The morphogenesis of disability policies and the personalisation of social services. A case study from Italy
Summary (3 min read)
1. Introduction
- The paper is structured in the following way.
- In Section 2 the authors clarify the difference between personalized and individualized social services; then (Section 3), they argument their hypothesis, methodology and research outline; in Section 4 they present their research on Sardinia personalized plans.
- In Section 6 the authors briefly comment on the results, pointing out the critical, controversial and contradictory aspects of Sardinian personalization policy.
2. The conceptual difference between personalization and individualization
- (2) collaborate in designing and co-producing services.
- Each and every solution has to be shared and decided together with case managers, personal advisers, users and others responsible for the service.
- This concept of co-production goes back to Elinor Ostrom's work (a process by which 'inputs from individuals who are not "in" the same organisation are transformed into goods and services ' 1996, p. 1073) and it is connected to policies governance (as co-creation, codesign, co-planning, co-management and co-assessment Pestoff, Brandsen, & Verscheure, 2012) .
- To conclude, in PSS persons are conceived as the medium of new social services.
- As Sabel demonstrated, the new welfare regimes will be based on 'capacitating social services' (Sabel, Zeitlin, & Quack, 2017) .
3. Hypothesis, methodology and research outline
- Methodologically, the authors use two different sociological approaches: Archer's morphogenetic theory 1 (1995) and Hedström's social mechanism theory (Hedström & Swedberg, 1998) .
- The authors try to include within the morphogenetic approach the so-called 'Coleman boat' to show how changes over time at different policies layers, can influence personalization (or not) .
- 'Basically, A's are extra-individual social factors that might be cited as causes of social phenomena and that might influence individuals' (Ylikoski, 2016, p. 5 ).
Morphogenesis of social policy administration Forms of governance Hp1
- Interaction between social workers, users and their supportive networks.
- Hp2 Individualised/Personalised social services Conditions for the implementation and delivery process properties of agents and their situations, like values, opportunities or interests (Node B) and to behavioural outcomes, like choices, behaviours, or actions (Node C).
- 'It is the starting point of the analysis that employs the diagram.
- The interviews with key informants have been divided into four parts: ( 1 Interviewing users, family members, and relevant social workers have carried out the analysis of personalized plans.
- On average, each interview lasted 90 minutes.
5.1. The four phases of the process: situational, actional and transformational social mechanism
- You don't care about all the personalized process.
- It remains personalized, but about all the participatory process where the choice is made ….
- You aim to have just a technical report that defines how high is your seriousness level and how much money and then they will explain you how to spend them ….
- If they will arrive to these conclusions, the authors will say nooo!.
5.2. Interactions through personalized plans: 'misunderstanding' and coproduction
- The other focus of their analysis concerns interactions taking place between users, their families, social workers, personal assistants and professionals.
- These interactions are now very ambivalent: in a certain sense, plan designs and their implementation are fully delegated to users and families, but this 'devolution' gives rise to a reaction that, paradoxically, generates a more bureaucratic procedure.
- This means that the collaboration between users, families and social workers collapses; but, at the same time, the absence and the breakdown of this institutional collaboration is balanced out on a different level: the design and implementation shift to users, families and their networks.
- Social workers and public officers simply limit their role and action to validate autonomized personalized plans.
5.2.1. The interaction between social workers and users and families: a 'creative misunderstanding'
- Interviewed social workers report that personalized plans are still able to meet families' requirement for care, but also report that support, monitoring and evaluation activities are not really carried out.
- Co-production is thus suspended, and users and families have to manage their relationship with personal assistants autonomously.
- In a sense, the process of co-production is creatively 'misunderstood' because care services become dependent on the family ability to operate on their own.
- At the same time and paradoxically, users, their families and the chosen staff are included in the care system because they are necessary for the daily workability of the system.
- Arbitrariness and freedom to design the plans autonomously are thus traded off for a restricted and limited co-production of services.
5.3. Interactions between users and personal assistants: three steps towards coproduction
- It is exactly here that the authors can see the difference between personalization and standardized services: users and families are not seen as mere passive targets, but as real proposers, people with competencies and capacities useful to elaborate solutions.
