Journal of Community & Applied Social Psychology

J. Community Appl. Soc. Psychol., 13: 475–485 (2003)

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/casp.752

From Participative Research to ParticipativePractice—A Study in Youth Care

RUDI ROOSE* and MARIA DE BIE

Department of Social Welfare Studies, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium

ABSTRACT

In this contribution the development in action research of a participative care practice in youth care

is discussed. The study was prompted by the intention of the Flemish government to reform youth

care. The initial research-question was how youth care can be organized in such a way that it (also)

represents an added value for the client(s). The aim was to find out to what extent the reorganization

of youth care could contribute to a social service that enhances a dignified existence for their clients

and contributes to a participative care. Hence, the aim of the research was not just to reorganize

youth care, but also to develop a participative care practice. The research findings highlight the ten-

sion between a reorganization that takes as its starting point an expert way of thinking, and the rea-

lization of participative care in which the clients’ perspective is taken as central point of departure.

Against the background of this tension, the question to what extent care workers actually have room

to realize a participative care practice turned out to be one of the most important issues within the

research. Copyright # 2003 John Wiley & Sons, Ltd.

Key words: action research; youth care; participation; discretion

INTRODUCTION

In this contribution the development in action research of a participative care practice in

youth care is discussed. The initiative to the study was partly inspired by the intention of

the Flemish government to reform youth care.1 Youth care appears to be neither efficient

nor effective. The arguments put forward for the reorganization are that assistance is more

focused on the supply side of the service than on the actual demands of clients, that there is

too much overlap in services on the one hand and too many gaps on the other hand, and

that too much depends on coincidence as to where the client might end up in care. The

government wishes to increase the efficiency and effectiveness of the services through

reorganizing youth care. In this process, one of the important issues is networking: enhan-

cing the collaboration and rapport between the different sectors in youth care and the dif-

ferent ways of working within these sectors.

* Correspondence to: Rudi Roose, Department of Social Welfare Studies, Ghent University, H. Dunantlaan 2,9000 Ghent, Belgium. E-mail: rudi.roose@UGent.be

Copyright # 2003 John Wiley & Sons, Ltd. Accepted 3 September 2003

1Belgium consists of a Flemish, a French-speaking and a (small) German-speaking region.

The reorganization of youth care is introduced via experimental projects in a number of

Flemish regions, the so-called pilot regions.2 However, some regions, not selected as a

pilot region, also started a discussion about the reorganization of youth care. One of these

regions, the Waasland region, asked the Department of Social Welfare Studies of Ghent

University to provide them with the necessary scientific support. This resulted in the Net-

working Youth Care Waasland (NYCW) research project which began in April 20013 and

was concluded in June 2003.

The initial research-question was: ‘How can youth care be organized in such a way that

it (also) represents an added value for the client(s)?’ The idea was to arrive at participative

care in which the perspective of the clients would be considered.

Action research was opted for as the research method because of the region’s request to

include both the clients and the practitioners, thus keeping the dynamics and the region’s

own experience of problems central. In this research project, a definition previously devel-

oped in youth care research in which action research was defined as a form of acting in

response to a problematic situation in order to change this situation in collaboration with

the people involved and aimed at theory development (Bouverne-De Bie, 1989).

In this contribution the research as a movement towards the problem field: from speak-

ing abstractly about participative care to (an attempt at) participative practice is described.

An important finding was that with regard to a participative care the commitment of the

care workers proved to be more important than the way care is organized: how care work-

ers treat clients and each other has more impact on the quality of care than, for instance,

the existing procedures.

Another important finding was that the dominant perspective on care—an expert way

of thinking—may loose sight of the clients’ perspective, thus contradicting the participa-

tory framework.

This lead to the question whether social care practitioners are allowed sufficient room to

develop a participative perspective on care. Focus is on how action research can help to

reach an alternative perspective on care and how participative research can facilitate a par-

ticipative practice.

