Co-production: The State of the Art in Research and the Future Agenda

In this introductory article to the thematic issue, our aim is to discuss the state of the art in research on co-production of public services. We define co-production, for the purpose of this article rather narrowly, as the involvement of individual citizens and groups in public service delivery. We discuss the concept along three main research lines that emerge from the literature: what are the motives for co-production? How can co-production be organized effectively? What are the effects of co-production? Secondly, we also critically assess the state of the art and discuss some conceptual and methodological issues that are still open to debate. Thirdly, we propose some directions for future research: greater methodological diversity and the need for empirical and comparative research with a specific attention for theoretical advancement in co-production research.     

Piloting different approaches to personalised offender management in the English criminal justice system

Various approaches to personalisation are well-established in the UK social care sector and are now starting to ‘travel’ to other sectors. In this paper we report findings from an evaluation of a pilot to test elements of personalisation in the management of offenders in probation services within the English criminal justice system. Following a review of evidence from social care, three different approaches to personalised-practice were developed and tested on a small-scale in three separate sites. The evaluation finds that all three approaches were implemented reasonably successfully, but challenges were identified including that personalised approaches are more time-consuming, that staff need support to exercise professional discretion and that balancing greater choice with managing criminogenic risk requires new ways of conceptualising the relationship between case manager and service user. Overall, ‘deeper’ approaches to personalisation, such as co-production, will take time to emerge. This paper makes two important contributions to the debate on personalisation in public services. First, it addresses the question of how transferable the concept of personalisation is from the social care sector to other sectors in the UK, in this case the criminal justice system. Secondly, it outlines a methodology for developing and evaluating personalisation pilots, prior to a wider roll-out.     

Co-production and Third Sector Social Services in Europe: Some Concepts and Evidence

The third sector is poised to play a leading role in public sector innovations in the twenty-first century. The third sector can enhance, facilitate, and promote greater citizen participation in the determination, provision, and governance of social services through co-production. This article explores some crucial conceptual issues related to the co-production of public services and the role of the third sector. It also provides some brief empirical evidence of the potential of the third sector, not merely as a service provider, but also as a facilitator of the re-democratization of the European welfare state. Here, collective action and third sector provision are crucial for distinguishing between co-production heavy and light. The conclusion focuses on the ability of the public, third, and for-profit sectors to embrace greater citizen participation and co-production.     

Trust and Health Care

Trust is believed to be particularly salient to the provision of health care, and since the establishment of the National Health Service (NHS) in the UK, trust has played an important role in the relationships between its three key actors: the state, healthcare practitioners, and patients and the public. Service users trusted the judgement, knowledge and expertise of health professionals to provide a competent service that met their needs, and they trusted the state to ensure equity in the allocation of public goods and services. These implicit or taken-for-granted trust relationships have, it is claimed, been challenged as a result of the introduction of changes in the organisation and funding for the health service, in the regulation and performance assessment of health professionals, and in public attitudes to health care and scientific medicine. This paper considers the influences of social changes and recent policy and professional initiatives in health care on the structure of trust relations in health care in the UK. It presents a theoretical framework for examining trust relations using the NHS as a case study and concludes with an agenda for future research.     

Service user or service provider? How social work and human services students integrate dual identities

Students studying undergraduate social work and human services (SWHS) degrees may have used health and human service agencies, before and during their university education. Using services provides them with insights that are useful for professional practice. However, this article identifies that they experience a fear of shame and stigma revealing this during their studies. In examining interview data from 15 undergraduate SWHS students they recounted how they integrated their experience of being a service user into their professional development. It is argued that insider knowledge of services can provide them with valuable insights for practice. Students spoke about how positive experiences motivated them to study and provided models of effective practice, exemplifying its potential power to assist those in need. Negative experiences of service use can also be beneficial for learning what ‘not to do’. Although students found the experience of service use invaluable, they felt it was never acknowledged within the curriculum. Consequently, students interviewed in this study identified service users as ‘others’. They feared disclosing their own use of services due to perceived shame and stigma. Failing to provide opportunity for students to integrate their service user experience into their professional development creates a false dichotomy which does not acknowledge the intersection of these dual identities.     