- In their actions they represent the precondition for the existence of personalized services.
'Interviewer:
- That means that she has followed, understood and then she does it.
- 2), 'the authors work on her skills and her desires' (story no. 4). Assistant's empathy and understanding are increased by two factors: the presence of a caring and collaborative family, and the possibility of a fruitful dialogue with other professionals (see Box 4 and 5) .
- She can discuss frequently with other assistants, can rely on several professionals in order to design each specific plan and can learn how to support disabled people in a very personal way.
- The authors worked on some useful activities but that F. might also like.
6. Conclusions
- Here external forces have a significant influence.
- In the logic of elimination (phase 4) the demand for cuts in social spending creates an austerity policy and consequently closes opportunities reducing the number of possible active actors.
- In the morphostatic logic of protection (phase 1), the policy system is steered by agreements between regional policy makers and big for-profit providers, immunizing themselves from external events and from the entries of new possible actors.
- Within the logic of correction (phase 3) unions, private in-home assistants and migrant caregivers emerge as leading actors.
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Frequently Asked Questions (14)
Q2. How many municipalities had presented personalized plans in 2002?
(A) Already in 2002, 266 municipalities, 70.5% of the municipalities of Sardinia, had presented at least one personalized plan in favour of residents with severe disabilities.
Q3. What was the role of the user led organizations in the development of personalized plans?
User led organizations supported families in designing their own plans, sustaining the relationship with social workers and personal assistants, influencing mass media conceived as a sounding board for requesting support to personalized plans.
Q4. What is the definition of individualized social service?
The authors define individualized social service (ISS) as a top-down example of policy making, aimed at offering a standardized and specified provision of social services, which could be better defined as ‘customization’ of services.
Q5. What did the researchers ask social workers to do?
Social workers have been asked to focus on their job, and personalization and co-designing strategies activated with users and family members.
Q6. What are the main reasons for the rise of new social services?
Introduction European Welfare states are facing a growing demand for personalized social services, due to – among many reasons – the de-standardization and heterogeneity of individual needs (Valkenburg, 2007) which give room to the dramatic rise of new (Taylor-Gooby, 2005) and non-actuarial societal risks (Sabel, 2012): harms whose incidence is so unpredictable that it is impossible for those at risk to create an insurance pool sufficient to indemnify those who incur losses.
Q7. What did users and families say about the amount of social expenditure reserved for disability and long-term?
Userled organizations and unions defended the amount of social expenditure reserved for disability and long-term care because it gave them power to negotiate.
Q8. What was the role of the user-led organizations?
User-led organizations were pushed to accentuate their defensive and advocacy role to the detriment of their previous proactive and supportive role.
Q9. How many hours can an assistant work with a child in a family?
An assistant can work with a child in a family from 6 to 10 hours maximum per week, but for the rest of the hours the parents and other figures around the family have to take care of them.
Q10. What is the main reason for the new form of opportunistic behaviour?
A new form of opportunistic behaviour is now developing, especially in some areas of Sardinia, where the pressure to have a household income in order to participate in consumption is very strong.
Q11. What is the case for personalization without co-design and co-production of services?
Without co-design and co-production of services, i.e. the inclusion and activation of users and clients into the service, personalization became mere (standardized) individualization.
Q12. What changed the way the care system was structured?
(Interview no. 9)(D) The care system changed in many ways: the funding strategy moved from a mutual public-private arrangement, to direct families’ reimbursements (according to eligible costs of personalized plans); the topic of social policies changed as well, from standard treatments based on experts’ knowledge to care services chosen and controlled by users.
Q13. Which of the following is more pluralistic?
Governance is more pluralistic when it is open to the largest number of actors: users and their families, users’ associations, for-profit or non-profit service providers, public administrations.
Q14. What is the morphogenetic cycle of the Sardinian social policy?
In identifying the development of the policy governance and its street-level functioning, the authors have observed a morphogenetic cycle composed by four different phases (Table 4): (1) the period since the Regional enforcement of the law 1682/98 (before 2000); (2) the period covering the start-up and the institutionalization of services (between 2000 and4.