Psychology Presentation

Feature

Human rights training: impact on attitudes and knowledge

Michelle Redman, Eleanor Taylor, Reuben Furlong, Ged Carney and Beth Greenhill

Abstract

Purpose – People with learning disabilities are vulnerable to human rights violations, creating a need for

human rights education for both services users and support staff. This research paper aims to examine

factors contributing to effective human rights training for staff. It seeks to investigate human rights

awareness training (HRAT) within an NHS setting and its effect on human rights knowledge and attitudes

towards human rights.

Design/methodology/approach – A total of 23 support staff were given HRAT, completing a ‘‘human

rights based approach knowledge quiz’’ and an ‘‘attitudes to human rights questionnaire’’ before and

after training.

Findings – The results indicated that HRAT had a significant effect on human rights knowledge scores;

however, training had no significant effect on attitudes towards human rights and no significant

relationship between staff attitude and human rights knowledge was found.

Research limitations/implications – Future training would benefit from a greater focus on

psychological theories of attitudes and behaviour in the planning, execution and evaluation of the

training. This may help to facilitate development of positive attitudes towards human rights. A validation of

the measure of attitudinal change is needed. Training models with a greater emphasis on staff’s emotional

responses, defences and the impact of organisational culture may allow a deeper understanding of the

complexities of delivering effective human rights training.

Originality/value – This research paper highlights the need for human rights training; one that

encompasses attitudinal change as well as basic education. Without effective training to secure staff

engagement in organisational change, human rights legislation is unlikely to create meaningful change

in the lives of people with learning disabilities.

Keywords Human rights, Staff training, Attitudes, Organizational culture, Learning disabilities, Psychological reactance

Paper type Research paper

Introduction

From the beginning of recorded history, people with disabilities have been enslaved, abused and

neglected (Owen and Griffiths, 2009, p. 15).

The protections afforded by the 1998 Human Rights Act are fundamental for vulnerable

groups such as those people with learning disabilities who face victimisation, discrimination

and violation of their rights (Mazzucchelli, 2001; Department of Health, 2008; Ministry of

Justice, 2008). Reports (Joint Committee on Human Rights, 2008) highlight abuse, lack of

privacy and difficulties arising from poor communication as explicit concerns for service

users with learning disabilities. Within an NHS based explicitly on human rights principles

(Department of Health, 2009), there is an urgent need to address these issues.

PAGE 80 j TIZARD LEARNING DISABILITY REVIEW j VOL. 17 NO. 2 2012, pp. 80-87, Q Emerald Group Publishing Limited, ISSN 1359-5474 DOI 10.1108/13595471211218811

Michelle Redman and

Eleanor Taylor are both

Assistant Psychologists,

Reuben Furlong is a

Community Residential

Services Manager, Ged

Carney is a Community

Learning Disability Nurse

and Beth Greenhill is a

Clinical Psychologist, all at

Mersey Care NHS Trust,

Liverpool, UK.

Due to a higher incidence of healthcare needs, people with learning disabilities often have

more interaction with the healthcare system compared to the general population (Owen and

Griffiths, 2009). Sutherland et al. (2002) suggest the limited degree to which people with

learning disabilities are given the opportunity to actively participate in their own healthcare

raises ethical concerns. Arguably, this combination of factors leads to the very real every day

indignities and high-profile abuses in the lives of people with learning disabilities such as

those identified in Death by Indifference (Mencap, 2007).

Commenting on the inquiries into human rights abuses in healthcare settings, the Healthcare

Commission (2007) stated ‘‘institutional abuse occurs when the rituals and routines of a

service result in the lifestyles and needs of individuals being sacrificed in favour of the needs

of the institution’’ (cited in Healthcare Commission, 2007, p.8). In this context, there is a clear

need for human rights education for both staff working with people with learning disability

and individuals themselves. Individuals who are unaware of their human rights are more

‘‘vulnerable to having them abused and often lack language and conceptual framework to

effectively advocate for them’’ and furthermore ‘‘cannot exercise them effectively’’ (Flowers,

1998, cited in Owen and Griffiths, 2009, p. 18).