‘A FORM OF ACTING . . . ’

Describing action research as a form of acting points to the relationship between research

objectives and social reality. A broad distinction can be made between a pragmatic

approach and an emancipatory approach (Boog, 2002). In a pragmatic approach, the social

position of the research is not fundamentally questioned. However, our point of view is

that research—just as welfare work—is not a neutral activity. As a researcher, one deter-

mines the position from which a social problem is considered. In an emancipatory

approach, social problem situations are analysed from the viewpoint of the problem car-

riers. In youth care, these carriers are the children and their parents. This point of view is

linked with the ideas of Paulo Freire, who is seen as the most important founder of the

critical emancipatory trend in action research (Boog, 2002). Participative research and

participative care are then considered as driving forces for cultural action, a process of

searching for new definitions of reality, which leads to the commitment towards critical

2These experiments started in January 2003 and will end July 2004.3Even though the experiments in the pilot region did not start officially until 1 January 2003, some work hadalready started, such as the development of those concepts to be used in the experiments.

476 R. Roose and M. De Bie

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thinking, ‘thinking which perceives reality as a process, as a transformation, rather than as

a static entity’ (Freire, 1970, p. 81). In the context of the NYCW research this meant that it

was not taken for granted that a reorganization of youth care would automatically result in

better outcomes for the clients. Rather, the question was how youth care could be (re)or-

ganized in such a way that it offers an added value to the clients. In other words, to what

extent does the reorganization of youth care contribute to a dignified existence for clients

and to participative care?

The right to an existence worthy of human dignity is an internationally recognized

human right (cf. Universal Declaration of Human Rights; International Convention on

the Rights of the Child). It was incorporated in the Belgian Constitution in 1993 (article

23). There are two schools of thought regarding the significance of this right: minimalistic

interpretations point to a more symbolic meaning, while maximalistic interpretations

point to the autonomous meaning of the right to an existence worthy of human dignity.

In this last interpretation the legal consequences are far-reaching: every regulation or

treatment should be able to withstand the test of human dignity (Hubeau, 1995). The social

welfare dimension, which is enclosed in the recognition of the right to an existence worthy

of human dignity, is underlined. Moreover, the right to a dignified existence implies a right

to social service: the development of a differentiated supply of care and services that

would offer all individuals scope to develop their potentials, in a diversity of situations

(Raes, 1995).

The development of a supply of service and care aimed at the realization of the right to a

dignified existence includes the recognition that welfare is an intersubjective notion: dig-

nity comprises the right to one’s own way of thinking and the right to differ in opinions.

This participative starting point is emphatically acknowledged in the International Con-

vention on the Rights of the Child: besides protection rights, the convention covers provi-

sion and participation rights (Verhellen, 2000).

What is important in accomplishing participative care is the continual realization that it

is not easy to model a participative approach. There is tension between the acknowledge-

ment of the diversity of possible welfare definitions and a tradition of care that has grown

historically, in which thoughts of protection were foremost and exclusively emphasized,

also when those requesting help were unable to identify themselves with this situation.

The right to social services implies that the available type of care must be beneficial

to the people who receive it. This means that one should not only view the help in

relation to what is necessary for a person to function socially but that it should also offer

support to those requesting help so that they have the chance to mobilize competences that

can make the tensions between individual aspirations and social expectations (more) man-

ageable. In this light a good supply of help is not only aimed at the individual but also at

society: as such it helps to keep the debate on the conditions in which people are expected

to lead a dignified existence open. Networking, for instance—resulting in organizations

being better attuned to one another—can form an important contribution to the realization

of a qualitative supply of help. However, when network development leads to a one-sided

reinforcement of the position of social workers, it can have the effect that the views of

those requesting help are ignored.

Linking the reorganization of youth care to the right to social services means that this

reorganization should result in the strengthening of the legal nature of the social service.

The criteria for determining the legal nature of the social service are availability, acces-

sibility, affordability, usefulness and comprehensibility (Parmentier, 1998). Availability

refers to the existence of a supply and to the fact that social services can be called upon

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for matters that do not relate directly to the assessed problem. Accessibility refers to the

(lack of) thresholds when care is needed, for instance an inadequate knowledge of the sup-

ply. Affordability refers to financial and other costs that client may encounter, for instance

giving up one’s privacy or negative social and psychological consequences of an interven-

tion. Usefulness refers to the extent to which the client experiences the care as supportive:

is the help attuned to the demand, the skills and the language of the clients? Comprehen-

sibility refers to the extent to which clients are aware of the reasons for the intervention

and the way in which the problem should be approached.

. . . ‘IN RESPONSE TO A PROBLEMATIC SITUATION . . . ’

Action research is undertaken because of an identified social need. In the NYCW research

this need concerned the intended reorganization of youth care by the Flemish government.

