Three perspectives on deinstitutionalisation process: a Finnish case
Antti Teittinen,
Research Manager, Finnish Association on Intellectual and Developmental
Disabilities
Co-author(s): Kirsti Kuusterä, Hannu T. Vesala
Abstract
Deinstitutionalisation has been an international common trend since 1970s in a care of people with intellectual disabilities (ID), but the first signals of this issue were observed already in the 1950s. In Finland this policy was taken seriously not until this century. Several policy programmes, action plans and practical changes in housing of people with ID have been realised. It gives a unique opportunity to study this issue as a practical and ideological process, but particularly as a paradigm shift in a decentralisation of one institutional living complex 2008-2010. In our study we are going to examine the deinstitutionalisation process from three perspectives: on individual level, focusing on the experiences of the persons moving out; on staff level, focusing on the staff views concerning their work; and on organisational level examining organisational changes of the caring system from institutional living practices to individual housing services. The Giddensian structuration theory of societal change is the main interpretative frame.
The study of the deinstitutionalisation process at the individual level pinpoints the concrete changes in one's life and reveals contradictions between the deinstitutionalisation discourse and resulting functions. The central question is how the deinstitutionalisation affects people's lives. Qualitative network analysis is used to map individual's social connections, changing needs and structure of life. The data is collected from the individuals themselves, care workers, documents, diaries and by observation.
Although there is evidence that the way staff provide services for their clients is one of the most important determinants of service outcomes, the research on deinstitutionalisation has largely neglected this aspect. Working methods or practices of staff are in turn steered by commonly shared goals of the housing unit and by personal factors such as skills and training, but also beliefs, values and attitudes held by staff. Data about the staff members' views concerning their work will be gathered by postal questionnaire at two time-points: before and after the closure of the institution.
Organisational changes of the caring system from institutional living practices to individual housing services will be studied based on the documentation materials that are plans, memos, minutes of meetings of administration and other interest groups. Also stakeholder interviews are needed to clarify the issue. The used method is rhetorics and argumentations analysis how to persuade the change ideologically, culturally, in policy-making and economically.
The results of the study can be utilised in the evaluation of this particular deinstitutionalisation process and on further development of the services, but also on the planning of similar processes in the future. And furthermore, the results will give us an opportunity to evaluate whether evidence of the paradigm shift can be found on different levels. Parallel processes are interpreted in the frame of the Giddensian structuration theory. It is expected that organisational changes mostly are argued by economical reasons. Ideologically it is called as a New Public Management (NPM). Its usual consequences are changing characteristics of caring work like multi-professionalism, needed new qualifications, temporary employments and gendered work. At the same time better housing conditions of moving persons are argued by inclusion to aim a full citizenship, human rights and responsibilities. As a conclusion there is a paradigm shift in housing practices, but it includes two opposite ideologies (inclusion and NPM). According to contemporary critical studies these opposites are represented in a neo-liberal ethos of modern societies.