Promoting a human rights culture: the need for human rights training in organisations

Kinderman and Butler (2006) highlight the need for all frontline staff to be trained in human

rights. Staff with greater familiarity with human rights, they argue, are more likely to believe in

upholding rights and are also more committed to upholding the rights of others (Tarulli et al.,

2004). Stoner et al. (2002) similarly report that support for service users is most effective if

staff have knowledge of human rights. The Ministry of Justice (2008) identified that specific

training on human rights was beneficial, not only to the member of staff receiving the training,

but to the organisation and service users for and with whom they work.

Effective human rights training in organisations

The Audit Commission (2003) recommends that to develop a ‘‘human rights culture’’,

awareness of human rights should be paramount throughout an organisation. They also

state that prevention rather than cure is key to delivering human rights and improving

services; human rights need to be seen to be proactively embedded and not just invoked in

response to legal disputes. When public bodies were not found to be responsive to the

Human Rights Act, this was usually due to competing priorities and to negative responses to

the act engendered by the organisation only responding to legal cases. The best

approaches identified were where organisations were positively promoting human rights in

their equalities strategies, policies and practices.

Effective human rights training in public services

Within the limited literature available, there appear to be two broad approaches to human

rights training; an ‘‘activist approach’’, characterised by Flowers and a ‘‘psycho-educational

approach’’ advanced by Kinderman and Butler (2006). Flowers (2000, p. 8) ‘‘challenges

students to ask what human rights mean to them personally and encourages them to

translate caring into informed, nonviolent action’’, proposing that a human rights education

‘‘promotes understanding of the complex global forces that create abuses, as well as the

ways in which abuses can be abolished and avoided’’. In less impassioned contrast,

Kinderman and Butler emphasise the importance of congruence with participants’ pre-

existing ideas.

Butler (2005) adds that training for staff should not only include rights and the FREDA

principles (Fairness, Respect, Equality, Dignity and Autonomy) but should also be developed

around tools that can be disseminated to structure practice (Greenhill and Whitehead, 2010).

As the training being evaluated was part of mandatory training for the support staff attending,

it seemed more fitting to adopt Kinderman and Butler’s approach. Human rights training can

be experienced by staff as contentious (see below for a discussion of ‘‘psychological

reactance’’), even when they are implicitly using the approach every day. Guidance for

Human Rights training in a UK context emphasises ‘‘working from the point of connection’’

VOL. 17 NO. 2 2012 jTIZARD LEARNING DISABILITY REVIEWj PAGE 81

rather than adopting a ‘‘radical activist’’stance which may risk alienating staff(Kinderman and

Butler, 2006).

Human rights training for staff working in LD services

The Rights, Respect, Responsibility (3Rs) training education programme (Owen et al., 2003)

in Canada informs service users with learning disabilities, and the people who support them,

about their human rights. The main aim of the 3Rs programme is for service users and staff to

distinguish rights, infringement of those rights and appropriate ways to challenge violations.

It places emphasis on the use of personal experiences and active trainee participation. The

training includes presentations, discussions of human rights scenarios and a range of

activities to engage participants in examining the nature of each of the rights to which the

organisation is committed. In evaluating this training, trainees reportedly comment that

examples are beneficial, as they provide a link between taught content and their own

professional experience. Following the training programme, service users and staff have

shown significant development in the ability to identify human rights and exercise them

effectively (Owen and Griffiths, 2009).

Attitude and behaviour change within human rights training

Kinderman and Butler (2006) suggest the key to using the Human Rights Act to ensure the

respect of all service users is promoting change in attitude and behaviour. They suggest

there are a number of components in the development and implementation of positive

engagement with human rights, including prevention and enforcement, strategy, planning

and evaluation, all underpinned by psychological theories of attitude and behaviour.

Various insights into our understandings of the links between attitude and behaviour have

been made by key theorists. Fishbein (1967) suggests that individuals are more likely to act

in a specific way and uphold attitudes when the attitudes in question are viewed as

originating from the self or as pre-existing. Kinderman and Butler (2006) argue that this is

particularly important when engaging staff around human rights. Ajzen’s (1991) ‘‘Theory of

Planned Behaviour’’ proposes that a person’s attitude, subjective norms and perceived

control of behaviour all influence their behaviour. This indicates a need to assess attitude to

human rights as a means of changing staff’s behaviour.

