Third and public sectors´ cooperation in rehabilitation (KoJu-project)
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Kuntoutussäätiö
121.04.23
Third and public sectors´ cooperation in rehabilitation
(KoJu-project)Hietala-Paalasmaa, Outi
Rehabilitation Foundation
Helsinki, Finland
Nordic civil society conference, Bergen, 18 – 20 May, 2011
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Kuntoutussäätiö
221.04.23
Research and development project (2010-2013)
• Goal:
- to examine the relationship between non-governmental organizations (NGOs) and public-sector actors in the context of rehabilitation
- to explore and develop better tools and abilities for the co-operation in this field
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Kuntoutussäätiö
321.04.23
Both rehabilitation and NGO´s are complex phenomena
• even cooperation is very general concept, an ”ideal” form of action and relationship between public an third sector actors
• to understand general conditions on these relationships one has to understand the historically constructed logics and ideological legitimitations of both ”sides”
• first discovery: the complexity of rehabilitation system and third sector > similarities and counterpoints
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Kuntoutussäätiö
421.04.23
Rehabilitation in Finland
• Based on legislation > institutional logic• Historical phases:
1950-60s building of the welfare services
1970-80 an extensive network of rehabilitation institutions were created
1991 legislation was completely revised to introduce improvements:
- the vocational rehabilitation of young people
- medical and vocational rehabilitation of middle-aged people
- rehabilitation of the severely disabled.
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Kuntoutussäätiö
521.04.23
Rehabilitation is implemented by and requires cooperation between
many authorities and actors:
Municipal health, social welfare and educational services
Occupational health servicesThe Social Insurance Institution Employment services Insurance companies
Fragmented actors and organizations > specialized expertice- medical, social and vocational rehabilitation
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Kuntoutussäätiö
621.04.23
REHABILITATION Between welfare-state, neoliberal politics
and business?
The economic crisis in 1990 >> problems in welfare state´s financing
Municipal self-governance 1993 >> diversity of local welfare (e.g. shutdown of services > outsourcing services > third sector, partnerships)
2007 Municipalities and service structure reform => ? Legal provisions in EU: free competition in service-
production, maximal productivity & efficiency of public sector (the public procurement act 2007)
Trends: responsibilities of citizens, individualized welfare, consumers replacing clients, urges concerning workcareer…
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Kuntoutussäätiö
721.04.23
Rehabilitation as a form of professional expertise (modern ideal)
- definations & classifications of disorders, injuries, impairment of abilities
- interprets peoples needs > assesment > solutions- systematic and objective expert knowledge
Strategic & goal oriented action, governed area separated from complex realities outside its boundaries (de Certeau 1984)
Strategic logic brings apart the multiplicity of everyday life, local concepts and experiences
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Kuntoutussäätiö
821.04.23
Third Sector in Finland• Multiple definations: unofficial,voluntary, non-profit or non-
governmental sector, organisation of general interest, civil society and intermediate sector, civic organisations
• Principles: solidarity, freedom of choice, flexibility• Combining features: general interest, ethics, social
aspects, voluntary action and non–profit services• Rehabilitation of third sector is based on historical
connections to public welfare/social- and healtcare • => contracts with municipalities, social insurance and
employment institutions • Revenue: grants from municipalities and RAY, project-
based financing EU/ESR• The potential of voluntary and civic associations is more
and more emphasized, particularly as an actor in social policy~rehabilitation...”partnership”
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Kuntoutussäätiö
921.04.23
Rehabilitation in NGO´s?• Courses of action?
- services- social opportunities & conditions for participation- lobbying, advocacy
• Professional institutions/foundations, rehabilitation centers
• NGONGO´s basic action integrated >< separate rehabilitation
• Community based action & participatory action subject-object rolemerging -> rehabilitation as side-effect
• Growing tendency: New organizational & economic forms: Incorporations (public-third), SGEI (services of general economic interest ), social & societal enterprises
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Kuntoutussäätiö
1021.04.23
Forms or rehabilitation in third sector
1. services <-->social capital?
