeted. Patient, client, customer, recipient, beneficiary, older person, older citizen, senior, service user – and if we were to include housing services it could extent to include resident and tenant. Here, we’re trying to name not just a ‘generic person’ or a ‘passive role’. We’re trying to identify a ‘person in relationship’ – a relationship between unique persons to something that is still not well anchored and somewhat amorphous. This is tricky territory as the types of professionalised or commercialised relationships named above can be about control, authority, knowledge and power, responsibility and assigned agency. They are rarely about equality, symmetry and free choice. For me, where we’re trying to empower an individual’s self-agency, in equilibrium with their emerging community-based eco-system of services and programmes, I think it’s more about ‘joining’ and ‘belonging’ rather than ‘transactional using’. ‘Member’, and ‘membership’ seems to be a promising and natural relationship – emphasising a sense of the personal – independence, autonomy, ownership and commitment – in chosen relation to, and invested in – our developing and healthier, communities, services and programmes.

What’s the art at its heart ?

mPower has fascinated because its partners have co-created a programme seeded in bringing together and fusing two interwoven intervention strands into a unified offering – community navigation and pervasive technologies – maybe even community navigation with digital technologies. However, there are at least three flavours of this programme intervention due to the origins, contexts, and cultures of the three jurisdictions in which they have been developed. Although there have been exceptions, a generally accepted model is that the referral orientation tends away from the ‘medical’ and looks to, and filters towards, healthy ‘but non-health service’ supports, activities and programmes – be they social, cultural, leisure, physical, environmental or technological. But between the initial referral, and a member joining a choir, exploring a museum, taking an exercise class, joining a Men’s Shed, adding an accessible shower or learning to use Whatsapp, there’s a transformation, a fire is lit, and it is first activated and energised by the spark and dynamism of the relationship between the navigator and our new member. Gently shifting perspectives and mind-sets, strengthening personal agency, and helping to channel a member’s confidence to identify and to try out news things, or reconnect with lost things, is ‘the art at the heart’ of this ‘mPower thing’.

Developing the right personal action or wellbeing plans, whether modest or ambitious – takes honesty, courage and the freedom to imagine. A second myth to explode is its logical straightforwardness. Whilst it is sometimes characterised as ‘ticking off a menu’ of what’s available, of connecting to what ‘I’d like or need’ – when done well, it’s more likely to involve an iterative process of careful questioning, probing and discernment. It’s partly an act of self-reflection and re-visioning (or re-considering) and partly of co-creation and co-production. Shifting from ‘what’s the matter with you’ to ‘what really matters to you’, or more precisely – from ‘what’s the matter with me’ to ‘what really matters to me’ – won’t always be straight forward. Many older people may never have been invited to ‘reflect’ upon their own concerns – to open gateways to their past, take stock of the present, and to dare to imagine a different future. At its heart, mPower has been about removing barriers and opening up possibilities and vistas – for individuals and communities. Community navigators, can’t solve peoples’ problems – but they can help to establish the conditions that make the emergence of good individual and community outcomes more probable and more frequent.

The digital services heartbeat – beyond community arrhythmia

The project’s impact films wonderfully illustrate the extent to which technologies (of both the e- and m- variety) have contributed to the project’s success. The arrival of COVID-19, with the extensive challenges that social distancing brought to our natural desire for physical presence, affinity and attachment, necessitated spatial isolation and increased separateness in space and time. However, for better or worse, these enforced spatial dislocation patterns, radically altered the conditions and necessities for technology take-up, and hugely accelerated the advancement of digital solutions and services. Traditional organisational barriers to digital transformation dissolved in the midst of our pandemic responses. With so much technology in people’s hands, it was no longer a question of if, but how well, might technology be accepted.

Models of technology acceptance have often focussed on perceived usefulness and ease of use, leading to behavioural intentions to use, and finally to experience in use. Interactive tablet screen devices, and hand’s-free (voice) interaction such as Alexa, and inclusive app design, have all been game-changers in ease-of-use, and have removed much of the functional, cognitive and sensory barriers to accessing digital services. While the experimental design of mPower helped buffer the uncertainties of emergent business models and ‘who pays who for what’, it did highlight two obstacles that continue to need attention. ‘Ease of use’ is now very much better, but it doesn’t address the foundational barriers of digital accessibility – particularly bandwidth availability and affordability in remote locations, and the baseline quality and quantity of digital literacy in some of our at-risk populations. Projects like mPower can greatly help – but enhancing digital availability and basic digital literacy needs a broader, community-wide response.