As the reader will recall, the research-question was ‘how can youth care be organized in

such a way that it (also) represents an added value for the client(s)?’ In pursuing the

answer to this question, a number of steps were taken.

The first stage of the research introduced the earlier reference framework, which

referred to the organization of care as well as to the way care workers act. The aim of

the research was to identify which criteria youth care has to meet, seen from a right to

social service. The reference framework was specified in two questions:

(1) The first question was: given the right to social services, how could a reorganization of

care ensure that the earlier discussed minimum conditions of care, e.g. availability,

accessibility, affordability, usefulness and comprehensibility (Parmentier,1998), are

enshrined in the care provision?

(2) Linked to this was the question as to what extent the clients within this care system are

recognized in their human dignity. After all, the legal nature of the social services is

no guarantee in itself for quality of care. It does, nevertheless, offer a framework in

which it is possible to offer help in the context of the right to a dignified existence.

A large unanimity among care workers concerning the reference framework was noticed.

The participating organizations saw this framework as a useful means to realize the reor-

ganization of youth care, mainly because it included the perspective of people requesting

care.

In the second stage of the research staff members of 34 participating services were

interviewed.4 They were asked about their ideas about care and what problems they

had encountered in their practice. The analysis of the interviews provided a lot of infor-

mation about the gaps in the supply of care, but little about the clients’ perspectives. This

initial analysis also revealed that the supposed communality regarding the reference fra-

mework was not that obvious. For instance, the concepts of availability, accessibility,

affordability, usefulness and comprehensibility had different, sometimes even contradic-

tory connotations. Some care workers, for example, interpreted working in a demand

driven manner passively, their understanding of ‘demand driven’ being that the practi-

tioner does not act unless the client asks for something. Other practitioners pointed to

the importance of an active approach, particularly in case people cannot or do not dare

4These interviews were held in the participating services. In some cases we interviewed managers as well as staffmembers, but mostly we talked to practice staff. In total 173 social care practitioners took part in thesediscussions. These interviews were recorded on tape and typed out in full.

478 R. Roose and M. De Bie

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to ask social care workers for help. It thus seemed that the common goal of the project was

present only on an abstract level.

In this stage of the research, the clients’ perspectives were sought indirectly by means of

a literature review of the opinion of clients on formal care (Roose, 2001). From this

limited literature review it appeared that clients—both children and adults—want to be

treated with respect and want to be taken seriously. Usually clients refer more to the

attitude of the social care worker than to the way care is organized. We asked the services

to discuss this review in each of their departments and to make suggestions to improve

their services. The results of this exercise too were, in general, very abstract and non-com-

mittal and did not lead to any action.

In the third stage of the research work was done in thematic discussion groups. In these

groups, the findings from the interviews were discussed in the light of current cases. Thus

it was hoped that the problem definition, which was still quite abstract, could be sharpened

in these groups. Moreover, it was hoped that the thematic discussion groups would lead to

the formulation of suggestions for reorganizing care, for instance by specifying criteria for

further referral. The themes of the thematic discussion groups were chosen by the services

in accordance with the data that were inferred from the analysis of the interviews.5

The thematic discussion groups concluded that the initial problem analysis—with the

emphasis on the organization of care—needed further work. They also reported that many

of the problems stem from the way the individual social care workers go about their work,

from the perspective of the services concerned, from the personal involvement with clients

and with one another, rather than from an inadequate organization of care. For instance, it

seemed that sometimes children were referred too quickly to special youth care. Increas-

ing the number of front line services was suggested as a prevention strategy. However, the

discussion in the thematic discussion groups showed that referral to special youth care did

not only occur because of a shortage of front line services, but also, for instance, because

of the tendency to refer ‘difficult clients’ quickly to special care services. From this point

of view, expanding the number of front line services could well lead to more instead than

less children in special youth care.

The results of the thematic discussion groups underlined the necessity to redefine the

need for improved youth care, or in other words, the need for improved youth care was no

longer to be seen as an organizational problem but also as an acting problem. This shifted

the focus from the external care factors—legislation, funding, etc.—to internal factors—

perspective, commitment, etc.—Where the initial problem definition concerned a ‘safe’

problem analysis, in which the problems were of an organizational and legislative nature,

it turned out that the main problems really concerned the way in which social care workers

deal with one another and with clients.

