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!
Dysfunctional communities !
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disability service organisations ! An
alternative model ! Community
research ! Community survey
Community care Vs
Institutional (social) care
Social care in the community
Social Role Valorisation (SRV)
Deinstitutionalisation
Disability services
Disability and community
What
Are Institutions
Institution -
Wikipedia, the free encyclopedia
How does the community care?
Removing the
barriers to community participation and inclusion
The role of
social care in the community
The
community of the building
The
reality in supporting people with high support needs
The role of
institutions in society
The
institutionalisation of community care
The
institutionalisation of deinstitutionalisation
Explanation
of
terms
Community care Vs
Institutional (social) care
The expression "care" is used to describe a concern or interest in, or,
a
set of behaviours or interventions that are used to support, aid,
assist or help a person or a group of people in meeting their needs.
This expression is used extensively in society to describe a multitude
of activities, programs and settings that are designed to support
people in society. Community groups and services provide this care in
society. Social services and organisations also provide
this care where it is unavailable in a community. The term
institution has been used to describe these social services and
organisations, however, this description is misleading in that an
institution describes a means of cooperation and coordiation only, and
not the settings that this cooperation and coordiation happens in. An
institution is a part of any community. It provides the mechanisms
for social order and stability (see
Characteristicts on an
institution). An Institution defines the way we interact
with each other within a community. It is determined by the formal and
informal cultures and
values of that community, and provides order and stability
within that
community. When we refer to a hospital, school or asylum we are not
talking about the building, but what happens within the building (the
community of the building).
Without a form of order and stability ...
... the community can not fulfill its
role,
... there are no boundaries that define the community,
... the members do not see themselves as a part of the community,
... communication brakes down, or is nonexistent
... the commnity looses its skills and reources,
... the community can not fulfill its needs,
... clubs, teams, groups etc are no longer are a part of
the
community,
While the care provided within the community, social service or
organisation is based on the institution of the community, social
service or
organisation, a distinction can be made between the institution of the
community and the institution of the social service or organisation.
I feel there are two basic types of care:
1) Community care (informal): where the
community has the skills and resources,
2) Institutional care (formal): where the community does not
have the skills and resources.
Shows the relationship between
the the skills and resources of the community,
and the amount of support that can be provided within the
community.
Community care:
Community care
Is about how the community looks after
its
members
What skills and resources does a community have?
Community care is ...
Informal, where there are no rigid
guidelines or principles that define the service. Is not bound by
government policy or practice.
Spontaneous, where the service is
temporary in fulfilling a specific
need at a particular time and in a particular setting.
Relies on community members to provide
the service.
About the
members supporting each other.
A value in being a part of the
community.
Having something to contribute to the
community.
Advantages:
(
Top)
The person keeps the existing
communities (living, recreational,
education or employment) that the person is a part of.
The person is supported by their
community.
The person is treated as a valued
member of their community.
The person keeps the existing
institutions of the community.
Minimual disruption to the persons
lifestyle.
Disadvantages:
(
Top)
The amount of support provided is
directly related to the existing skills and resources of the community.
Where a person has no existing
communities (living, recreational,
education or employment), that person will be disadvantaged in not
being able to fulfill his/her needs.
Other community members may
treat the
person as an object of pity,
sick, an idiot, a trouble maker, wasting resources that are needed
elswhere in the community etc.
Where is the line drawn between
community care and institutional
care?:
(
Top)
I feel that community care is about ordinary community members
getting together as a group to provide for the needs of others in
their community. Institutional care is more organised around a
specialised service that provides specalised skills and resources that
are not
available in the wider community, to a group, whose needs can not be
fulfilled within the wider community.
Personal
Fulfillment, Values and The Role of Supportive Communities
Institutional (social) care:
(
Top)
Institutional care can also be described as "Social care".
Institutional care
Where there is a specific need that can not be managed by the
community, a service is created that specalises in that need.
Hospitals, for example, are designed to fulfill a specific need in the
community. The hospital has a specific set of values, behaviours and
cultures (institutions) that are unique to the hospital and not used in
the wider community. There is generally a set of criteria, process or
rite of passage that
allows entry into the service. There is also an induction where a
person goes through some formal procedure before entry.
