Third and public sectors´ cooperation in rehabilitation (KoJu-project)

1. 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

2. 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

3. 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

4. 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.

5. Rehabilitation is implemented by and requires cooperation between many authorities and actors: Municipal health, social welfare and educational services Occupational health services The Social Insurance Institution Employment services Insurance companies Fragmented actors and organizations > specialized expertice - medical, social and vocational rehabilitation

6. 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…

7. Rehabilitation as a form of professional expertise (modern ideal) - definations & classifications of disorders, injuries, impairment of abilities • interpretspeoplesneeds > assesment > solutions • systematic and objectiveexpertknowledge Strategic & goaloriented action, governedareaseparatedfromcomplexrealities outside itsboundaries(de Certeau 1984) Strategiclogicbringsapart the multiplicity of everyday life, localconcepts and experiences

8. 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”

9. Rehabilitation in NGO´s? • Courses of action? • services • social opportunities & conditions for participation • lobbying, advocacy • Professional institutions/foundations, rehabilitationcenters • NGO´sbasic action integrated >< separaterehabilitation • Communitybased action & participatory action subject-objectrolemerging -> rehabilitation as side-effect • Growingtendency: New organizational & economicforms: Incorporations (public-third), SGEI (services of general economic interest ), social & societalenterprises

10. 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?)

11. Rehabilitation in third sector? • 2) Policy: to reflect the needs and aims of the members & citizens • 3) Vocationaltraining; offeringspecificknowledge for • The publicsector & professionals • 4)Informing general public 5)Development and researchprojects:serviceuserspoints of view, new rehab. methods, combinations of experience-based & professionalknowledge

12. 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

13. 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 <

14. 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)

15. KoJu: Indepth-phase (autumn 2011-2012) Meanings given to rehabilitation? Dorothy Smith: institutional ethnography Research as discovery, method of inquiry > < objectification & explanation • 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

16. 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)

17. The relationship between institutional and third sector actors in rehabilitation? ->meanings given to actions and aims • Lay knowledge expert knowledge? • Lifeworld System(Habermas) • Experience near experience far (Geertz) • Experience basedtext-based speech (Smith) • Everyday life  institutions (Smith) • Social organizations > resources for giving meaning to rehabilitation, actions and aims • Mutual understanding  strategic (Habermas)

18. The dimensions & levels of relationships based on rehabilitation • Servicesystem and expertknowledge • controll • qualifications Commer-cial and productivelogic . ? Strategic/tactic action and/or mutual understanding Professionals -mediating -controlling Lay-/experienceknowledge

19. 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.