‘ . . . IN ORDER TO CHANGE THE SITUATION . . . ’

Action research is not only aimed at acquiring knowledge, but also at solving problems

and expanding the competence of the actors involved (Boog, Coenen, Keune, & Lammerts,

1996). The thematic discussion groups concluded that realizing a participative approach in

youth care would not be easy, not in the least because it was difficult to get an understanding

of the perspective of the client: how did the client feel about the intervention? Was the

5The themes were: knowledge of the supply, participative care relation, transparency of care, crisis intervention,dealing with information about the clients, intake.

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outcome of the intervention a positive experience for the client? One of the causes hamper-

ing a participative approach is that, usually, social care workers—thinking like experts—

rely on a standard repertoire in their answer to individual problem situations. As a conse-

quence, problems that do not fit the standard supply are referred to other specialized ser-

vices (Skrtic, 1999), which often leads to a referral carousel.

Because of the problems identified earlier, in the fourth stage of the research, we

decided to involve the clients personally by introducing case studies.6 Service staff mem-

bers were invited to bring open cases into the discussion. The intention was to interview

clients about their experiences in the care system, as well as discussing the cases amongst

the different care workers involved. Unfortunately, due to a lack of (interesting) cases,

only few clients and no care workers were interviewed.

Only four services selected a case. Although these four cases led to interesting material,

there was some doubt as to why these cases were chosen. All four cases represented satis-

fied clients and illustrated rather good collaboration between care workers. Although the

cases did not offer a lot of scope to discuss possible ways to change interagency collabora-

tion, the reasons for their selection were interesting. When asked why these specific cases

were chosen, one of the services indicated that other cases would have been better for dis-

cussion, but it would have been too difficult to interview the clients. This does of course

raise questions about how care workers actually deal and communicate with these ‘diffi-

cult clients’ in their daily practice.

This limited number of cases illustrated, nevertheless, that, on the one hand, the appre-

ciation of clients was dependant on the degree to which the social care workers committed

themselves. On the other hand, it showed that the problem analysis made by the social care

workers was not always shared by the clients. In one case, for example, a care worker saw

the waiting list as a problem in the care process, whilst the client indicated that it was more

the way in which this was communicated that she found negative.

Finally, the fact that only four cases were selected for discussion was questioned, espe-

cially as a second invitation to select more cases was equally disappointing. We wondered

whether this non-response could be explained by a lack of commitment to the research

question. In other words, was the problem analysis—the focus must lie on the acting

rather than on the organization—shared by all of the services? Participative care requires

room for reflection, for creativity and can only take shape in practice, since quality of care

can mean different things in separate situations. Thus, participation calls for a different

perspective on care and professionalism. It is necessary that the organizations and social

care workers are able and willing to change their way of working and to develop a view on

professionalism that is different from the existing expert way of thinking.

Skrtic (1999) argues that, in order to achieve participation, a ‘model of adhocracy’

should be adopted, whereby care workers creatively anticipate new situations and—rather

than side-tracking problems that do not fit into the supply—develop new practices in

response to new problems. Reason and Bradbury (2001) argue that a pedagogy of the

oppressed should be supplemented with a pedagogy of the privileged, whereby, for exam-

ple, social care workers learn to use power together with others, rather than over others.

Participative care, then, requires reflection about the meaning of one’s own supply and

one’s own (non) interventions for those desiring care.

After insistent discussion with the participating services, it appeared that the lack of

response on our question to select more cases was not to be understood as a lack of

6Six clients were interviewed: three adults and three minors.

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commitment but rather as the expression of a fundamental problem, namely the question

of how much room social care workers have and use to act reflectively and to develop and/

or to implement a different perspective on care within the context of the existing proce-

dures and structures.

Social care workers can apply their discretion defensively or reflectively. Lipsky (1980)

states that the social care workers (street-level bureaucrats) apply their discretion in a pre-

dominantly defensive way in order to manage work pressures, a finding that was con-

firmed in later studies (Ellis, Davis, & Rummery, 1999). Other research, however,

indicates that social care workers are capable of acting reflectively within the existing

rules and the influence of their surroundings (Baldwin, 2001). We saw a clear example

of defensive and reflective acting within the same rules during our own research with

regard to the interpretation of professional secrecy whereby social care workers—within

the same legal framework—developed completely different practices. Whilst social care

workers can employ professional secrecy to protect their clients from needless prying into

their private lives, they can also call upon professional secrecy to protect the way they act

themselves. The discretion that social care workers have will depend to a large extent on

the policy of the service, the extent to which and the way in which services give their

workers room, for instance, by protecting them against pressure from outside.