Rose and Holmes (1991) provide an example of how training can produce attitude change to

promote and maintain human rights. They evaluated two workshops designed to change the

attitudes of staff towards the sexuality of people with learning disabilities, e.g. risk taking

behaviour, freedom of choice and expression of sexuality. Significant levels of change in staff

attitude were identified following workshops. A longer training event created a significant

change in staff attitude, in a more ‘‘liberal’’ direction. However, Rose and Holmes do not

specify which components of the workshops were most effective in changing participants’

attitudes.

Potential barriers to effective human rights training: attitudes and ‘‘Psychological Reactance’’

Kinderman and Butler (2006) set out certain guidelines when training people around human

rights. One area they felt to be important was that human rights should be seen as

complementary to current public service work. To prevent ‘‘reactance’’ to human rights

training, it is important that staff do not feel ‘‘railroaded’’ into change, rather, that a human

rights approach can bring about service improvements compatible with current working.

During training, enabling people to share their own experiences and practice and retain a

sense of congruence with their own thoughts and beliefs are important in reducing

‘‘psychological reactance’’ towards training and human rights (Kinderman and Butler, 2006;

Owen et al., 2003; Ministry of Justice, 2008).

This is consistent with Rose and Holmes’ (1991) explanation for possible attitude change.

They suggest workshops may provide an environment where participants are able to

increase their knowledge whilst providing a platform for a full and open expression of their

views. Post-test participants were able to express their views more easily which is indicative

of attitude change.

PAGE 82jTIZARD LEARNING DISABILITY REVIEWj VOL. 17 NO. 2 2012

Summary

The above literature highlights the victimisation and discrimination people with learning

disabilities face in respect of their basic human rights. It suggests a need for a human rights

approach and for it to be proactively embedded within services. Furthermore, it promotes

staff training as a means to accomplish this. However, training is not without its own potential

difficulties in respect of psychological reactance and attitudes, issues which can be

addressed and tackled.

The following study took place as part of one of five pilot sites within the ‘‘Human Rights in

Healthcare’’ project, a Department of Health initiative aiming to increase explicit use of

human rights in health care settings.

Method

This research study examined the impact of human rights awareness training (HRAT) on

healthcare staff’s knowledge of human rights and attitudes towards human rights, within a

learning disability service. The relationship between attitude and knowledge was also

explored.

Ethics

This training was part of a larger service delivery and evaluation project. Advice was sought

from within the NHS trust conducting the evaluation who advised the study constituted

service evaluation. Central Office of Research Ethics Committee permission was not

therefore necessary.

Participants were provided with a participant information sheet, and were asked for their

informed consent. They were informed they could withdraw at anytime without prejudice or

penalty. Anonymity was maintained.

Measures

A quiz was developed in-house by some of the authors (BG, GC, MR), to measure

participant knowledge of human rights and a human rights-based approach (HRBA). The

quiz was piloted with Community Learning Disability Team staff. Some questions needed to

be changed to reduce high scores and were adapted accordingly. The quiz consisted of

13 multiple choice questions which required participants to circle the correct answer.

For example:

The framework that brings human rights into UK law is:

B The Bill of Rights.

B The UK constitution.

B The Human Rights Act.

Participants were given one point for each correct answer and the sum of those points gave

the final score. High scores indicated higher levels of human rights and HRBA knowledge.

The attitude questionnaire was developed by one of the authors (BG) in collaboration with

Ipsos/MORI as literature searches suggested there were no other tools available measuring

attitudes towards human rights. This questionnaire aimed to measure participants’ thoughts

and feelings towards human rights. 12 items were rated using a five-point Likert-type scale

ranging from ‘‘strongly agree’’ to ‘‘strongly disagree’’. Four items reflecting an unfavourable

attitude were reverse scored. For example: ‘‘Human rights are not useful or relevant to my

day-to-day work’’ (strongly disagree, disagree, neither agree nor disagree, agree, strongly

agree). An attitude score was obtained by summing up each of the individual item scores.

A high score indicated a positive attitude.

Procedure

The measures were arranged in a randomised order with each participant completing them

individually and anonymously. At Time 1 (T1) participants also completed a demographic

VOL. 17 NO. 2 2012 jTIZARD LEARNING DISABILITY REVIEWj PAGE 83

data sheet and consent form. They were verbally prompted to complete all the measures in

the order in which they found them in their pack. They then took part in the HRAT. The training

consisted of a one-day course on human rights awareness which included what human

rights are, why they are important, their relevance to healthcare and an explanation of a

HRBA. A Clinical Psychologist (BG) and Community Learning Disability Nurse (GC)

delivered the one-day course on two separate occasions and employed both experiential

and didactic teaching methods, including various participant exercises related to human

rights. Two service users were present on the second training day.

