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

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

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

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.

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

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…

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

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”

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

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?)

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

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

1221.04.23

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 <

1321.04.23

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)

1421.04.23

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

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)

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

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

?

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.