The outside pressure became increasingly apparent in the NYCW action research.

Beside the fact that the project manager left, the pressure—albeit unintentional—from

the pilot regions was felt strongly. After all, the services were pressed to become involved

in the thinking and practice of what was being developed in the pilot regions. In these pilot

projects the expert way of thinking is emphasized, for instance, by focussing on assess-

ment and case-management. At the same time, there is an emphasis on the rationalization

and formalization of care, by modulating care, by employing standardized assessment fra-

meworks among others. Although standardization leads to no substantial change in the

views on professionalism that have developed through socialization and education, it does

restrict the space for reflective action (Skrtic, 1999).

Thus, the research question became: how do services and social care workers use their

professional discretion, do they wish to and to what extent are they able to deal with ques-

tions about professional discretion?

. . . ‘IN COLLABORATION WITH THE PEOPLE INVOLVED . . . ’

The relationship between researchers and research subjects is one of the crucial issues in

action research (Boog, Keune, & Lammerts, 1998): it is an intersubjective relationship in

which the research object is likewise a subject. In the NYCW research a collaborative rela-

tionship was established by setting up a research structure in which a steering group, com-

prising staff and/or managers of the participating services formed a central platform. This

steering group was viewed as the main actor to realize change at the policy level. Likewise,

day-to-day management and a partnership were also set up. The partnership included all the

youth care organizations in the region as well as the funding authorities. Clients became

directly involved in the later stages of the research in the framework of the case studies.

An important point regarding action research is the position of the researcher with

regard to the research subject. Van der Kamp (1996) suggests that the role of the

researcher can best be described as an engaged and competent outsider. The role of

outsider can nevertheless be problematic and lead to resistance, for instance, when

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suggested changes are not supported by the researchers’ subjects. A position as insider,

however, can lead to a canonization of the research subject (ibid.), in which all objectivity

or critical distance disappears. In this research, we tried to find a solution to this insider/

outsider tension by redoubling the research assignment through a double act relationship

within the research (Titchen & Binnie, 1993). This double act relationship was realized in

the action research by appointing a project manager as co-researcher of the university

researchers. At the same time this project manager was one of the initiators of the project,

someone with years of experience and well respected in the region. The project manager

was seen as a fellow-researcher: the research concept, planning and execution occurred in

close consultation with the university researchers. Thus, both research actors—the project

manager and the university researchers—had their own legitimate roles.

The role of the university researchers as committed outsiders can be further explained

using three intrinsic components, namely an advisory function, a training function and a

research function. An advisory function means that the researcher brings the research sub-

ject into contact with relevant data both from within and outside the relative field of

research. One example of this was the introduction of the literature review of clients’ per-

spective on formal care. A training function means that the researcher asks questions

about the practice methods of care workers, how data are used and from which premises

one starts. The purpose of the training is to increase the reflection on the development of

practice, to improve learning processes and to make alternative action feasible. Inspired

by the earlier mentioned idea of Reason and Bradbury (2001), the NYCW action research

interpreted participative care as a pedagogic training process for the social care workers.

Training sessions were introduced during the third and the fourth phase of the research

process. For example, training was organized around the themes of professional secrecy

and open reporting, in which experts were invited to reflect, in joint discussion with the

care workers, on the interpretation of these concepts. The research function signifies that

the practical actions are examined on the basis of the existing theory and with a view to

new theory development. In the course of this research, for example, the existing knowl-

edge regarding participative care was adjusted in the light of the finding that realizing a

participative approach has more to do with commitment and perspective than with orga-

nizational aspects.

The role of the insider researcher, the project manager, mainly implies the implementa-

tion of change from within the organization and the creation and monitoring of the support

for the research. The importance of this insider became strikingly clear after the project

manager left for another job. A new project manager replaced him, but she only worked

part-time and had an entirely different position in the region. Besides the macro influences

that we observed—for example the earlier described pressures of the pilot regions—the

replacement also led to diminished support for the research and a change in the research-

er’s position. The lack of a platform or lever to mobilize people and to keep the dialogue

alive increased the distance between research and practice. According to Molders (2001)

action research is not merely a matter of dialogue but often concerns a multilogue. There-

fore, Boog (2002) argues that action research is a living social network. The role of the

insider was crucial in order to sense this living social network if only to tap into and

expand on the existing communication flows surrounding the research. The loss of this

insider shifted the core of the dialogue to the steering group. However, the care workers

warned us not to rely entirely on this channel for the multilogue, since it was not clear how

far each steering group member could appeal to and motivate his/her organization for the

research questions (i.e. for the development of a network).

