Projects Empowerment of Vulnerable People in The Netherlands
2008 - ongoing
Application Constitutional Factors of the SQT in 75 Dutch Care Organizations
The first stage of the social quality oriented project of the ‘Impuls Academic collaboration Center at Radboud University Medical Center in Nijmegen’ aims to be a strength-oriented recovery program for people who are in multi-problematic situations and who therefore risk becoming isolated. It is called ‘Pathways to Empowerment’ (PTE), currently applied in 75 Dutch Care Organizations. This PTE concerns threatened women, young and old homeless people, refugees, addicts, ex-prisoners, vulnerable citizens in neighborhoods. The aim is to restore their own capacities to enhance 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. It is in theoretical sense based on the theory of the constitutional factors of social quality and its approach.
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 ‘Impuls 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 societal contexts and emphasize patient activation in a strong individualist way.
This Dutch project took from the beginning the social quality theory (SQT) and 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 has happened in the American PCC-approach. The evident success of the Dutch PTE during the past decade – 75 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 on the constitutional factors concerns the indispensable link for understanding the social quality at a certain time and place. But this should happen in addition to studies on the nature of the conditional factors as aspect of people’s daily circumstances. Their dialectic determines the difference between the Dutch PTE and the American PCC.
Publication of the Study bout the first Stage of the PTE
From the side of ‘Impuls Center’ a study is published with help of many professional stakeholders about the content and operationalization of the first stage of the PTE ‘in the making’. The first edition appeared in 2012 and the second (revised) version in 2017. The book Krachtwerk (Pathways to Empowerment)was published in Dutch. A summary in English can be found here. Their methods and its applications were also called Krachtwerk, which means ‘working toward (self-)empowerment.' As explained, the aim of the presentation is to give an impulse to the methodical action of counselors with the aim of improving the quality of the counseling of vulnerable people. As a central ordering principle the crossing of two basic tensions, namely (1) the horizontal axe (between world of systems or formal world and the lifeworld or informal world) and the (2) vertical axe (between societal transformations and biographical transformations) - see the social quality theory (SQT) - is used for understanding the different nature of people and the different contexts of these people. The assumptions underlying the crossing of the two basic tensions has been implicitly used at this stage of the work. A stronger explication followed in the forthcoming four years, resulting into the ‘Pathways to Empowerment’. In fact this Dutch publication about the work done since 2008 delivered the first points of departure for theoretical thinking through the implicit applied ‘social quality assumptions’ (more on this below).
Blending Into an International Comparison, in the USA and The Netherlands
This project in progress has thrown itself into the analysis of the state of affairs for an international audience. One of the projects concerns the study ‘Reframing Healthcare Services through the Lens of Co-Production (RheLaunCh). It focuses on the significance of a SQT’s and 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 Centers. 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 uses 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.
The First English Language Study Of Pathways to Empowerment
A second research project concerns a very first rounded study about the application of the SQT and SQA to assist vulnerable people in 75 Dutch care organizations led by the Impuls Center. In the history of social quality work, this is the first study about the nature, functionality, and meaning of the constitutional factors based on the practice of more than a decade in many care organizations. The study, titled Pathways to Empowerment: The Social Quality Approach as a Foundation for Person-Centered Interventions, was published in the International Journal of Social Quality. This research project has been realized by representatives of the Impuls Center and the IASQ. Three different questions were examined:
- How to explicate in a more articulated way the application of the theory of the four constitutional factors as adopted by the 75 care organizations, namely (1) the human (personal) security, (2) social recognition, (3) social responsibility and the empowerment of clients, (4) strengthening personal capabilities and executive functions,
- In what sense (theoretical and practical) are these four factors made functional for the specific targets of these care organizations, namely to elaborate their various ‘recovery tasks’, which are strongly linked to the biographical development of personal agency. The accent is dedicated to puzzles which encountered in the development process of the clients of these organizations.
- What do the outcomes of this application mean for the current nature of the theory about the constitutional factors. These outcomes, do they demand for enhancing the theory about these constitutional factors? Which hypotheses can be formulated for making this theory more adequate for the challenge of the desirable elaboration of the current ‘Pathways to Empowerment’. In other words, how to enhance the conceptualization of the constitutional facts and their dialectical relations with the conditional factors?