3 results
1 - From a collaborative and integrated welfare policy to frontline practices
- Edited by Kirsi Juhila, Tampere University, Finland, Tanja Dall, Aalborg Universitet, Christopher Hall, Juliet Koprowska, University of York
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- Book:
- Interprofessional Collaboration and Service Users
- Published by:
- Bristol University Press
- Published online:
- 21 December 2021
- Print publication:
- 06 April 2021, pp 9-32
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Summary
Introduction
During recent decades, Western welfare states have gone through a number of substantial transformations. One such transformation was the turn to active welfare states, based on the neoliberalist ideas of limiting the role of the state in welfare provision and emphasising citizens’ responsibilities instead of rights. Along with this, there has been a transition to a managerialist mode of governance, calling for more effective and efficient welfare services, and an increasing demand to understand service-using citizens as active participants in service provision. Common to these kinds of transformations is that they travel across countries and are often defined as indispensable steps to maintaining welfare states and to securing effective, fair and flexible responses to citizens’ wishes and needs. In other words, these are globally promoted and shared policies of welfare states, which are then realised in national legislation and guidelines.
New managerialist modes of governing have, among a range of other features, facilitated an increasingly specialised organisation of work in health and social care services. The idea is that specialised units of professionals will be able to develop more effective and productive service delivery due to both a specialisation of professional skills and an optimisation of procedures guiding work. However, this specialisation has produced fragmented services, which lack coherence and coordination in individual cases and between services more broadly. This has led to a call for collaborative and integrated welfare services across service sectors and national contexts. The resulting collaborative and integrated welfare policy and its accomplishments and implications in frontline social welfare service practices are at the core of this book. This policy stems from the aforementioned welfare state transformations, but it also has specific roots and justifications. It is promoted as a solution to overcoming the challenges of ineffective, dispersed and professional-led health and social care services. ‘Collaboration’ in this book refers to both collaboration between different professionals and organisations, and collaboration between professionals and citizens as service users. ‘Integration’, for its part, refers to the view that health and social care services should be seen as a whole, responding comprehensively to people's complex problems and service needs, in contrast to segmented sections concentrating solely on strictly targeted issues (Cameron et al, 2014; Fenwick, 2016, p 112).
5 - Alignment and service user participation in low-threshold meetings with people using drugs
- Edited by Kirsi Juhila, Tampere University, Finland, Tanja Dall, Aalborg Universitet, Christopher Hall, Juliet Koprowska, University of York
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- Book:
- Interprofessional Collaboration and Service Users
- Published by:
- Bristol University Press
- Published online:
- 21 December 2021
- Print publication:
- 06 April 2021, pp 115-140
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Summary
Introduction
Since the 1980s, service user participation has been a widely discussed ideal among politicians, health and social care professionals and service users themselves (for example, Velasco, 2001; Kvarnström et al, 2012; Finset, 2017). Service user movements have highlighted participation as an issue of freedom of choice, human rights and self-determination (for example, Cook and Jonikas, 2002; Raitakari et al, 2015; Lakhani et al, 2018; see also Chapter 1). In general, the concept signifies that service users play an important role in directing health and social care service systems as well as their personal service pathways. Additionally, service users are portrayed as evaluators, informants, consumers, decision makers, experts-by-experience or collaborators in professional encounters.
Western policies emphasise that services and multi-agency collaboration should be pursued in a way that strengthens service user participation (for example, Thomas, 2010; Fox and Reeves, 2015; see also Chapter 1). However, there is conflicting knowledge on how this aim is actually realised in frontline practices of health and social care (for example, Kortteisto et al, 2018; see also Chapter 1). Multi-agency collaboration is a challenging way to realise participation because it requires various competencies, such as the capacity to express oneself, to consider the stances of other parties and to cross potential barriers, such as poor communication and lack of respect (Hopwood and Edwards, 2017; Naldemirci et al, 2018).
In this chapter, service user participation is examined through interprofessional interactions in multi-agency meetings in Finnish lowthreshold substance use services. The aim is to scrutinise interactional practices that strive to collaboratively strengthen the service user participation of vulnerable groups. Hence, our approach differs from previous studies that have constructed various conceptualisations of service user participation (Arnstein, 1969; Hickey and Kipping, 1998) or barriers in service pathways that service users experience (for example, Borg et al, 2009). Some studies have examined service user participation in multi-agency working exclusively in theoretical terms (Fox and Reeves, 2015), in conjunction with service user interviews (Thomas, 2010; Kvarnström et al, 2012) or through analysing interactional data from multi-agency meetings (Juhila et al, 2015; Koprowska, 2016), as is done in this chapter.
Collaboration requires sufficient sharing of institutional agendas and decisions, and aligning with one another's views and aspirations in interactions. Collaborative participation can thus be distinguished from participation that is based on acting as an individual consumer or advocate within services.
7 - Negotiating epistemic rights to knowledge concerning service users’ recent histories in mental health meetings
- Edited by Kirsi Juhila, Tampere University, Finland, Tanja Dall, Aalborg Universitet, Christopher Hall, Juliet Koprowska, University of York
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- Book:
- Interprofessional Collaboration and Service Users
- Published by:
- Bristol University Press
- Published online:
- 21 December 2021
- Print publication:
- 06 April 2021, pp 171-196
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- Chapter
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Summary
Introduction
Face-to-face interactions between professionals and service users are central to mental health services. Participants jointly seek, gather, produce and assess knowledge about concerns, risks and troubles that need to be addressed, for example, mental health, financial and interpersonal issues. Social work and health care are often conducted in multi-agency settings and meetings where professionals from different disciplines and service users address each other. In multi-agency meetings, mental health service users are both talked to and talked about, and they also describe their own situations and experiences. This creates a sensitive interactional task for professionals. Professionals need to express such knowledge about the service users that they deem relevant to tackle the issues at hand and make judgements in situations where service users are co-present as listeners, yet also co-producers of knowledge. Producing and using knowledge is bound to epistemic rights, to the ‘distribution of rights and responsibilities regarding what participants can accountably know, how they know it, whether they have rights to describe it, and in what terms’ (Heritage and Raymond, 2005, p 15).
This chapter studies how knowledge of service users’ recent histories and their experiences is produced, presented and used in statutory Care Programme Approach (CPA) meetings in England. The participants in the meetings are service users, their care coordinators, housing support workers and psychiatrists. The analysis displays which participants in this multi-agency interaction epistemically own knowledge about the service users’ recent past. What makes the ownership of this knowledge interesting is that despite dealing with service users’ personal histories, at times it is the professionals who hold this knowledge based on their previous interactions with a particular service user. Thus, in analysing the meetings, we are interested in how professionals present themselves as knowledgeable about the service user's history, and how service user participation is realised or not on these occasions.
The Care Programme Approach
The Care Programme Approach (CPA) was introduced in 1991 as a statutory framework for people requiring support in the community for more severe and enduring mental health problems (Department of Health, 1990). The framework has four main requirements:
• a systematic assessment of the service user's health and social care needs;
• the formulation of a care plan to address these identified needs;
• a named key worker (now called a care coordinator) to coordinate the care plan;
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