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Contractual audit and mental health rehabilitation: a study of formulating effectiveness in a Finnish supported housing unit
- Authors:
- SAARIO Sirpa, RAITAKARI Suvi
- Journal article citation:
- International Journal of Social Welfare, 19(3), July 2010, pp.321-329.
- Publisher:
- Wiley
In modern welfare states, reforms of management models in the health and social services have often been implemented according to the principles of new public management, with mental health non-governmental organisations (NGOs) in Western Europe increasingly being managed by contractual audit procedures. This article details how contractual audit and its emphasis on effectiveness of care impact on the practices of long-term mental health rehabilitation. To demonstrate this concept, a case study of a Finnish NGO that provides supported housing is presented. The example looks at how service purchasing practices, as stated in the contract between the municipality and the NGO, are reflected in the meetings among practitioners. Documentary and meeting data were used together with Mitchell Dean's notion of technologies of agency. Findings suggest that practitioners actively sought to show the effectiveness of their everyday work in terms of contractual audit by indicating both the economic and progressive aspects of care. Thus, in summary, professional competency in mental health rehabilitation appears to involve both the skills of care interventions and the ability to perform these interventions as cost efficiently and financially accountable as possible.
Ethics in professional interaction: justifying the limits of help in a supported housing unit
- Authors:
- JUHILA Kirsi, RAITAKARI Suvi
- Journal article citation:
- Ethics and Social Welfare, 4(1), April 2010, pp.57-71.
- Publisher:
- Taylor and Francis
- Place of publication:
- Abingdon
In this study, the researchers examined professional ethics in action in daily work at a supported housing unit situated in a large Finnish city targeted at clients with mental health and substance abuse problems, by studying interactions in meetings among the unit's professionals where discussions covered rationing resources and setting limits to helping work in situations where the need for professional help is not questioned. Five types of implicit ethical justification for limiting helping activity were identified: the unit deals with certain kinds of problems only, clients need more intensive care and control, excessive care produces dependency, clients make their own choices in life, and the interests of other clients ought to be considered. The researchers noted that ethical issues and difficulties are constantly discussed and negotiated in mundane professional work practices, even though the word ethics is not necessarily mentioned, and that although the workers reflect continuously on the ethical justifications of the limits of helping, this does not mean that they end up limiting help in situations where no real alternatives for getting help for the present clients exist.
Documenting a well-planned and effective client process in child welfare
- Authors:
- GUNTHER Kirsi, RAITAKARI Suvi
- Journal article citation:
- Nordisk Sosialt Arbeid, 28(3/4), 2008, pp.182-193.
- Publisher:
- Universitetsforlaget AS
Child welfare practice in Finland has been blamed for being not enough target-oriented and poorly documented. In this article the client documents written in child welfare practice are read as practitioners' argumentative tools with practical goals and consequences. The client-related plans are for example increasingly used as a proof of an effective child welfare. It is analysed how the client-related plans are constructed and what kind of textual devices are used when augmenting for a progressive client process. The analysis shows how the support plan is constructed as a process with distinguished elements defining the eligible client, assessing grounds for extending or terminating the period in supporting housing and arguing for positive changes. The analysis gives a concrete insight to the textual devices used with child welfare clienthood is constructed as a goal-directed process.
Devoted work without limits? Activities and premises of home visit work at the margins of community care
- Authors:
- JUHILA Kirsi, HANSEN LOFSTRAND Cecilia, RAITAKARI Suvi
- Journal article citation:
- International Journal of Care and Caring, 5(2), 2021, pp.247-262.