Immediately after training, participants completed a training evaluation sheet and repeated

the measures (Time 2 (T2)).

Some participants failed to complete all measures. Three participants with incomplete

measureseitherat T1or T2wereomittedfrom theanalysis, thus reducing thesamplesizeto 23.

Results

Preliminary analysis

As the attitude questionnaire was devised ‘‘in-house’’ a statistical test was performed to

measure whether the questionnaire items produced similar scores (‘‘internal consistency’’).

The Cronbach’s alpha for the questionnaire was 0.84 for T1 and 0.77 at T2 suggesting the

questionnaire was adequate for measuring attitude (Pallant, 2007).

HRAT and knowledge scores

Table I shows mean scores on the human rights knowledge-based quiz before and after

training. Analysis indicated that there was a significant increase in knowledge scores

following training (z ¼ 23.451, p ¼ 0.001).

HRAT and attitude scores

Differences between attitude scores at T1 and T2 were analysed. There was no significant

difference between pre- and post-training attitude scores (t ¼ 20.920, df ¼ 22, p . 0.05),

suggesting that the training did not affect attitude.

Relationship between attitude and knowledge scores

Statistical analysis revealed there was no significant relationship between attitude and

knowledge at T1 (r ¼ 20.054, n ¼ 23, p . 0.05) or T2 (r ¼ 0.363, n ¼ 23, p . 0.05).

Discussion

Overall results

It was anticipated that HRAT would increase knowledge scores. A significant difference

between the pre- and post-training knowledge scores was found. This is consistent with the

findings of the 3Rs training where staff showed significant development in ability to identify

human rights (Owen and Griffiths, 2009).

It was also proposed HRATwould affect attitude scores. Although there was a small increase

in mean attitude score at T2, there was no significance difference between staff’s pre- and

post-training attitude scores. However, participants’ pre-training scores were high so there

Table I Mean and standard deviations for the HRBA knowledge quiz and the attitudes to human rights questionnaire pre-

and post-training

Knowledge pre-training Knowledge post-training Attitude pre-training Attitude post-training

Total N 23 23 23 23 Mean 7.17 9.61 49.17 50.13 Standard deviation 1.99 2.37 4.80 5.52

PAGE 84jTIZARD LEARNING DISABILITY REVIEWj VOL. 17 NO. 2 2012

may not have been much margin for change. Moreover, adopting Flowers’ more ‘‘activist

approach’’ may have produced greater attitude change than the ‘‘psycho-educational

approach’’ (Kinderman and Butler, 2006) used. Although Rose and Holmes (1991) managed

to achieve attitude change within their training, it is important to note that they were unable to

specify the components most responsible for this result.

Kinderman and Butler (2006) have suggested that human rights training should be

presented as congruent with trainees’ existing values to decrease psychological reactance.

Therefore, it was felt there may be a link between participants’ knowledge and attitude

towards human rights, as there may be fewer barriers to learning in those well-disposed

towards the subject matter. However, analysis revealed there were no significant correlations

between knowledge and attitude. This finding may have been due to having a small sample.

The potentially complex interface between knowledge and attitudes to human rights is an

area for further investigation.

It is suggested that there are a number of components needed to facilitate positive attitudes

to human rights (Kinderman and Butler, 2006). It could be argued that the content of the

HRAT emphasises cognitive change rather than emotional responses which may not be

enough to promote personal reflection and therefore attitudinal change, as implied by

Flowers (2000). This supports Kinderman and Butler (2006) and further implies that some of

the components suggested for development of positive attitudes may not have been

addressed within our planning and implementation of the human rights training.

Group dynamics

Various dynamics were observed on the training days which may have impacted on the

results. For instance, the presence of two service users on one of the training days may have

affected the dynamics of the group and subsequent attitudes divulged on the training day

and on the attitude questionnaire. It could be argued that, with service users present, it may

have been harder for staff to fully and openly express their views. Rose and Holmes (1991)

identify this as a necessary factor for the facilitation of attitude change within their

workshops. Conversely, observations made over the two days of training indicated that the

sessions were more focused and service user orientated when service users were present.

