Želje, potrebe in pomoč: perspektive socialnega dela : doktorska disertacija

Kapus, Andraž (author), Zaviršek, Darja (mentor), Hünersdorf, Bettina (comentor)

Doktorska disertacija predstavlja delo koordinatorjev obravnave v skupnosti, socialnih delavcev, zaposlenih na centrih za socialno delo, ki nudijo podporo ljudem s težavami v duševnem zdravju, ki živijo v skupnosti. V raziskavi smo poskušali odkriti, kako koordinatorji obravnave v skupnosti konstruirajo predmet socialnega dela skupaj z uporabniki storitev, kako pridejo do razumevanja, kakšne cilje imajo uporabniki storitev in kakšne spremembe so potrebne, da se spremeni njihova življenjska situacija. Skozi raziskovanje in pisanje doktorske disertacije smo poskušali razumeti, kako koordinatorji obravnave v skupnosti uporabljajo metode ocene situacije (osebno načrtovanje) in kako je ta ocena povezana s koncepti, kot so potrebe, problemi, želje, cilji itd. Poskušali smo bolje razumeti, kako koordinatorji obravnave v skupnosti razmišljajo v praksi in kako uporabljajo svoje znanje, ko so soočeni s kompleksnostjo svojega dela. Disertacija je sestavljena iz štirih delov. Prvi del predstavlja teoretični okvir za razumevanje predmeta socialnega dela. V teoretičnem delu disertacije določimo koncepte in opišemo teme, kot so: konstruktivistična perspektiva za socialno delo, znanje socialnega dela, konstrukcija predmeta socialnega dela, ocena situacije, cilji, želje, potrebe in (socialni) problemi. Podrobneje si ogledamo predmet socialnega dela na področju duševnega zdravja. Na koncu teoretičnega dela disertacije predstavimo teoretični in zakonodajni okvir koordinatorjev obravnave v skupnosti. V drugem delu disertacije opišemo metodologijo raziskave in pokažemo uporabo utemeljene teorije med terenskim raziskovanjem, intervjuji, analizo podatkov in pisanjem. V tretjem delu so predstavljeni rezultati, v četrtem pa sinteza rezultatov in diskusija. Raziskava je pokazala, da je delovni odnos med koordinatorji obravnave v skupnosti in uporabniki storitev dinamičen, v fazi osebnega načrtovanja in izvajanja storitev. Proces osebnega načrtovanja (ocena situacije) in nudenje podpore se med sabo prepletata. V praksi koordinatorji obravnave v skupnosti opravljajo oceno situacije (osebno načrtovanje) na različne načine, ki so pogosto odvisni od želja uporabnikov storitev, specifičnih situacij, a tudi preferenc samih koordinatorjev. Le-ti uporabljajo predvsem dve strategiji osebnega načrtovanja – strukturirano in nestrukturirano. Nekateri koordinatorji uporabljajo osebno načrtovanje tako, kot je predstavljeno v literaturi in je del njihovega izobraževanja. Drugi pa uporabljajo strukturo metode osebnega načrtovanja zelo ohlapno ali pa se poslužujejo samo nekaterih elementov osebnega načrtovanja. Kljub različni uporabi metode so pri obeh strategijah prisotni elementi osebnega načrtovanja, ki se ohranjajo, kar še posebno velja za koncept ciljev, ki so pomemben del strukture osebnega načrtovanja ali pa predvsem fokus ocene situacije. Pomembno spoznanje raziskave je, da je lažje razumeti življenjsko situacijo uporabnikov storitev, če je ocena situacije neprekinjen proces, ki je hkrati povezan z nudenjem podpore. Izkušnje koordinatorjev