- Publisher:
- Policy Press
Community care provided through home visits is an increasingly common way to respond to adult citizens’ complex needs due to, for example, mental health and substance abuse problems. This study explores the activities and core premises that this work entails. The data contain six focus group interviews with practitioners in five service settings in Finland and Sweden at the margins of community care. Through a two-stage coding process, 11 activities and three premises ‐ situationality, boundlessness and empathy ‐ were identified. The findings show that home visit work at the margins of community care is comprehensive and flexible, requiring reflexivity. (Edited publisher abstract)
Tackling community integration in mental health home visit integration in Finland
- Authors:
- RAITAKARI Suvi, HAAHTELA Riikka, JUHILA Kirsi
- Journal article citation:
- Health and Social Care in the Community, 24(5), 2016, pp.e53-e62.
- Publisher:
- Wiley
This article explores how community integration is understood and tackled in mental health floating support services (FSSs) and, more precisely, in service user–practitioner home visit interaction. The aim, through shedding light on how the idea of integration is present and discussed in front-line mental health practices, is to offer a ‘template’ on how we might, in a systematic and reflective way, develop community integration research and practice. The analysis is based on ethnomethodological and micro-sociological interaction research. The research settings are two FSSs located in a large Finnish city. The data contain 24 audio-recorded and transcribed home visits conducted in 2011 and 2012 with 16 different service users. The study shows how the participants in service user–practitioner interaction give meaning to community integration and make decisions about how it should (or should not) be enhanced in each individual case. This activity is called community integration work in action. Community integration work in action is based on various dimensions of integration: getting out of the house, participating in group activities and getting along with those involved in one's life and working life. Additionally, the analysis demonstrates how community integration work is accomplished by discursive devices (resistance, positioning, excuses and justifications, delicacy and advice-giving). The article concludes that community integration is about interaction: it is not only service users' individual challenge but also a social challenge, our challenge. (Edited publisher abstract)
Boundary work in inter-agency and interprofessional client transitions
- Authors:
- SAARIO Sirpa, JUHILA Kirsi, RAITAKARI Suvi
- Journal article citation:
- Journal of Interprofessional Care, 29(6), 2015, pp.610-615.
- Publisher:
- Taylor and Francis
This article analyses the accomplishment of boundary work performed by professionals engaged in inter-agency collaboration. As a means of building authority within a particular field, boundary work is found to be a common feature of most professional practices. By analysing the talk of Finnish professionals who work in the field of supported housing in mental health, the article investigates the ways professionals - as collective representatives of their service - talk about doing boundary work when transferring their clients to another agency. The study drew on the principles of exploratory case study design and ethnomethodology. A key finding from the analysis of professionals’ focus groups and team meetings indicated that boundary work is employed when disputes arise between supported housing and collaborating agencies. The article goes on to suggest that professionals accomplish boundary work by rhetorically presenting themselves as holders of "day-to-day evidence" of clients’ mundane living skills and serious ill-health. The paper concludes by arguing that in inter-agency collaboration, boundary work building on day-to-day evidence is used to influence the decision on the most appropriate living arrangement for the client. Boundary work is also used for boosting the authority of professionals as representatives of a relatively new and fixed-term agency in the service system. (Publisher abstract)
Accounting for the clients' troublesome behaviour in a supported housing unit
- Authors:
- JUHILA Kirsi, HALL Christopher, RAITAKARI Suvi
- Journal article citation:
- Journal of Social Work, 10(1), January 2010, pp.59-79.
- Publisher:
- Sage
Troublesome behaviour is defined as action by the clients that the professionals construct as undesirable in terms of rehabilitation expectations. This article studies the ways in which professionals working in a supported housing unit situated in a large Finnish city account for (construct explanations of) their clients' troublesome behaviour, using a data-driven analysis of some of the everyday conversational practices which occur in the unit. The research data used in the study came from 23 meetings among the professionals in which clients' progress is discussed and analysed. There were 225 episodes where the professionals explained clients' troublesome behaviour, with three ways of accounting appearing with similar frequency: blaming clients for their behaviour, excusing clients' behaviour, and excusing clients and blaming others for the clients' behaviour. The authors report that the analysis displays the complex ways in which policy imperatives and professional ethics are routinely managed in everyday situations, and discuss how blame, excuses and responsibility are combined in different ways.