This may be an area for further investigation.

Existing human rights concerns for specific participants within their working roles may also

have had an effect on attitudes and the dynamics in the group. However, Kinderman and

Butler (2006) identify a need for training groups to be made up of a range of individuals so a

wider range of experiences are shared and the concept of cooperative working instilled.

As Arthur et al. (2003) suggest, for training to impact and take effect the working

environment needs to be receptive and supportive.

Methodological limitations

Although the questionnaire is unvalidated, the results from a preliminary analysis of internal

consistency suggested the questionnaire was adequate in measuring attitude. However, the

questionnaire could be improved by looking specifically at the items that may not have been

as strong as others. Moreover, the difference in alpha values at T1 (0.84) and T2 (0.77) may

be due to response set for the reversed items on the questionnaire. At the end of the training

session (T2) participants were eager to leave which may have led to them misreading the

negatively worded items (see ‘‘Measures’’ for example). Although a significant difference in

human rights knowledge scores was found post-training, many participants scored highly

prior to human rights training suggesting the quiz may have been too easy. If the quiz is to be

used again researchers may have to revise some of the questions to address this or lengthen

it to incorporate more questions further assessing knowledge of human rights.

Future training recommendations

B As identified, a greater focus on psychological theories of attitude in the development and

implementation of the HRAT is needed.

VOL. 17 NO. 2 2012 jTIZARD LEARNING DISABILITY REVIEWj PAGE 85

B Using Fishbein’s (1967) concept of attitude originating from the self, future training would

need to address potential pre-existing negative attitudes towards human rights and

induce and enhance positive ones.

B Utilising Flowers’ approach, which somewhat echoes Fishbein’s concept, may produce

attitudinal change.

B Ensuring the participation or perhaps co-facilitation of service users at all training

sessions may maintain the session focus and promote positive attitudes, although future

research needs to investigate the impact of service user presence.

B The emotional impact of human rights may need to be considered and addressed in

future training.

Further recommendations for future research

B Given that the training produced little effect on human rights attitudes, future research

may want to consider how psychological theories of attitudes and behaviour operate in

this context to facilitate development of positive attitudes towards human rights.

B A validation of the attitudinal measure; exploring test-retest reliability, identifying weaker

attitude questionnaire items and adapting the questionnaire to make it more reliable.

B Replication of this study using a larger sample and the use of a control group will help

increase the reliability/validity of the findings.

This study’s findings suggest numerous areas for further exploration. These include

investigating if the presence of service users on training days facilitates attitude change.

Furthermore, exploring trends between attitude and knowledge and pre- and post-training

and also attitude trends pre- and post-training could be valuable. Demographic factors that

may predict attitudes to human rights could also be researched.

Conclusion

Staff training interventions are widely used as a tool in learning disability services to share

knowledge and create changes in organisational culture. In the current study, HRAT

produced increased human rights knowledge; it did not create an attitudinal change to

human rights as indicated by a newly developed measure. We believe changes in both

knowledge and attitude are important for creating cultural shift. Further validation of the

human rights attitudinal measure will help to establish whether the lack of change in the

current study is an artefact related to the current methodology, or a function of the training

package. In either case, theories of attitude may need to be more carefully applied to future

training resources. Of course, it is also important to remember that factors other than specific

training, such as the overall ethos of the organisation, are likely to contribute substantially to

staff culture and behaviour (Ministry of Justice, 2008).

References

Ajzen, I. (1991), ‘‘Theory of planned behaviour’’, available at: http://people.umass.edu/aizen/tpb.html

(accessed 15 April 2011).

Arthur, W., Bennett, W., Edens, P.S. and Bell, S.T. (2003), ‘‘Effectiveness of training in organizations:

a meta-analysis of design and evaluation features’’, Journal of Applied Psychology, Vol. 88 No. 2,

pp. 234-45.

Audit Commission (2003), Human Rights: Improving Public Service Delivery, Audit Commission,

London.

Butler, F. (2005), Improving Public Services: Using a Human Rights Approach, Institute for Public Policy

Research, London.

Department of Health (2008), Government Response to the Joint Committee on Human Rights: A Life Like

any Other? Human Rights of Adults with Learning Disabilities, Crown, London.