Institutional care is (see
Characteristicts on an
institution)
:
(
Top)
Formal, where there are rigid
guidelines or principles that define
the service. Is bound by government policy or practice.
Has a set agenda, charter which
determine the role, objectives and
outcomes of the service or organisation.
Permanent, where the service fulfils a
specific on going need.
Relies on its own skills and resources
to provide the service.
Institutional care has
(see
Characteristicts
on an
institution)
:
(
Top)
Formal institutions:
Short term care.
Long term care.
Informal institutions.
Groups or communities within the
service that are seperated from the wider community
Social networks
Professional networks
Advantages:
(
Top)
The person is treated as a valued
member of the service.
A person gets the appropriate care.
The service is built around the persons
needs.
The service provides the community of
support for the person.
The institutions of the service provide
valued outcomes for the person.
The person has the opportunity to
participate in normal social
activities that are available to others in society.
Disadvantages:
(
Top)
A person may not be eledgible or fit
the criteria of the service.
A service may not have room for the
person.
A service that is specialised in the
needs of the person may not exist.
The service may not have the skills and
resources to provide for the
persons needs.
A person may lose his/her existing
communities (living, recreational,
education or employment).
The person has to learn and adjust to
the institutions of the service.
The institutions of the service may
devalue the person.
A co-dependent relationship may exist
between the community and the
service.
Other community members may treat the
person as an object of pity,
sick, an idiot, a trouble maker, wasting resources that are needed
elswhere in the community etc.
A question of values:
(
Top)
Negative outcomes (devalued):
(
Top)
Collins 1993 (
from
Mental health care for elderly people By Ian J. Norman, Sally J. Redfern,
P 501) describes institutional characteristics that are negatively
valued as:
"...
denial of humanity and individuality
...
no personal space
...
no privacy
...
little choice
...
little comfort
...
little personal safety
...
few possessions
...
no dignity
...
pauperized
...
dependent
...
no control, participation or
decision making
...
cannot function as ordinary human
beings"
Other negative outcomes:
... A small staff/client ratio
... Low expectations
... Are treated as objects (numbers,
interns, defectives ect)
... Settings and activities are
structured around staff --> residents
... Strict separation of staff and
residents
... Separation of residents into groups
... All residents are all treated and
dressed the same
... All residents follow the same daily
patterns of communal living
... There is no variety in the routine
... Activities are confined to the
facility and separated from the
community
etc.
Positive outcomes (valued):
(
Top)
Ramon, 1991 (
from
Mental health care for elderly people By Ian J. Norman, Sally J. Redfern,
P 503) describes institutional characteristics that are positively
valued as:
"...
people first
...
respect for the person's
...
right to self-determination
...
right to be independent
... empowerment"
Other positive outcomes:
... A large staff/client ratio
... High value
... High expectations
... Settings and activities are
structured around residents --> staff
... Residents are treated as individuals
... Less structured daily patterns of
communal living
... Variety of activities and different
patterns in the routine to
suite
the residents
... Mixed activities where residents
are included in the normal
activities of the community (living, recreational, education and
employment)
etc.
Goffman describes four main
characteristics of institutional care as:
Batch living
Binary management
The inmate role
The institutional perspective
Rather than describing a characteristic
of institutional (the building
and the
"social construction") life, Goffman
is actually describing a set of outcomes that are characterised by the
"social construction"of the
institution. These outcomes are described as negatively valued
outcomes. When used in the context of the corrective services or
similar institutions, or in another culture, these outcomes may be seen
as positive outcomes.
Batch living, for example, describes the conditions of living, the
activities and the attitudes of the management and staff towards the
residents.
Batch living is used to describe negatively valued outcomes:
The members are separated into groups -
authoritarian -
subservient
The members of the subservient groups are all treated the same - as a
group (group living, group activities etc.), rather than as individuals
(no personal choice, no variety etc.) by the authoritarian group.