• guidance, tecnical device and services (operations, medical rehab)
• professionally organized peer groups at rehab-courses and phases (social rehab)
• casework, councelling, solution oriented and dialogical methods (individual clients social and vocational empowerment)
• Training of experience-experts, peer-counsellors• Spontaneous peer-support, volunteering,
participation in local social arenas and everydaylife (rehabilitation?)
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Kuntoutussäätiö
1121.04.23
Rehabilitation in third sector?• 2) Policy: to reflect the needs and aims of the
members & citizens• 3) Vocational training; offering specific
knowledge for - The public sector & professionals
4) Informing general public
5) Development and research projects: service users points of view, new rehab. methods, combinations of experience-based & professional knowledge
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Kuntoutussäätiö
KoJu: The preliminary results of the survey
• The questionary was sent to 926 organizations (local, regional and national level)
53% replied (in
60 % (N: 291) of these were active in rehabilitation
24% central organizations
38% operating on regional bases
38% local accociations
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Kuntoutussäätiö
The results of the survey…• Rehabilitation is mainly in near connection to basic
aims and activities of the civic organisations (80%), (4% of repliers were service producers)
• 40% (N 117) were connecting/intergrating volunteering into rehabilitation
• The number of volunteers connected to rehabilitation:
40% 1-3 persons
40% 4-10
20% 11 <
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Kuntoutussäätiö
The results…
• The relation on professionals/peers (expert
and experience knowledge):• 5% rehabilitation is lead by professionals
(>individual clients)
• 35% combine professional expertise/abilities with directed peersupport & experience knowledge (>peergroups)
• 55% place professionals and peers on equal positions (trained experience-experts)
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Kuntoutussäätiö
1521.04.23
KoJu: Indepth-phase (autumn 2011-2012) Meanings given to rehabilitation?
• everyday life > experiences > resources, language
• experiences of actual people
• explicate embodied experience
• social organization > logics and orientations
• ruling relations
• institutional discourses
• text-mediated social organization
Dorothy Smith: institutional ethnography
Research as discovery, method of inquiry > < objectification & explanation
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Kuntoutussäätiö
1621.04.23
Work knowledge (Smith) Based on subjects participating in objectified
relationships• ”Informants´work knowledge”is based in experience and hence
authoritative for the ethnographer => ethnographer does not interpret or assign them a value that they do not claim.
• Each informant contributes only a piece of social organization,co-oordinated achievement of people´s doings.
• In writing ethnography researcher assembles different work knowledges of people situated in and contributing differently to the process on which research focuses.
• What is being explicated is how people´s work is coordinated in a given institutional process or course of action. (Smith 2005, 160)
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Kuntoutussäätiö
1721.04.23
The relationship between institutional and third sector actors
in rehabilitation?
Lay knowledge expert knowledge?
Lifeworld System(Habermas)
Experience near experience far (Geertz)
Experience basedtext-based speech (Smith)
Everyday life institutions (Smith)
Social organizations > resources for giving meaning to rehabilitation, actions and aims
Mutual understanding strategic (Habermas)
->meanings given to actions and aims
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Kuntoutussäätiö
1821.04.23
The dimensions & levels of relationships based on rehabilitation
Servicesystem and expert knowledge-controll
-qualifications
Lay-/experience knowledge
Professionals-mediating-controlling
Commer-cial and
productive logic
.
Strategic/tacticaction and/or mutual understanding
?
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Kuntoutussäätiö
1921.04.23
References:• de Certeau, Michel 1984: The Practice of Everyday
Life. Berkeley, University of California Press.• Geertz,Clifford 2000: Local Knowledge Further
ersseys in interpretative anthropology. Basic Books. • Habermas, Jurgen (1984/Vol 1, 1987/Vol2) : The
Theory of Communicative Action. Boston, Bacon Press.
• Smith, Dorothy 2005: Institutional Ethnography. A Sociology for People. Oxford, Altamira Press.