PAGE 86jTIZARD LEARNING DISABILITY REVIEWj VOL. 17 NO. 2 2012

Department of Health (2009), Valuing People Now: A New Three-year Strategy for People with Learning

Disabilities, HMSO, London.

Fishbein, M. (1967), ‘‘Theory of reasoned action’’, available at: www.istheory.yorku.ca/

theoryofreasonedaction.htm (accessed 15 April 2011).

Flowers, N. (2000), ‘‘The human rights education handbook: effective practices for learning, action and

change’’, available at: challenges">www.scribd.com/doc/53987765/Human-Rights-Education-Hand-

book-Effective-Practices-for-Learning-Action-Change-Flowers?query ¼ it þ challenges (accessed

15 December 2011).

Greenhill, B. and Whitehead, R. (2010), ‘‘Promoting service user inclusion in risk assessment and

management: a pilot project developing a human rights based approach’’, British Journal of Learning

Disabilities, Vol. 39 No. 4, pp. 277-83.

Healthcare Commission (2007), Investigation into the Service for People with Learning Disabilities

Provided by Sutton and Merton Primary Care Trust, Healthcare Commission, London.

Joint Committee on Human Rights (2008), A Life Like Any Other? Human Rights of Adults with Learning

Disabilities: Seventh Report of Session 2007-08, The Stationery Office, London.

Kinderman, P. and Butler, F. (2006), ‘‘Implementing a human rights approach within public services:

an outline psychological perspective. A report for the Department for Constitutional Affairs’’, available at:

www.mhe-sme.org/assets/files/Human%20Rights%20committee/Implementing_a_Human_Rights_

Approach_within_Public_Service.pdf (accessed 15 April 2011).

Mazzucchelli, T.G. (2001), ‘‘Feel safe: a pilot study of a protective behaviours programme for people with

intellectual disability’’, Journal of Intellectual and Developmental Disability, Vol. 26 No. 2, pp. 115-26.

Mencap (2007), Death by Indifference: Following up the Treat Me Right! Report, Mencap, London.

Ministry of Justice (2008), ‘‘Human Rights Insight Project’’, Ministry of Justice Research Series 1/08,

Ministry of Justice, London.

Owen, F. and Griffiths, D. (2009), Challenges to the Human Rights of People with Intellectual Disabilities,

Jessica Kingsley, London.

Owen, F., Griffiths, D., Stoner, K., Gosse, L., Watson, S.L., Tardif, C.Y. and Vyrostko, B. (2003),

‘‘Multi-level human rights training in an association for community living: first steps toward systemic

change’’, Journal on Developmental Disabilities, Vol. 10 No. 2, pp. 43-64.

Pallant, J.F. (2007), SPSS Survival Manual: A Step by Step Guide to Data Analysis Using SPSS,

Open University Press, Maidenhead.

Rose, J. and Holmes, S. (1991), ‘‘Changing staff attitudes to the sexuality of people with mental

handicaps: an evaluative comparison of one and three day workshops’’, Journal of Applied Research in

Intellectual Disabilities, Vol. 4 No. 1, pp. 67-79.

Stoner, K., Gosse, L., Vyrostko, B., Griffiths, D., Owen, F. and Sales, C. (2002), 3Rs (Rights, Respect and

Responsibility): Training for Staff in Agencies Supporting Persons Who have Intellectual Disabilities,

Community Living-Welland/Pelham, Welland.

Sutherland, G., Couch, M.A. and Iacono, T. (2002), ‘‘Health issues for adults with developmental

disability’’, Research in Developmental Disabilities, Vol. 23 No. 6, pp. 422-45.

Tarulli, D., Tardif, C.Y., Griffiths, D., Owen, F., McQueen-Fuentes, G., Feldman, M.A., Sales, C. and

Stoner, K. (2004), ‘‘Human rights and persons with intellectual disabilities: historical, pedagogical and

philosophical considerations’’, Encounters on Education, Vol. 5, pp. 161-81.

Corresponding author

Beth Greenhill can be contacted at: [email protected]

To purchase reprints of this article please e-mail: [email protected]

Or visit our web site for further details: www.emeraldinsight.com/reprints

VOL. 17 NO. 2 2012 jTIZARD LEARNING DISABILITY REVIEWj PAGE 87

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.