obravnave v skupnosti kažejo, da ocena situacije ni pretirano kompleksna ali zahtevna, če je osebno načrtovanje daljši proces, kjer se razkrivajo potrebe, želje in cilji uporabnikov storitev skozi proces ocene situacije in z nudenjem podpore oziroma izvajanjem storitev. Koordinatorji obravnave v skupnosti razumejo osebno načrtovanje kot dinamičen proces, kjer ni neobičajno, da se cilji spreminjajo ali oblikujejo novi. Izkušnje koordinatorjev obravnave v skupnosti iz prakse kažejo, da mnogi uporabniki storitev vedo, kaj so njihove želje in potrebe in kaj je pomembno v njihovem življenju. To spoznanje lahko predstavlja osnovo za dodatno raziskovanje njihove življenjske situacije. Pri oceni situacije zato ni težava v tem, kako priti do pomembnih informacij, ampak kako krepiti moč uporabnikov storitev v primerih, ko izražanje želje ni enostavno ali nedvoumno. Uporabnost osebnega načrtovanja je pogojena s prilagoditvami, ki jih koordinatorji obravnave v skupnosti naredijo v svoji praksi. Osebno načrtovanje je pogojeno z zmožnostjo koordinatorjev, da ustvarijo dober delovni odnos in zaupanje. Uporabniki storitev morajo imeti dovolj moči, da izrazijo svoje želje in potrebe. Osebno načrtovanje mora biti poleg tega kontinuiran proces, kjer se prepletata ocena situacije in izvajanje storitev. Namen osebnega načrtovanja je oblikovanje predmeta obravnave v skupnosti – ciljev. Raziskava je pokazala, da je zastavljanje ciljev dinamično. Cilji pa niso le produkt osebnega načrtovanja, ampak služijo tudi drugim namenom. Niso pomembni samo za določanje predmeta socialnega dela, ampak služijo kot orodje koordinatorjem obravnave v skupnosti (in uporabnikom storitev). Cilji so pomembni v fazi ocene situacije kot referenčne točke za nadaljnje raziskovanje, kako uresničiti cilje – kdo, kdaj in kaj je potrebno narediti. Cilji so orodje za strukturiranje razmišljanja koordinatorjev obravnave v skupnosti. Pomembni so za evalvacijo obravnave v skupnosti in so lahko tudi orodje za utemeljevanje socialnega dela pri komunikaciji z drugimi socialnimi in zdravstvenimi službami ter organizacijami. Pri osebnem načrtovanju je ključnega pomena referenčni okvir potreb. Strokovno in znanstveno utemeljene potrebe dajejo koordinatorjem obravnave v skupnosti orodje, s katerim preverjajo potencial ciljev, da se uporabnikom izboljša kakovost življenja. S pomočjo potreb pa lahko koordinatorji obravnave v skupnosti reflektirajo lastne referenčne okvirje, ki so jim v pomoč pri delu. Čeprav je obravnava v skupnosti prostovoljna storitev in koordinatorji obravnave v skupnosti upoštevajo perspektivo uporabnikov storitev, se ne morejo izogniti vprašanjem moči. V procesu podpore lahko vplivajo na uporabnike storitev in imajo strokovni mandat, da ukrepajo v situacijah, ki jih razpoznajo za škodljive. Koordinatorji so pri svojem delu soočeni tudi z dilemo, kako podpreti uporabnike storitev, da so kar se da neodvisni, hkrati pa nuditi pomoč za boljšo kakovost življenja ali preprečevanje škode, kar ni vedno isto. Raziskava pokaže, da je delo koordinatorjev obravnave v skupnosti na področju duševnega zdravja v Sloveniji pomembno, saj omogoča celostno, individualizirano podporo, ki temelji na perspektivi uporabnikov storitev.

