Users as Citizens: Collective Action and the Local Governance of Welfare

Self-organization amongst users of community care services preceded the consumerist developments of the 1980s and early 1990s, but can be considered to have been "legitimized" by top-down objectives relating to "user involvement". Nevertheless, the objectives and value bases of disabled people's organizations and organizations of users (or survivors) of mental health services have not always been consistent with those of consumerism, and user groups have experienced tensions in determining the extent to which they should respond to official agendas. Drawing on theories of new social movements and of citizenship, this paper considers the developing place of user organizations within systems of local governance. It looks at the way in which groups have sought to assert the legitimacy both of experiential knowledge and of their position as citizens in the face of official responses which have constructed them as self-interested pressure groups. It draws on empirical research investigating local groups of disabled people and of mental health service users conducted in the first part of the 1990s. It discusses the significance of shared identity as a basis for collective action alongside more pragmatic motivations to influence the nature of health and social care services. In the context of appeals to "community" and "partnership" which are starting to replace the discourse of markets and contracts as the key metaphor for both policy-making and service delivery, the article considers likely future roles for groups comprising people often excluded from community.     

Supervisor ideology and organizational response: HIV/AIDS prevention in outpatient substance abuse treatment units

Distinct practice ideologies or ideologies of care are deemed to influence greatly the selection of intervention methods and the mix of services adopted by the providers. Examined here is the relation between clinical supervisor ideology and variation among human service organizations in their provision of HIV/AIDS prevention services. Data were drawn from a 1990 national, representative sample of outpatient substance abuse treatment (OSAT) units. The study affirms that ideology is central to both means and ends in HSOs, helping to define the organization's mission and goals, and establishing guidelines for practice and procedures. Future research on the relationship between ideology and HIV/AIDS education can benefit from efforts to develop alternative strategies for measuring ideologies of care among both managers and staff in substance abuse settings.     

Giving a Voice to Women Survivors of Domestic Violence through Recognition as a Service User Group

Perhaps surprisingly, given the germinal role played by thewomen’s movement, women survivors of domestic violenceare not amongst those commonly conceptualized as service usergroups. This paper explores why this may be the case and whyit matters. It draws upon the findings of a multi-methodologicalstudy of specialist domestic violence services and of relateduser and professional views. It demonstrates the limitationsto survivors’ influence within these services, some ofthe key obstacles women experience, and the commonalities anddifferences between these and the experiences of other usergroups. In particular, the specific issues of women still ‘beingin the experience’ and of professionals who are also survivorsbut who feel unable to disclose this are discussed as usefulcontributions to the theory of service user involvement.     

Administrative Buy-in for User Participation in Managing Social Services

Abstract

This paper reports the findings of a study conducted in Hong Kong on the value position of the social service providers regarding user participation in service management. Using a survey instrument to collect data from 642 service providers in an elderly service organization, the study explored whether or not the value position had an effect on the views of the service providers on the structural set-up for user participation, and whether the value position of the professional staff was significantly different from that of the non-professional staff. Exploratory factor analyses (EFA), confirmatory factor analyses (CFA) and structural equation modeling (SEM) were applied in the analysis. The findings identify that administrative buy-in needed to support shared decision-making with the welfare service users has not been achieved in the studied organization, owing to the absence of value commitment to the user participation cause. As the professional staff was more supportive of values favoring user participation, the paper calls for an acculturation process that would be stimulated and led by professionals to develop a participatory culture. The paper also recommends conducting similar study on a larger scale and qualitative inquiry into factors influencing the formation of values about user participation in future research.     

Linking illicit substance misuse during pregnancy and child abuse: what is the quality of the evidence?

In most Australian states, legislation makes provision for professionals to report their concerns about the future welfare of an unborn child to appropriate authorities. The legislation establishes guidance for the implementation of family supports to minimize future child protection involvement. Given the legislation and the potential benefits, empirical research linking substance misuse during pregnancy and child protection involvement is relatively limited. We review 21 original studies linking substance misuse during pregnancy with child protection outcomes and the potential generalizability of results to the Australian context. The majority of studies reviewed were conducted in the USA and were mostly retrospective. Other differences between studies include sample sizes, comparison groups, study setting, participants’ ethnicity and pattern of drug use. In the postnatal literature, it is well established that child abuse is associated with a complex array of factors including partner, as well as broader family factors and yet, the studies reviewed focus upon maternal substance abuse without including the wider context. Given the available evidence‐based literature, it is difficult to come to definitive conclusions that can assist clinicians involved in frontline decision‐making for early intervention. Well‐designed research, accessible by antenatal health‐care professionals, is needed to adopt an evidence‐based approach to risk assessment in the prenatal context.     

