. The document brings together feedback from the field on the participation of concerned individuals in the field of autonomy, organised around five challenges (p. 3 to 15). It describes adjustments made by teams (clarification of roles, pairs with a peer, facilitators attached to headquarters, rewriting of institutional documents) as well as the obstacles encountered (p. 5, 6, 11, 15). It proposes a mapping of the 18 projects supported between 2015 and 2023, with their lead and their territory (p. 19).
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1️⃣ SUMMARY
These acts report on the Innovation Meetings organised by the CNSA on 1st October 2024. The approaches and results of eighteen projects were presented, supported under the thematic project calls dedicated to participation and the annual project call "Experimenting to support the evolution of medico-social services and the adaptation of responses to the needs of individuals" (p. 3). The projects concern services for individuals, medico-social establishments and municipalities, for elderly people and people with disabilities (p. 3, 19). The report is organised into five sections: accessibility and communication; status, recognition and support for participants; transformation of professional practices; capillarity between participation spaces and governance bodies; valorisation of experiential knowledge and active citizenship (p. 4 to 15). A second part deals with structuring, spreading and sustainability (p. 16-17), before a summary (p. 18).
2️⃣ WHAT TO REMEMBER
1️⃣ Separate the roles of supporter and participant. In the project "SAM’Concerne" (APF France Handicap), professionals who were both supporters (transport, preparation) and participants complicated the horizontal co-construction. The document concludes that these roles must be clearly dissociated (finding from a project, p. 5).
2️⃣ Proposals struggle to reach decision-making bodies. Institutional language, unsuitable meeting formats, proposals rarely revisited: the document describes these barriers, then the "intermediate links" established by certain projects (Council of storytellers and the "development" commission at ADMR, peer-support at La Roche, integration of supported individuals into the board and office for POLDER) (finding, p. 11).
3️⃣ The sustainability after external support remains a major issue. The majority of the observed initiatives benefited, at their launch, from external support (social design, participatory engineering). In the "Projet’on nous" project of the SESSAD of ASEA 43, a specific part-time educational role was mobilised to animate the tools created with designers, but the professional was quickly absorbed by the urgency of direct support. The assessment also highlights a lack of internal know-how to evolve the tools once expert support has ended. These findings show the importance of dedicated human resources and a sustainable internal engineering (finding, p. 4, 16-17).
3️⃣ TO ACT
1️⃣ Identify the guides and kits already produced by the projects. The document cites a guide for scaling up supported employment in the Grand Est, a kit for home support and tools from the Gerontology pole of the French Mutuality Isère (p. 17). Case : existing tools cited. The document provides neither links nor access modalities.
2️⃣ Draw inspiration from the "Journey of the Idea." This object, one of the seven prototyped with the OpenCommunities agency for UNAPEI 17, allows visualisation of the decision-making process, from the expression of a wish to its validation (p. 16). Case : existing tool cited; its dissemination outside the project is not specified.
3️⃣ Anchor the approach within a clear operational framework. The document states that locally initiated approaches must anchor themselves in a readable, stable, and sustainable framework; the opinion of the CNSA Council (2024) mentions a charter specifying objectives, transparency, and evaluation of the impact of contributions (p. 17). Case : action requested by the document.
4️⃣ 3 PRACTICAL QUESTIONS
1️⃣ Can a professional be both a supporter and a participant? The document indicates that professionals can be present either as representatives of their team or to support and facilitate; support roles must be separated from those of participant (p. 5).
2️⃣ Can we pay the peers who participate? Some projects explore compensation (employee status or financial compensation). The document specifies that this point remains little discussed and poorly implemented, with obstacles, notably the reduction of allocation amounts related to the consideration of allowances (p. 5). The association La Roche relies on a paid peer supporter (p. 6).
3️⃣ How can we prevent relatives from speaking on behalf of the individuals? The document highlights this risk of substitution and calls for clarifying roles and developing distinct forms of participation, so that that of the supporters complements that of the individuals without substituting it (p. 7; see also the "protective third party posture", p. 9).
5️⃣ TO GO FURTHER
Blog Health Practices — Participation in health: from the democratic ideal to field practices - https://www.pratiquesensante.com/participation
Primary source — CNSA, Council Opinion on the representation of people and their direct participation in the field of autonomy (27 June 2024). Opinion cited p. 17 of the document; full text available on cnsa.fr. https://www.cnsa.fr/sites/default/files/2024-07/20240703_Avis_Conseil-sur-la-participation-des-personnes_VDEF_0.pdf
External source — HAS, "Support for the development of self-determination and the power to act of individuals in ESSMS – Framing Note" (validated on 11 March 2025, published online on 19 March 2025). It concerns elderly people, people with disabilities, young people in child protection, and people in situations of extreme vulnerability or related to social inclusion. https://www.has-sante.fr/jcms/p_3598052/
6️⃣ #️⃣ HASHTAGS
#healthpractices #UserParticipation #SelfDetermination #PowerToAct #PeerSupport #ExperientialKnowledge #SocialLifeCouncil #MediSocial
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