Synthesizing ENABLE-AGE Research Findings to Suggest Evidence-Based Home and Health Interventions

ABSTRACT

As the quest for knowledge translation from research to practice and policy contexts is growing stronger, researchers need to develop strategies for synthesizing research findings. Since home environments constitute an important context for the delivery of health care and social services to older adults and people aging with disabilities, research in this field can serve as an example for such endeavors. Using 35 original publications and one unpublished doctoral dissertation based on the European ENABLE-AGE Project, we aimed to demonstrate a systematic approach to synthesize research findings generated by large research projects as the basis for evidence-based interventions. The synthesized findings highlighted the complex interactions between objective and perceived aspects of housing and aspects of health in very old age, impacting on, for example, residential decision making. Independence in daily activity is influenced by the sociocultural care and service context. A familiar and safe neighborhood, a social network, and a good supply of services are important to perceptions of participation. Going further, we suggest housing-related interventions that address problems and challenges related to ongoing demographic changes. This article contributes to the development of strategies for knowledge translation, connecting research and practice and policy contexts struggling to meet the societal challenges that accompany population aging.     

The use of mental health care,psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.     

“We Have to Create Family”: Aging Support Issues and Needs Among Older Lesbians

Gay and lesbian seniors are more likely to be single, live alone, and be childless. The current evidence base suggests that limited social supports are associated with a variety of health disparities among all older adults. Research regarding the aging issues of lesbian seniors is scarce. This instrumental collective case study of 4 older lesbians (ages 59 and older) illustrates unique aging support concerns, issues, and needs. The purpose of the case study is to increase provider sensitivity and provide supportive evidence of the need for more research. Findings suggest that limited biological family support, childlessness, and “families of choice” may be important factors in support service and health care decisions for older lesbians. Implications for care providers in working with the older lesbian population include exploring existing supports and assisting with the formation of culturally acceptable support systems and services. Given the current evidence base regarding the impact of social support on elder health, it is critical for providers to have a better understanding of elder lesbians’ unique concerns and needs relating to support and health care services in order to prevent health disparities among this vulnerable population.     

Processes of Institutionalization and Differentiation in the Italian Third Sector

The article describes the recent evolution of the Italian third sector, focusing particularly on its changing role in relation to welfare policies and on its contribution to the development of the provision of social services. In contrast with those considering the emergence and development of the sector solely, or mainly, as a consequence of decisions made by external actors, especially public institutions, the article shows a more complex and dynamic picture. The article demonstrates that the Italian third sector, although at the present time largely engaged in contractual services with the public sector, has maintained a level of autonomy that allows for continuous innovation both within and external to the social service sector. The Italian case supports the need for further debate on the role of the third sector in modern society.     

Understanding Professional Projects in Welfare Service Work: Revival of Old Professionalism?

The professional terms for occupations that provide welfare services are changing, and here the introduction of new public management in the Nordic countries since the 1990s is indicative of wider developments. The article explores professional projects in welfare service work from both conceptual and empirical perspectives. The aim is to produce a gender‐sensitive analysis of the professional projects at the lower levels of the occupational hierarchies in health care. The first part reviews the literature conceptualizing the societal and institutional embeddedness of professional projects. The institutional matrix of welfare states emerges as a key context in shaping the welfare service work performed by women‐dominated professional groups. The second part examines the case of Finland and suggests that recent reforms have created new inequalities in the system of professions, in which occupational groups in welfare service work are becoming marginalized. This signals a move away from ‘democratic professionalism’ towards a revival of ‘old professionalism’.     