Does educational inequality predict exercise of users' choice? Survey evidence from domiciliary care services among elderly in Oslo,Norway

The traditional goal of equality in services remains at the heart of the Scandinavian welfare model; however, in recent decades, policymakers have also placed increased emphasis on user influence over services. Voice and choice are two channels to achieve this goal. The possibility to give feedback and voicing dissatisfaction to service providers (voice) is a well-established channel of service users' influence, however it is increasingly supplemented by user choice schemes (choice), where one can choose between different public and private service providers. We use the case of domiciliary care for the elderly to examine how the traditional goal of user equality is associated with the growing emphasis on user influence through voice and choice. The analyses are based on user surveys carried out by the municipality in the city of Oslo, which is arguably the only municipality in Norway where user choice plays a significant role in elderly care. Since the municipality subsidizes the private providers, individual economic resources should have less relevance. However, voicing dissatisfaction and choosing between different providers may anticipate cognitive resources that are not equally distributed among the users. The survey data indicate that there is an association between level of education and propensity to exploit all channels of user influence. Expanding user influence by introducing user choice thus confirms the differences between highly educated and less educated.     

Ability of the Behavioral Model to Predict Utilization of Five Services by Individuals Suffering from Severe Mental Illness and Homelessness

Abstract

This study examined the ability of the behavioral model to predict utilization of five specific services in a sample of individuals who suffered from severe mental illness and who were homeless at baseline. Nearly 4000 individuals from 18 sites provided data at baseline and 12 months later for this study. Hierarchical logistic regression was used to analyze the data. The behavioral model did not explain much of the variance of utilization of medical services, housing services, and public support. The behavioral model did explain a moderate amount of the variance of utilization of psychiatric services and substance abuse services. Enabling variables explained more of the variance of psychiatric services than either predisposing or need variables. In contrast, predisposing and need variables explained more of the variance of utilization of substance abuse services than enabling variables. Social support from professionals and self-perceived need for service were the most consistent predictors of all of the service utilization variables.     

Leadership and Listening: The Reception of User Voice in Today's Public Services

Over the last decade leadership has become a watchword in public service provision, especially in its association with the seemingly ubiquitous ‘delivery’ agenda. As leadership styles change in response to developments in the contemporary public service environment, it has become imperative for service providers to find ways to listen to service users. However, listening is itself widely recognized as an underdeveloped public sector competency. This article addresses the relationship between leadership and listening. Using findings from recent research, it identifies a ‘listening gap’ in public services, before pointing to ways in which this gap might be better understood and subsequently narrowed. In doing so, it seeks to present new ideas about the essential balance between ‘leadership’ and ‘listening’, and how this can be struck in today's public service environment. First, the nature of the user voice is examined. By talking to service users who have communicated their views in different ways in each of three different services (housing, social care and leisure), the article seeks to understand the nature of users' ‘projects’ in the expression of their views. These projects are compared with those of public service leaders. Second, the congruence (or incongruence) of these projects is considered through a comparison of the world views of both users and leaders. Finally, aspects of the context are considered in the discussion of the way public service organizations might go about defining the relationship between leadership and listening.     

Accepting and Negotiating Service Users' Choices in Mental Health Transition Meetings

Across Western welfare regimes, policies emphasize that service users should have more choices regarding their services. This article examines how service choices are presented, responded to and decided in interactions between service users and professionals in mental health transition meetings. Choice is often associated with consumerist user involvement ideas, but in mental health choice also relates to the democratic user involvement approach and to shared decision making between professionals and service users. The results of the study show that professionals construct service users as consumers by offering service options in choice making sequences, expecting users to make appropriate choices. Service users mostly act like consumers by responding to these choice options. However, the study also demonstrates that the professionals do not always accept the user's first choice but respond to them as non‐preferred. Sometimes, they also suggest choices on behalf of the users. In these ‘non‐accepting’ sequences, choices are negotiated in interaction between the parties, rather than users acting as autonomous choice makers. The sequences are based on two kinds of professional reasoning: first, the professional‐led needs assessment and, second, the structure of the service package that the user is being offered. This negotiation has elements of shared decision making and the ‘logic of care’. But it also has elements of paternalist control which challenge both consumerist and democratic service user involvement and suggests consideration of more collectively oriented service user actions.     