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An additional complexity was the double target group orientation of the research. The

direct target group—the group with whom the university researchers were directly work-

ing with—consisted of services and their practitioners. The ultimate target group con-

sisted of those at whom the target intervention was aimed: those wanting care. The

question arose in what way the interests of both target groups ran parallel. From the cli-

ents’ perspectives participative care means a request for change. Introducing this request

for change through action research, however, can threaten the status quo and cause con-

flicts regarding the power balance in the relationship between care workers and clients.

This refers to the fact that action research asks implicit political questions concerning

the organization of care: how does one deal with this power? Does one wish to change?

Is there room for change? The question’s possible threatening character results in indivi-

dual practitioners or services being unable to act alone on this, given the possible conse-

quences for their position as care providers and their relationship towards other services

(Williamson & Prosser, 2002).

‘ . . .AIMED AT THEORY DEVELOPMENT’

Theory development is every research’s mission. In this research, theory development

happened on the level of the creation of participative care. At present, the theoretical con-

cept of participative care is understood mainly in terms of the presence or absence of orga-

nizational thresholds to care. The NYCW action research pointed to the fact that accepting

a commitment to clients as well as the perspective from which this commitment takes

shape is of vital importance for participative care.

The validity of theoretical knowledge in action research is continuously tested. This

continuous process of validation is called reciprocal adequacy. It concerns a continuous

dialogue between researchers and research subjects (Coenen, 1998). However, in research

situations, insights are not adopted automatically, but through intersubjective negotiations.

‘These negotiations are necessary to find out how statements and terms must be under-

stood, and whether statements and terms are true in concrete situations’ (Coenen, 1998,

p. 20).

During the research, this dialogue took place on a structural level, especially through

research data being brought into the steering group and testing it on its adequacy. The

research was then adjusted on the basis of this data. Besides this, a partnership meeting

was organized twice a year in which the research results were submitted to the whole

region and tested on their usefulness. The theory development mission of the research

is being further taken up by fitting the research results into a broader historical and social

analysis of the special youth care in Flanders.7

AND AS FOR THE FUTURE

The NYCW action research as a movement towards the problem field has been described:

from speaking in abstract terms about participative care in interviews, over more grounded

discussions in thematic discussion groups towards analysing real life practice in case stu-

dies. Through this movement, the need for a shift of focus—from ‘reorganizing’ to

‘rethinking’ youth care—became apparent.

7This occurs in the framework of Rudi Roose’s Ph.D. research.

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What also became apparent was the complexity of realizing a participative approach in

both the research approach and the care itself. Through the inherent expectation of acting

differently and the continuous adjustment of the research towards the problem field in

action research, a shift from talking about participative care towards a participative prac-

tice was pursued. On the one hand, this is a fundamental condition to be able to reach

relevant changes in care: working participatively supposes reflective acting of care. On

the other hand, this condition for care also appears to be threatening since it raises the

pressing question of how much room for change social care workers have in reality? This

question gives rise to another one: in what way do the interests of social care workers and

those of clients relate to one another?

The lack of room for reflective action can lead to resistance against the kind of research

and the type of questions such as developed in the NYCW action research. Zeelen (in

Boog, 2002) draws attention to the necessity of analysing interests, preceding the involve-

ment of those studied in a research process. Sometimes this can lead to the conclusion that

it is better not to research a particular problem field. In this research, revealing these inter-

ests was not a preceding fact, but a research result. The NYCW action research illustrated

that the assumed common interest in the first stage of the research was not sufficient for a

common commitment and the development of a common perspective on care. After all, as

the organizations were urged to show their commitment throughout the research, the

alleged common interest turned out to be very heterogeneous.

Together with the participating organizations it was decided, given the conclusion that

there was limited room for change, to stop the action research and spend time on reflec-

tion. However, this did not mean that the work in the region stopped, nor that the research

could not be resumed in one way or another. A mutual commitment was agreed upon

between researchers and organizations to get to grips with new questions from the practice

field and in doing so translate these fundamental questions into practicable knowledge.

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