personalised care or caring communities challenges to social work in the time of change

7/29/2019 Personalised Care or Caring Communities Challenges to Social Work in the Time of Change

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Personalised Care or CaringCommunities: Challenges to Social

Work in the time of change

Vito Flaker

University of Ljubljana, Slovenia


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Community work The duality of working with individual and community has

been intrinsic to social work (e.g. Mary Richmond andJane Adams) it has to observe social dimension of personal distress or a person within the community

Casework (clinical social work) has however become adominant form of practice in 50s.

Community work: community organisation, development,mobilisation was prominent in Europe in seventies

In nineties community care was a dominant issue. In the

dilemma of just care in the community or care by thecommunity. Former somehow prevailed.


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Move from institutions

Collective Therapeutic communities, Cooperatives

Group homes Users and advocacy

associations

Individual Case management

Care planning andmanagement

Independent service

brokerage Personalised care


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Longtermcare

coordinated

continuous

personalisedHolistic

Plural andpolivocal

Long-term care as new pillar of socialsecurity


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Long-term care innovationsOld paradigm New paradigm

Provision Health and social care Special long-term care

Entitlement Status and diagnosis Needs

Quantity of resources Based on employment Based on services needed

Payment Indirect - providersreceive funding

Direct - users receivefunding

Relationship to helpers/professionals

DependencePatronising

IndependencePartnership

Position of user SegregationDevalued roles

Community participationValued roles


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Innovations in methods andorganisation

Organisation of care Drama of institutionalisation Continuity of care

Methods of care planningand implementation

Standard servicesPassive recipient

Tailor madeUsers choice and desire

Knowledge Professional Axiomatic

Users Experiential

Informal helpers Overburdened or excluded

SupportedLinks to community

Image of the user Helpless, dependent Productive consumer

Services received Service ledSometimes unnecessary

User ledGets precisely needed

Finance Not clear Transparent


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5 intensities of personal service

Action LevelTalk RepresentationSupport DeedsArc of help PowerCoordination (caremanagement)

Organisation

Residence Dislocation


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support

help

coordination Institutional

world

Life world


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Planning

Providing

approval

Virtual - desires

Actual - deeds

Care planning


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Common effort

Plan is persons will To be approved by the state (if funded) and

accepted by the participants

Approval and acceptance transform individualwill into common action

Provision is a concerted effort of formal andinformal helpers conducted by the user

Appropriation of public resources andmobilisation of the personal and common good


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Ownershipp of resources

Resources Alienated Own

Public State Movements

Private Market Networks


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Resources provided example of mental health

Market pills State hospital, or any other services Networks tolerated, or even cared for in

safety and well-being. Movements join with other people

dissatisfied by the position, and the way

people with mental health distress aretreated, and try to find ways to feel betterand recover from the distress.


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Knowledge

Market commoditised knowledge (pills) Networks territorial knowledge (recipes).

State territorialising knowledge(panopticion, labels) Movements critical knowledge of change.


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What does the deinstitutionalisationchange?

Deinstitutionalisation impossible without Movements (of users, relatives and professionals). decrease in institutional space : smaller parking space more traffic. state provides services at home:

transforming private space into public or its agents (professionals) into friends, acquaintances or visitors.

intermediate residential structures : a new home to the residents or a mini-institution.

Direct funding is money public or by persons own. Way out:

quasi)markets of services, living in the community is a right

Markets thus developed are only a means of privatisation of public funds home, community is in principle private. return of the people who have lost their networks (community, relatives, etc.).

buy services in the market Caring friends however cannot be bought.

Community can be provided only by a Movement. Sublime community!


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Perils for social work

Withering of Welfare State Bureaucratisation

Controlism Gate keepers antiwelfare watchdogs Labelling and confinement

Economisation and medicalisation of everyday life (loneliness, commercialisationof distress,


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Direct Social Work Action(bailing out people not banks)

Conservation of social state Self-defence of the people

Recreating the communities

Joining the movements of today

Direct democracy and common fare Imperative of non exclusion


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Bailing out the people not the banks

Stable social security (universal income, access to servicefor good quality of life, right to live in the community,long-term care insurance, direct payments, minimalbureaucratisation of social care)

Protection and defence against debto-cleptocracy(protection and insurance in loosing work due tooredundancies and bankruptcies, evictions, debts,advocacy, crisis interventions)

Strengthening communities (enabling communities,strengthening capacities for self-providing, self-organisation and self management and self government;establishing cooperatives, mutual help groups, timebanks, self help clubs; reclaiming the social ownership of the public sector, shifting care into community).


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Conclusion Welfare is undergoing big and irreversible changes Not only threats but also challenges Common-fare is a personal appropriation of public good and

public expression of personal desire Social Work has to adapt and contribute to the changes It has to find new alliances with people,movements, unions and

reformulate the relationship to the state and market Social work has to continue to be practical synthesis of freedom

and care it has to continue with personal approach to theservices and re-create communities that would be able to sustain

systemic shocks Social work has to resurge and a assert itself as a independentactor and profession connecting people to create common goodand humane communities

personalised care or caring communities challenges to social work in the time of change

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