"It is characterised by a
bureaucratic form of management .... 24 hours a day without variety or
respite." (
Goffman,
1961 : 5-6, in, K. Joans & A.J. Fowles : P.71)
Within the wider community, we see these same outcomes, and although
they
may be less extreme, they are still there in all forms. Sometimes these
outcomes, described as batch living, are a necessary part of the
activity and the setting and are positively valued in providing
positive outcomes for its members. A package tour, for example, the
members are all living together and participating in the same
activities. They are restricted in what they can and can't do, they
have a set timetable that has to be followed, the service provider is
responsible for their welfare etc. The value that is placed on the
packaged tour is determined by the experiences of the members of the
tour. I'm sure you have read or heard about a tour where the members
were poorly treated, were placed in lousy accommodation, left on a ship
or in a hotel for the whole time (these things have happened) etc.
Boarding schools, the
army, a prison are other examples of batch living.
We also see these outcomes (in varying degrees) in living, recreation,
employment and education services that support disadvantaged people in
the community. Does this mean that we need to remove all organisations,
community
groups or services that support disadvantaged people?
NO! There will always be a need for institutions and institutionalised
care in the community.
Goffman states that no
institution is all open or all closed. That they all share similar
characteristics.
An institution is either positively
or
negatively valued, according to the values
of the community or society that the institution is a part of.
It is the
total value of the outcomes of the institution that determine whether
the
institution is
positively or negatively valued, rather than the characteristics of
the
institution.
The value of these outcomes are determined by the values of the
community and it's members.
Institutions and institutionalisation
can then be seen to have two
definitions within
society.
1) the community definition is
concerned with normal community
activities such as education, religion, the legal system, or any body
of knowledge or behavior that is a part of the community and is
organised within a set of formal and informal
settings, beliefs,
values,
roles,
expectations and
behaviours. These are
usually positevely valued
outcomes.
2) within the human services, the terms
institutions and
institutionalisation have been used to describe the social conditions
that
people with an intellectual disability lived in, in
society. These are
usually negatively valued
outcomes.
While the term
Institutionalisation can be seen to have
two definitions, they are describing the same things.
Community definition: the model of care is positively valued.
Social definition: the model of care is negatively valued.
"The
term institutionalisation
is widely used in social theory
to
denote the process of making something (for example a concept, a social
role, particular values and norms, or modes of behavior) become
embedded within an organization, social system, or society as an
established custom or norm within that system. See the entries on structure and agency and social construction for theoretical
perspectives on the process of institutionalisation and the associated
construction of institutions.
The term
'institutionalisation' may
also be used to refer to the committing by a society of an individual
to a particular institution such as a mental institution. The term
institutionalisation is therefore sometimes used as a term to describe
both the treatment of, and damage caused to, vulnerable human beings by
the oppressive or corrupt application of inflexible systems of social,
medical, or legal controls by publicly owned, private or not-for-profit
organisations or to describe the process of becoming accustomed to life
in an institution so that it is difficult to resume normal life after
leaving." (Wikipedia:
Institutionalisation)
Deinstitutionalisation:
(
Top)
Deinstitutionalisation is the
process of changing the outcomes of a setting from a negative value
(black)
to a positive value (white).
Negatively valued
outcomes : low expectations, conform, structured around
the
needs of the staff etc.
Positively valued outcomes : high expectations,
individual, structured around the needs of the residents etc.
When providing the most appropriate
care for people with high support
needs ...
1) The community is not where the
person is living, but where the
person participates, shares experiences and has valued relationships
with others.
2) People with high support needs (severe disability, aged etc.)
will always need support structures as a part of their lives.
3) The amount of participation in a community (living, education,
employment or recreation) is directly related to the skills and
resources of the person, and, the skills and resources of the
community that the person wishes to participate in.
4) Institutions are going to be around in one form or another
whether we like it or not, It is the way that they are used that is the
problem.
5) The institutions of a society towards a particular group
determine the way the group participates in society.
6) The institutions of a particular government department,
organisation,
profession or service define the way the person is supported within
that society.
7) Facilities that support people with high support needs do not
need to be the nursing homes or prisons in the
sense
that they are today, but can become warm inviting community places that
offer a range of services to the community, as well as be a part of the
wider community within that society.
8) People with high support needs are a minority group in our
society, and will have the same problems as other minority groups in
being a part of society.
01/10/2010
Peter Anderson
http://www.psawa.com