The Substance Abuse Treatment Self-Efficacy Scale

Abstract

Evaluating substance abuse services in ordinary treatment environments requires the use of instruments to measure various dimensions of the intervention process in order to link those processes with client outcomes. This paper reports on the further validation of the Alcohol and other Drug Self-Efficacy Scale (AODSES), designed to measure social workers' perceived self-efficacy with regard to the implementation of substance abuse services. In the first validation study, Kranz (2003) employed exploratory factor analysis to reduce the original 98 items to six factors (43 items) that accounted for 76% of the variance, and demonstrated excellent internal consistency. The current study is a reanalysis of the same data using confirmatory factor analysis, a more stringent test of construct validity. Results were strongly supportive of a 5-factor model with seven of eight indices showing excellent fit of the observed data to the model, and high internal consistency for all subscales. Potential practical applications for clinical evaluation in substance abuse environments and limitations of the study are discussed.     

Ownership differences in the provision of outpatient substance abuse services

The authors examine the assumption of the 1980s that the provision and costs of substance abuse services, among others, could best be met by expanding programs in the private sector. The study presents a comparison of public and private substance abuse services, based on data drawn from a national sample of outpatient units, and develops a profile of treatment and financing within three auspice (ownership) categories--private nonprofit, private for-profit, and public. An input-throughput-output framework was used to assess the public-private differences within a wide range of organizational characteristics.     

The Role of Housing Managers in the Implementation of Community Care

This article will outline the response of housing management to the implementation of community care policy in the North East. It will locate housing's role within the broader development of community care policy, and briefly review the reasons for housing's relatively late arrival as a key partner, alongside social services and health, in the planning and delivery of services. Using information gathered from interviews with housing professionals, part-time housing students, voluntary organizations, and workers within health and social services, it outlines and evaluates five main factors which appear to be affecting the successful integration of housing management into the process of planning and delivering community care services in the North East.     

Street children in Russia: steps to prevention

This article examines the historical evolution of the development of social policy toward street children in Russia and makes recommendations for prevention. The historical examination begins with the Soviet period, when statistics on social problems were not publicly known. It continues through the post-Soviet period when there was an emerging awareness about the increasing number of abused, abandoned children and children living on the streets. Etiological factors, such as child maltreatment and parental substance abuse, are then discussed. Based on these etiological factors, the article then proposes a model in which existing institutions and professionals are supported in facilitating an integrated system of primary, secondary and tertiary prevention. This includes improving child protection services and interventions to prevent children leaving their homes, early identification of children who are becoming involved in street life and a continuum of care for children who cannot return home.     

Physical and Sexual Abuse,Battering, and Substance Abuse

Abstract

Women born before 1945 are the older women of today. Many of these women were subjected to childhood physical and sexual abuse and spouse battering at a time where there were no laws to protect them and few people discussed such subjects. Some of these women became substance abusers or lived with substance abusers. While there are retrospective studies on the experiences of adult women who suffered abuse in the family, little is known about the experiences of women over the age of 60 years.

Similarly, there is information on substance abuse among young and middle-aged women, but very little information on or about older womens' experiences with substance abuse. In this study, we review the literature on abuse and substance abuse. We present three clinical cases of older women who have experienced various forms of abuse and who in turn abuse substances. The cases are analyzed. Assessment, treatment, and evaluation methods for social workers are discussed.     

Which Champions,Which People? Public and User Involvement in Health Care as a Technology of Legitimation

This paper concerns two practices, public consultation and user involvement, whose adoption has been urged upon the UK National Health Service in recent years. Public consultation is a local attempt to seek the views of a broad constituency of persons. User involvement is a local attempt to include organized groups of service users in the planning, and occasionally the management, of such services. The paper has four objectives. First, it locates the topic in the context of several related current debates. Second, it outlines the main findings of a recent empirical study of public consultation as they relate to the above debates. Third, it summarizes the relevant findings of an empirical study of user involvement. Finally, it examines these two practices as "technologies of legitimation" which can be seen as a means by which managerial legitimacy is maintained in the context of an increasingly pluralistic policy arena.     

The new privatized market: A question of ideology or pragmatism within the Swedish addiction treatment system?

Given its traditions of universal welfarism and social democracy, Sweden had already scored unexpectedly high on New Public Management by the 1980s. Health and welfare services remain primarily tax‐funded, but the production of care is increasingly transferred to a competitive quasi‐market. To what extent can this development be understood in terms of right‐wing governments, and to what extent in terms of other, socioeconomic and pragmatic factors? We examined this question through official statistics on providers of institutional addiction care since 1976, and through the total expenditure and purchases by local‐level municipal social services of interventions for substance users in Sweden in 1999, 2004, 2009, and 2014. We have analyzed the distribution across public and private providers within the addiction treatment system, and whether national developments and local differences across the 290 municipalities—which bear the major treatment responsibility—can be understood in terms of local‐level political majority, population size, and local wealth. The share of purchased services has remained stable, but the treatment system shows increasing financial turnover and an increasing share of for‐profit providers among producers of purchased care, especially in outpatient treatment. While venture capital enterprises emerged as a new actor, non‐governmental organizations lost out in importance. Bourgeois government correlated with larger shares of purchasing and purchases from for‐profit providers. However, purchasing on a market dominated by for‐profit providers has also become the “new normal”, regardless of ideology, and recent years have shown a reversed effect of left‐wing municipalities purchasing more services than right‐wing governments. Pragmatic reasons also influence local‐level purchasing.     

