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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
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