The research group Participation, Care and Support is part of the Research Centre for Social Innovation of Utrecht University for Applied Sciences. This is a transdisciplinary research centre, doing practice based research focused on relevant social issues, connecting different fields like social work, care, law, employment, policy and organisation. In the centre, around 125 researchers are active and every year several hundreds of students are participating in research projects. Our research group has around 15 members, including people with personal experience with a disability or a mental health issue. For example, we have two persons with a mild learning disability employed as co-researchers. Our aim is to provide professionals, students and educators with knowledge to support quality of life and social inclusion of persons with disabilities. Our disability groups include persons with psychiatric experiences, learning disability, acquired brain damage and dementia.
Research group and development program
We do research projects together with service providers and consumer organisations, mostly in the centre of the Netherlands, but also in other parts of the country. We also participate in European projects.
Our research & development program consists of 4 themes:
- Inclusion and human rights
- Transformation of social care
- Experiences as source of knowledge, recovery and empowerment
- Balanced care
Around each theme we have a number of activities and projects. To mention some examples: In the first sub program, we have a project in one district of the city of Amersfoort to find out how persons with an intellectual disability can have more valued social roles in the neighbourhood where they live. In the second sub program, we are following the development of a number of social teams in the province of Utrecht, mapping how they work and progress. One of the projects in the third sub program is to investigate what the additional value is of experts by experience in the bachelor education of Social Work. An example of a project in ‘balanced care’ is to find out how social workers can improve their support for family carers of people suffering from dementia.
Our research group and care ethics
Our research group is a member of the research network Critical Ethics of Care. Why?
With our research, we support developments in the field and we provide knowledge for the education of current and future professionals. We cannot do this, so is our belief, without a proper ethical frame work. This framework consists of the following two elements.
(1) Principles of Social Work.
Since a great deal of our research is taking place in the social domain, which is connected to social work, the ethical principles of social work, as stated in the international definition (IFSW/IASSW, 2014) are one of the anchor stones: Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work.
As researchers, we look at social work practices, to investigate whether and how these principles are reflected. The principles mentioned above, remain just general notions, if they are not further defined. What does social justice mean? What does respect for diversity mean? How are these principles put into practice? We believe that just following professional codes of ethics, difficult cases and decision-making models, are not sufficient to ensure ‘good work’ in the complexity of today’s practices. We agree with Sarah Banks (2008) that we should move towards more embedded and situated approaches to ethics in professional life.
(2) Principles of ‘good care’.
A second angle is our care ethical view. Inspired by the work of Joan Tronto, Axel Honneth, Andries Baart, Frans Vosman and Annelies Van Heijst, I have used these insights to develop a theory of good care (Wilken, 2010).
I state that good care is embedded in a dialogical relationship that is based on human dignity and the wellbeing of people in a vulnerable position. Based on my research, analysing narratives of people with a long history of care dependency, I found that good care includes dealing with six fundamental tenets, namely presence, shared perspective, diversity, recognition, autonomy and vulnerability, and empowerment. It is the challenge of every professional to develop a ‘caring relationship’, to create a framework of (mutual) understanding, to deal with ‘sameness’ and ‘otherness’, to install Honneth’s three key elements of recognition (love, respect and solidarity). Then, professional service providers should address matters of both autonomy and vulnerability. Good care supports the autonomy and dignity of the person (often in a reciprocal sense, in interaction with a supportive environment), and does whatever is necessary with regard to the vulnerability (either caused by personal of environmental factors, or in an interaction between the two). The last challenge is to not only help to maintain the autonomy and the abilities of the person, but also to help him/her to increase these.
Different perspectives
We use empirical research designed to explore and describe how practitioners conceptualize and tackle issues in their day-to-day practice, and analyse professional behaviour from different perspectives: the perspective of the professional, the perspective of the service receiver and the institutional perspective. From these three, the perspective of the service user is for us the dominant one. We thereby choose a subjective point of view: the perception of the service receiver regarding the quality of the services. Are the services beneficial and helpful? The perspective of the professional can or cannot be in line with the user’s perspective. So, the perspectives are confronted with each other. In case of tensions, this forms a meaningful cause for discussion and reflection, a chance to practice ‘care ethics’. The institutional perspective cannot be left out, since both the behaviour of the care giver and the care receiver are nearly always influenced by this. I am referring to the procedures, guidelines and protocols of service organisations, and to the way bureaucratic systems work.
Working from different perspectives, we combine different sources of knowledge: scientific knowledge, professional knowledge and experiential knowledge. We use our care ethical lens to interpret the findings. Ideally, in cases when our research forms a part of a ‘good practice’ development programme, this lens has already been constructed in and by the practice itself. The data we present help to sharpen the quality of both the focus and the practice.
Since we want to play an active role in the transformation of care and welfare, we want to cross boundaries between different sectors, specifically the social domain, the health care domain and the disability domain. Since the decentralisation of responsibilities from the central government to the local governments in 2015, all these domains have become part of the local political arena. Professionals and organisations providing services are confronted with new legislation, local policies and contracting schemes, and with new ways to organise care. The most common form is the social team, which is responsible to provide comprehensive services to a geographical area of a district, neighbourhood or village. We are both monitoring these developments, and support a number of teams with the development of these services. From our monitors, we discover again and again that a team without a clear vision and values, has difficulties with collaboration and developing a common way of working. If we work with these themes in an action-research programme, we encourage these teams to look for a set of guiding principles, as a common ground. In this process, which also shapes the identity of the team, the focus which is set has always to do with ‘the good of the client’. Ethical reflection is needed to answer the question about the ultimate aims of the services the team is providing. First, this can be a general shared conception of what ‘good’ is. Good can be associated, for example, with ‘quality of life’ or ‘needs which are satisfied’. Second, the challenge is to apply the general notions to specific situation. This requires ‘reflection in action’ and ‘reflection on action’ (Schön, 1983), and what Sabrina Keinemans (2016) calls ‘ethical agency’.
Epilogue
This short publication gives a glimpse of our work and how care ethics is reflected in our research. We believe research is only a means to an end. Our activities should contribute to a better understanding and a better practice, which turns around what really contributes to services which care recipients are perceiving as supportive and helpful for leading ‘a good life’. Our empirical data confirm that both the quality of relationship (perceived in terms like careful, attentive, understanding, supportive and encouraging) as the quality of the activities (expressed in terms like competent, skilful and effective) constitute ‘good care’. Care ethical principles help us to steer our activities as researchers as well as to develop new innovative practices in the changing welfare state.
References:
Banks, S. (2008). ‘Critical commentary: social work ethics’, British Journal of Social Work, 38, 6, pp. 1238-1249.
IFSW/IASSW (2014). International definition of social work. IFSW/IASSW
Keinemans, S. (2016). The impact of ethical agency. Ethicsofcare.org
Schön, D.A. (1983). The reflective Practitioner. How professionals think in action. London: Temple Smith.
Wilken, J.P. (2010). Recovering Care. A contribution to a theory and practice of good care. Amsterdam: SWP Publishers.