Project: 2018 – 2020
Book publication: 2017

Strengthening Capacities of Vulnerable People in the Netherlands Since 2008

The First Stage 2008-2018: Focus on the Constitutional Factors

The first stage of the social quality oriented project of the Radboud University Medical Centre in Nijmegen aims to be a strength-oriented recovery program for people who are in  multi-problematic situations and who therefore risk becoming isolated. This concerns threatened women, young and old homeless people, refugees, addicts, ex-prisoners, vulnerable citizens in neighborhoods. The aim is to restore the quality of their everyday life that they themselves desire in order to have a chance, like every citizen, to play a responsible role in society and to belong to it.

Recovery is about a meaningful existence with hope and insight into a better future and living in safety. The project started in 2008  under the lead of the ‘Academic Workplace’ – called Impulse – of the Research Centre of the university’s Public Health Research Center. It was inspired by the ‘Strengths Approach’ in the United States, which is dedicated to a ‘people-centered care’ (PCC). Originally, it looked at patients living with chronic disease to assist them to live well and to build the competences and resources that they and their communities need for this assignment.

But herewith connected  patients, informal care givers, peer workers, people in the community, professionals and policy makers – involved with various needs and aspects of the living conditions of patients – often lack a comprehensive common (theoretical) perspective through which they are enabled to get a shared understanding of all factors influencing the health and well-being of patients and of one’s role in the care processes as part of a larger whole. Medical workers are usually not  always aware about the influence of physical living conditions and general societal circumstances and their biophysical problems. Up to now collaborative approaches in the context of the PCC have to a large extent focused on the task-oriented interactions and status differences between patients and clinicians. This implies a neglect of the significance of relationships and emphasize patient activation in a strong individualist way.

This Dutch project took from the beginning the social quality approach (SQA) on board, as elaborated by the European Foundation on Social Quality and afterwards by its successor,  the International Association on Social Quality (IASQ). The centerpiece of this approach is dedicated to the dialectic between processes of people’s self-realization (referring to the constitutional factors) and general societal processes (referring to the conditional factors) . The project especially aims to offer an answer to the pitfall of the individualized approach. Next to the PCC (see above)  it started with ‘Pathways to Empowerment’ (PTE) based on the social quality approach (SQA). This approach proved useful in providing a comprehensive overview of factors influencing the quality of daily circumstances of citizens and therefore also of clients, including the institutional and societal processes involved and the various types of recovery that are necessary in order to promote agency and realize a life worth living.

Two out of the six strengths principles of PTE refer to this relationship: (1) the community is viewed as a crucial source of support and resources for clients, and (2) the primary setting for working with clients is the community; the use of institutional settings should be minimized. With this focus, the project implicitly presents in this era, with help of the SQA, a contemporary interpretation of the principles of the movement  ‘Democratic Psychiatry in Italy’ from the 1970s onwards.

The evident success of the Dutch PTE during the past decade – 21 care-institutions took on board the PTE, organized 542 trainings for 5204 professionals, obtaining their certifications – reveals the functionality of the application of the SQA. A key issue consistently has been the understanding and interpretation of the constitutional factors of the SQA. They concern the focal points of professionals’ actions for the enhancement of clients’ agency, to stimulate processes of self-realization. In the history of theorizing and applying aspects of the SQA,  this focus concerns the indispensable link for understanding the social quality at a certain time and place, in addition to the studies on the nature of the conditional factors with help of the application of social quality indicators to measure the changes of the second set of factors. See also the summary of Krachtwerk by Judith Wolf.

The Second Stage 2018-2020: Blending Into an International Comparison

The project has thrown itself into the analysis of the state of affairs for an international audience. One of the activities concerns the study ‘Reframing Healthcare Services through the Lens of Co-Production (RheLaunCh).  It focuses on the significance of a SQA’s oriented people-centered and coproduced care, thus from the patient’s perspective. It is operationalized in the investigation of the quality of daily circumstances and experiences of patients with a chronic condition through a survey study and in-depth interviews with patients with a confirmed diagnosis of congestive heart failure (CHF). These in-depth interviews refer to the instruments of the constitutional factors, namely, ‘profiles’. The research is dedicated to patients who were treated in two large, urban hospital Center. The first is the Hennepin County Medical Center in Minneapolis, USA and the second is the Dutch Radboud University Medical Centre in Nijmegen.

The survey used the SQA as an analytic framework to explore associations among twenty formal and informal, societal and individual-level factors. The outcomes will be published in the English language. A second activity concerns the start of the analysis of the applied SQA and herewith related  practices in The Netherlands. The main question is, what the interpretation of the SQA  int this project means for the international debate about the SQA as put forwards by the IASQ. This happens in a workgroup of the project’s Academic Workplace and the IASQ. Are there arguments for changing aspects of the theory and practices as built up in this project and what does it means for the current stages of the social quality theory in general sense?  Since 2019 a start is made with two studies about aspects of this target which will be published for a worldwide audience in 2020.

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