National consistency and provincial diversity in delivery of long-term care in Canada

The aim of this article is to demonstrate the diversity in delivery of long-term care at the provincial level, within a national legislative framework that provides universal health insurance and public administration. Not all provinces have legislated provision of long-term care, but mandates for provincial long-term care programs typically address the needs of those with chronic health needs and maintain them in the community for as long as possible. Eligibility is based on common criteria of residency, health need, facility, assessment, and consent. The three common components of the service delivery system are institutional care, community-based services, and home-based services; the kinds of services within each component and the mix among them vary from province to province. There are also five common features in provincial service delivery systems: single point of entry, assessment, client classification, case management, and single administration. Throughout the article, examples from different provinces show the varying ways in which these aspects of service delivery have been addressed, and recent innovations have furthered this diversity. A detailed account of quality management systems also shows that while all provinces have adopted a common set of principles, they use a range of methods to pursue quality of care and to promote good practice.     

An Aging Workforce in an Increasingly Global World

Summary

The aim of this article is to demonstrate the diversity in delivery of long-term care at the provincial level, within a national legislative framework that provides universal health insurance and public administration. Not all provinces have legislated provision of long-term care, but mandates for provincial long-term care programs typically address the needs of those with chronic health needs and maintain them in the community for as long as possible. Eligibility is based on common criteria of residency, health need, facility, assessment, and consent. The three common components of the service delivery system are institutional care, community-based services, and home-based services; the kinds of services within each component and the mix among them vary from province to province. There are also five common features in provincial service delivery systems: single point of entry, assessment, client classification, case management, and single administration. Throughout the article, examples from different provinces show the varying ways in which these aspects of service delivery have been addressed, and recent innovations have furthered this diversity. A detailed account of quality management systems also shows that while all provinces have adopted a common set of principles, they use a range of methods to pursue quality of care and to promote good practice.     

Adversarial Allies: Care,Harm, and Resistance in the Helping Professions

Professional encounters bestow moral esteem upon professional helpers while denigrating those who access services. Yet society is arranged in such a way that professional services are indispensable for many to survive, and service users can experience them as simultaneously helpful and oppressive. We explore the ambivalent figure of the professional “adversarial ally” working within these systems through accounts from two research studies that straddle or resist the common-sense line that separates care from harm. Professionals need to acknowledge how we are experienced as adversaries in order to better forge relationships of solidarity or “alliance” with those using social and medical services.     

Keyworkers for elderly people in the community: case managers and care co-ordinators

In the United Kingdom a range of services for elderly people in the community has developed that is delivered by a variety of professionals and administered within different organisations. This has resulted in a problem of co-ordinating services to meet the individual needs of the most frail elderly people. In the United States 'case management' has been introduced as a way of improving the co-ordination of care. Despite structural differences in the provision of health and social services between the United States and the United Kingdom, the concept of case management has influenced the design of a number of innovatory schemes in the United Kingdom, including the Gloucester Care for Elderly People at Home project (CEPH). These innovatory schemes have demonstrated the need for a 'keyworker' and clarified the tasks that are involved in taking responsibility for co-ordinating services to meet the needs of elderly people at risk of failing to cope at home. There is, however, a danger of proliferating the complexity of service provision by creating a new breed of professional; an alternative might be to alter the responsibilities, attitudes and team orientation of existing professional workers so as to include taking on the keyworker role for some of their clients.     

Organization and delivery of long-term care in Taiwan

Taiwan reached the World Health Organization (WHO) benchmark of 7% aged 65 and over for defining an aging population only as recently as 1993. With this proportion projected to double to 14% by 2020, Taiwan faces a rapid increase in need for long-term care. This article presents an account of the current service delivery system, which is divided between health and social affairs administrations, with a substantial role also taken by the Veteran Administration, and growing provision of facilities that operate outside the government-registered system. While a basic level of both institutional and community care services has developed, they are not organized into an integrated service system. Problems arising from the divisions and overlaps in responsibility are identified in relation to competition for resources, differences in regulation and eligibility, funding arrangements and misallocation of resources, and divergent views about the philosophical basis of long-term care. Other aspects of services fall under each jurisdiction, but there is also some overlap. A case study of Taiwan's second largest city, Kaohsiung City, reports the outcomes of these divisions as a thin spread of a range of services rather than a coordinated service network. Several planning exercises have been undertaken in recent years to address these problems, and although at an early stage of implementation, the outcomes of these plans are seen as shaping the future directions of long-term care in Taiwan.     