GDPR, data security, privacy and protection – matter. But so too does data-sharing! Streamlining care and supporting integrated pathways, choreographing services across multiple public and community organisations, and ensuring that information is up-to-date, reliable, and available to all who need it, when they need it – these are all vital potential benefits of ‘open data’ for smart communities and smart cities. However, benefits are stymied when we hide behind over-zealous interpretations of data protection legislation and fail to leverage the opportunities to share data with confidence, permission and valid ethical intention. Today, while so much superfluous data flows unconstrained, too much worthwhile data still flows irregularly, or not at all.

The route less travelled: Pathways, forks, destinations and tacking.

The ethical and moral basis for a project innovation such as mPower could be seen both as a community duty or responsibility to ‘care innovatively’ for our at-risk older citizens, and as a utilitarian response to ‘increase outcome benefit’ through ‘longer, healthier life-years’ and the avoidance of more costly and less attractive alternatives – be-it admission avoidance or discharge acceleration. However, I feel that it offers much more than this. When the components are taken within a unified framework – I think is reaches beyond ‘supporting self-management’ to inviting ‘self-liberation in later life’ – to helping to create the conditions where members can question ‘what really matters to them’, and, to quote Michael Novak, ‘to fashion small acts of honesty, courage and freedom’ in the direction of their own goals and aspirations. Such a confidence building, and meaningful void filling service can be truly universal. Going forward, whether through directly related mPower continuation and sustainability initiatives, or indirectly, through related drives in complementary sectors and settings – promoters, policy makers, stakeholders, service designers and implementation teams would do well to look at talent, technology and the tolerance of transgression in forging capacity for growth, sustainability and impact.

Talent: There is a need to grow the pool of talented ‘navigators’ – and for this we need to look at core attributes and aptitudes, training and skills, and essential life experiences to underpin practice development. An impending fork in the road ahead is the extent to which this role can, and should be truly universal – or whether it will diversify and specialise for different sectors, segments and cohorts. Sourcing and rewarding talent, and providing exciting career development pathways is still very embryonic.

Technology: mPower has highlighted the prominent, and sometimes essential, role that digital technology is now playing in all aspects of forming and sustaining healthy and connected communities. We’ve only begun to scratch the surface of the wonderful benefits available, but as we do, we are also presented with the significant digital threats that lurk within it. As we question ourselves about ‘what matters to us’ with honesty courage and freedom, technology is ever more likely to become part of the object, the subject and the means of such inquiry and exploration.

Tolerance of transgression: Finally, our place and belonging within personalised, community-based eco-systems of support will only be successful if all the parts of the eco-system are working in some level of harmony. Collaboration between community organisations, and across public, private and voluntary sectors isn’t easy. As the WHO documented in their guide to health governance in the 21st century, good collaboration involves sharing resources and planning towards common goals. It often involves the attenuation of control across partners. In reality, rather that achieving true collaboration, maybe the best we can hope for might be the ‘tolerance of positive transgression’ – that we can work and learn better together and plan to avoid stepping on each other’s toes as little as possible! This is not just about procurement and SLAs. It’s about working in partnership and continuously questioning our, and our partner’s interests, and the extent to which they are aligned, shared or in tension. In many instances, our navigators are working in, and across this milieu of juxtaposed organisational structures and cultures, trying to make sense of it for their members.

At this early stage of development, it may be premature to say if there are right ways or wrong ways to progress. In the spirit of incremental and stepwise improvement, having the agility to tack one way or another, dependent upon the prevailing conditions may be the best strategy going forward at the moment. Between mPower, and the growing range of social/cultural/technology prescribing initiatives now taking root here and internationally, it seems that the general approach has now surpassed its threshold of validity, and now reaches for sustainability. Our question is no longer should we do it – it’s now a case of how do we organise ourselves to do it better, and do it for more people who can gain by it.