• Language: Slovenian
• Keywords: koordinatorji obravnave v skupnosti, skupnostno socialno delo, duševno zdravje, ocena situacije, predmet socialnega dela, cilji, želje, potrebe, znanje, moč
• Work type: Doctoral dissertation
• Typology: 2.08 - Doctoral Dissertation
• Organization: FSD - Faculty of Social Work
• Place of publishing: Ljubljana
• Publisher: [A. Kapus]
• Year: 2020
• PID: 20.500.12556/RUL-121820
• COBISS.SI-ID: 35622147
• Publication date in RUL: 31.10.2020

Secondary language

• Language: English
• Title: Desires, Needs and Help: Social work perspectives

Abstract

Doctoral dissertation explores the work of community care coordinators-social workers employed at social work centers in Slovenia, who provide support to people with mental health problems living in the community. In our dissertational research we tried to ascertain how community care coordinators form the subject of social work together with service users; how they come to conclusions; what kind of goals service users have; and what changes have to occur to change their living situations. Throughout the research and the writing of this doctoral dissertation we tried to comprehend how community care coordinators use assessment methods (personal planning) and how social work assessment is connected to concepts such as needs, problems, desires, goals etc. We tried to obtain a better understanding of the ways community care coordinators think in practice and use their knowledge when faced with the complexities of their work. The dissertation is divided into four parts. The first part presents the theoretical framework for understanding the subject of social work. In the theoretical part of the dissertation, we define concepts and describe issues such as a constructivist perspective of social work, social work knowledge, constructing the subject of social work, social work assessment, goals, desires and (social) problems. We take a closer look at the subject of social work in the field of mental health. At the end of the theoretical part of the dissertation, we present the theoretical and legislative framework of the community care coordinators. In the second part of the dissertation, we describe the methodology of a doctoral research and show how grounded theory was applied during our fieldwork, interviews, data analysis and writing. In the third part of the dissertation, we present results and in the fourth part the synthesis and the discussion of the results. Research showed that the working relationship between community care coordinators and service users is dynamic, both in the personal planning and in the service delivery phases. Throughout the process, personal planning (assessment) and service provision are intertwined. In practice community care coordinators carry out assessments (personal planning) in different ways which often depend on the desires of service users, specific situations and also on the preferences of the coordinators themselves. Coordinators mainly use two strategies of personal planning: structured personal planning and unstructured personal planning. Some community care coordinators use a personal planning method mostly as it is presented in the literature and is a part of their education. Other coordinators use the structure of a personal planning method very loosely or use only certain elements of personal planning. Despite the different use of the method, both strategies have elements of personal planning that are maintained, which is especially true for the concept of goals, which is an important part of the structure of personal planning or, above all, the focus of situation assessment. An important finding of the research tells us that it is easier to understand a life situation of service users if the assessment is a continuous process connected with the provision of services. It is an important experience of coordinators that the assessment is not too complex or demanding when personal planning is a long-lasting process in which the needs, goals and desires of service users are revealed through the assessment of the situation and the provision of services. Community care coordinators understand personal planning as a dynamic process in which it is not uncommon for goals to change or new goals to form. The experience of coordinators shows that many service users know what their desires and needs are - what is important to them in their lives - and this can be the basis for further exploration of their living situations. The experience of community care coordinators shows that with such an approach to the assessment, the problem is not how to extract important information from service users, but rather how to empower service users in cases where expressing the desires is not straightforward and unambiguous. Viability of personal planning is conditioned by the adjustments community care coordinators need to make in their practice. Personal planning is conditioned by the ability of coordinators to establish a good working relationship and trust. Service users have to have sufficient power to express their desires and views. Personal planning also needs to be a continuous process in which the assessment of the situation and the delivery of services are combined. The purpose of personal planning is to design the subject of community care: goals. The research showed that goal setting is dynamic and that goals - in addition to being a product of personal planning - serve other purposes. Goals are not only important from the point of view of defining the subject matter of social work, but also serve as a tool for the community care coordinators (and service users). Goals are important during the process of assessing the situation as a reference point for a further exploration of how to achieve goals and to address who, when and what needs to be done. Goals are a tool for community care coordinators to structure their thinking. Goals are important for the evaluation of community care and can also be used as tools and a means to advocate for service users when communicating with other services or organizations. In personal planning a reference framework of needs is crucial. Professional and science-based needs provide community care coordinators with a tool to test the potential of goals to improve users' quality of life. With the help of needs, community care coordinators can reflect their own frame of reference to help them in their work. Although community care is a voluntary service and coordinators respect the perspective of service users, they cannot avoid the issue of power, as they have the ability to influence service users in the support process and use professional mandate to intervene in situations they recognize as harmful. Coordinators are also faced with a dilemma of supporting service users to be as independent as possible while providing them with a better quality of life or avoiding more harm, which is not always the same. The question of power is important in instances when coordinators have to provide a more caring form of support. The research shows that the work of community care coordinators is important in the Slovenian mental health field as it provides comprehensive, individualized support, based on the perspective of service users.

• Keywords: community care coordinators, community social work, mental health, social work assessment, subject of social work, goals, needs, desires, knowledge, power