天下为“公”：民国时期县级公产管理制度与产权变迁

近代公产转型与基层公共事业、国家治理机制的演变紧密关联，并承载了“公”观念的变迁。本文从产权视角出发，以民国时期浙江县级公产管理制度为基础，考察公产转型的历史进程。民国成立后，县级公产被纳入地方自治机构统一管理，其有别于“官产”“私产”的产权性质得到法律的确认与规范。在国家政策变动与治理事务扩张的背景下，自治机构对公产的管理引发诸多问题。20世纪30年代中期，南京国民政府推动县级行政制度改革，逐步将公产纳入政府管理，“公产”的概念也随之扩展，并逐渐向政府财产偏移。     

Incorporating self‐determination into substance abuse prevention programming for youth transitioning from foster care to adulthood

Youth transitioning from foster care to adulthood are at higher risk for alcohol and substance abuse disorders than general population youth. At the same time, these youths are often recipients of strong clinical intervention, often at levels considered unnecessary, for other mental health or behavioural challenges. Because of this, there is sometimes resistance from providers to offer services such as substance abuse prevention programming as it may be seen as contributing to youths' overclinicalization, stigmatization, or retraumatization. Using thematic content analysis, this qualitative study analysed focus groups with community stakeholders providing recommendations on support services for youth transitioning from foster care to adulthood to derive strategies for delivering substance abuse prevention programming in a way that enhances youth self‐determination. Findings were organized by self‐determination theory's 3 key psychological needs: autonomy, competence, and relatedness. All three needs were represented in stakeholder recommendations, which were translated into strategies for bolstering youths' achievement of each need. Strategies include a mix of those already present in motivational interviewing‐based brief substance abuse prevention interventions as well as more unique strategies that are much less frequently employed but that may better meet the needs of youth with foster care experience.     

Perceptions of Stigma and User Involvement in Child Welfare Services

Correspondence to Dr E. M. Scholte, Department of Social and Behavioural Sciences/Centre for Research on Youth Welfare, University of Leiden, PO Box 9555, 2300 RB Leiden, The Netherlands. Summary This paper explores the perceptions of social disqualificationor ‘stigma’ that service users attributed to publicchild welfare services in random samples of service users takenfrom the Netherlands, a part of Spain (Catalonia) and a partof the United Kingdom (Wales). It was found that, in all threesamples, foster and residential care invoked the greatest senseof stigma, while the health related and the preventive familyservices were perceived as the least stigmatizing types of publicwelfare services. Comparative analysis further revealed thata positive attitude towards the use of public welfare services,a perception of supportive or non-stigmatizing social normsregarding the use of such services, and a perception of publicwelfare services as helpful correlated in all three sampleswith higher levels of user satisfaction and involvement in theservices. It was further found that, in the British and Spanishsamples, a positive attitude towards public welfare services,as well as a perception of public welfare services as helpfulfor their recipients, were the predominating factors promotinghigher levels of satisfactory user involvement in the services,while, in the Dutch sample, a perception of supportive socialnorms was the factor that most promoted satisfactory user involvement.     

How social networks affect policy implementation: An analysis of street-level bureaucrats' performance regarding a health policy

Policy implementation is an interactive process between citizens and street-level bureaucrats. Although the literature has already addressed different factors that influence discretion, there is still a gap in understanding if and how bureaucrats' relational profiles affect policy implementation. This article analyses bureaucrats' interactions and the relational environments in which they exercise their discretion. The hypothesis is that bureaucrats' different relational profiles specify policy implementation at the street level. We study bureaucrats in a Brazilian health care programme involving community workers that requires regular visits to beneficiary families' homes. The research departs from ethnography and network analyses with workers from three very different contexts. We analyse bureaucrats' practices, the discursive styles mobilized in their interactions, and their personal networks. The results show that organizational factors are central to explain variations in practices, and their relational profiles highly influence the discursive styles used by bureaucrats in their interactions with citizens. The article concludes that relational elements can affect the exercise of discretion and influence interactions at the street level and should be incorporated more systematically in the implementation literature.