UNTANGLING A COMPLEX MEDIA SYSTEM

This article provides empirical insights into how one online service – Twitter – was used for political purposes during three separate election campaigns in Sweden, Denmark and Norway, specifically how Twitter users, with hyperlinks, connect with other channels for political communication. Methodologically, the study employs three large sets of data on Twitter use tagged as relevant for each of the election campaigns, covering a one-month period. The approach allows for an untangling of the complex interconnections between novel online services, mainstream media, official political party websites, public information, individual blogs and social network sites. By moving beyond a study merely of the type of websites linked to, to also include classification of the actors publishing the content linked to, the article provides insights into the actual use by politicians, interest groups as well as grassroots activists of diverse Web genres.     

Co-Production in the Context of Finnish Social Services and Health Care: A Challenge and a Possibility for a New Kind of Democracy

Alongside the ongoing renewal process of the Finnish welfare state, the role of the citizens is also revisited. So far the attention has mainly focused on how the responsibility for service provision is shared between the public sector and the service users, while the role of public services as a part of the democratic system has been more or less ignored. Based on the results from a 3-year participatory action research project called KAMPA, this article will discuss if the development of co-production in the context of public welfare services shows the way forward toward a new kind of society where democracy is an inseparable part of the structures and procedures of the service provision. The data gathered during the project (textual material, interviews, notes from meetings, and observation diaries) are analyzed using thematic analysis. The results show that while legislation and official policies strongly highlight the participation of citizens and service users, there are still many obstacles to overcome at both the attitudinal and practical level. The development of co-production and arenas of a new kind of democracy requires continuity in the attempts and recognition of the achievements, but it also has the potential to demonstrate the way in which a new more lively democratic society can come true in practice.     

Evaluating correctional health care. The lessons of New York City.

New York City's correctional health care system is a complicated one, with many component parts. Correspondingly, the task of developing an evaluation process to assess this system turned out to be complex as well. The major responsibility for developing such a process and for keeping it in motion lies with the Contract Evaluation Unit of the Department of Health. Our experiences in meeting these challenges, as well as the historical and institutional factors that have influenced our efforts, should be of interest to professional groups facing similar tasks in other localities and to readers curious about how particular health service evaluation approaches take form. This article describes our method, how it emerged, and that it entails, with an eye toward identifying what might usefully be applied to the study of other correctional health care services and settings.     

Self-managed Supervision

The growth of professional supervision in social work has been accompanied by complex attempts to theorise key elements of supervisory practice and highlight the need to further examine what constitutes supervisory support in current regulatory environments. Changes in human service organisations resulting from new public management generate a need to theorise broader patterns of support available to human service workers. This article draws on an electronic, mixed-method self-reporting study of advice and support-seeking behaviours of 193 human service professionals in 3 South Australian organisations. The findings indicate the fluidity of current professional supervision practice, with workers seeking professional wisdom, identifying practice direction, and debriefing with a range of colleagues within and outside their organisation. Accordingly, the article confirms that supervisors should no longer be thought of as the sole providers of professional advice and support for human service workers and conceptualises the workers as active agents shaping their own learning.     

The state and future of social service enterprises—a Finnish case

There has been a rapid increase in private social services in Finland, where the tradition of social care services has placed the main emphasis on public services. The aim of this article is to compare the situation of Finnish social service enterprises in 2001 and 2005/2006, in the light of two national surveys, in order to increase knowledge about the state and the future of such enterprises as providers of social care. Particular attention is paid to the profiles of men and women as entrepreneurs, as these differed somewhat. The composition of private care enterprises and their management remained fairly similar between 2001 and 2005/2006. Most of the enterprises were owned by middle-aged women with an extensive experience of social and health care. The owners of the older enterprises were more pessimistic about the future than the owners of the more recently-established firms. Social workers have not been active in setting up firms, but the public–private processes should be steered and evaluated from the social work perspective, too, because they are actors who have a relevant part to play in the long-term co-operation and development work of public and private social services.