Process Of Deinstitutionalization Research Articles

Introduction: Special Forum on Sociological Perspectives of Accounting

A nthony Hopwood (e.g., 1983) has long observed that we have had few field studies that have examined accounting in the contexts in which it operates. Indeed, in his 2006 plenary address as the American Accounting Association’s Presidential Scholar, Hopwood concluded that accounting research has become ‘‘increasingly detached from the practice of the craft . . . [as well as] too cautious and conservative, too rigid and traditional, and insufficiently attuned to grapple with the new, and to embrace novel insights and bodies of knowledge’’ (Hopwood 2007, 1365, 1370). In part, he urged that more innovative field research be conducted, informed by theories derived from sociology and employing qualitative, naturalistic research methods (e.g., Hopwood 2007, 1372). This special forum of Behavioral Research in Accounting is devoted to publishing original papers detailing field studies of accounting in their natural organizational and institutional contexts which have drawn on sociological perspectives and employed qualitative methods. Webster’s dictionary defines sociology as ‘‘the science of society, social institutions, and social relationships: the systematic study of the development, structure, and function of human groups conceived as processes of interaction or as organized patterns of collective behavior.’’ As such, a sociological perspective of accounting as a form of structure focuses on examining the multiple roles accounting plays in the social constitution of organizations and institutions, or on the social constitution of accounting, rather than the orthodox view that accounting faithfully represents an objective, economic reality. On this theme, for example, Fombrun (1986; see also Van de Ven and Poole 1996; Dirsmith 1998) reasoned that such forms of structure as accounting may simultaneously serve as: technological solutions to the instrumental problems of production; political exchanges among contending organizational and institutional factions; and social interpretations within the organization and by its external, institutional constituents. Thus, accounting may simultaneously be seen as: technical solutions to the problems of fostering production rationality—the more traditional, orthodox province of accounting, and as political advocacy devices for representing the positions of various constituent groups within the

Programas de continuidad de cuidados: éxitos, fracasos y retos futuros

Los programas de continuidad de cuidados surgen a finales de los años 70 en EEUU, en respuesta a los problemas detectados durante del proceso de desintitucionalización de los hospitales psiquiátricos. Desde entonces, se han extendido por todo el mundo, con variaciones y peculiaridades según las regiones, convirtiéndose en piedra angular de la atención a las personas con enfermedad mental grave y persistente. En este artículo se revisa el origen de estos programas, su desarrollo a lo largo de más de treinta años, la filosofía que los ha guiado en su devenir, así como los éxitos y fracasos en su desarrollo.

Role of Enterprise Systems in Organizational Transformation

:This paper offers a new perspective on the role of the Enterprise System (ES) as an instrument for radical organizational change. The findings are based on an in-depth case study in a large, European, high-tech company that went through a major re-organization, adopting a matrix organization structure. The paper offers valuable insights into the de-institutionalization process and the role of ES in a company's re-organization. The findings show how ES-in-use served as an agent and a platform for de-institutionalization and later as a powerful force in forming the new institutional arrangement.

Developments in Deinstitutionalization and Community Living in the Czech Republic

AbstractThe Czech national policy on social services and health is based on the principal of human rights and empowerment of persons with disabilities. Based on published literature and reports, as well as knowledge and experience from working in the field, this mainly conceptual article summarizes progress over the past two decades in the Czech Republic in moving from an institutional era toward one that values community‐based alternatives. While European and national policy is supportive of community living, and new individualized funding streams have been created, progress in the Czech Republic toward the goal of community living for everyone with a disability has been slow and has met with many barriers. The authors highlight the need to consider issues such as the availability of data related to funding and delivery of services, planning of the transitional period toward community‐based services, accessibility of reports on quality of services (including institutions), and the conflict of interests created by the system of guardianship. The authors conclude that despite economic circumstances that may slow down the process of deinstitutionalization, the direction of change toward community living needs to be sustained.

Reconsidering Administrative Reforms in Russia: Institutionalization, De-institutionalization and Re-institutionalization process

Reconsidering Administrative Reforms in Russia: Institutionalization, De-institutionalization and Re-institutionalization process

Deinstitutionalization and attitudes toward mental illness in Jamaica: a qualitative study.

To consider whether or not deinstitutionalization and the integration of community mental health care with primary health care services have reduced stigma toward mental illness in Jamaica. A qualitative study of 20 focus groups, with a total of 159 participants grouped by shared sociodemographic traits. Results were analyzed using ATLAS.ti software. Participant narratives showed that stigma had transitioned from negative to positive, from avoidance and fear of violent behavior during the period of deinstitutionalization to feelings of compassion and kindness as community mental health services were integrated with Jamaica's primary health care system. The Bellevue Mental Hospital and homelessness were identified as major causes of stigma. Attitudes toward the mentally ill have improved and stigma has decreased since the increase of community involvement with the mentally ill. This reduction in stigma seems to be a result of the rigorous deinstitutionalization process and the development of a robust community mental health service in Jamaica.

P03-220 - How do Symptoms and Level of Functioning Affect the Quality of Life in Schizophrenia? a Study on the Community Mental Health Centre of Ferrara (Italy)

IntroductionA specific interest regarding quality of life(QoL) of patients with schizophrenia dates back to the de-institutionalisation process. Italy worked on decentralising its mental health services since 1978. It was apparent that capturing psychopathological symptoms alone was not sufficient to reflect relevant outcomes. In particular, information on the social functioning and quality of life is regarded as essential for evaluating long-term outcomes.ObjectiveThe relationship between Quality of life and global functioning and symptoms in outpatients with Schizophrenia.MethodIn the present study we examined all the subjects with a diagnosis of schizophrenia attending a same Community Mental Health Centre in Northern Italy, in 2008. Each patient completed the WHO QoL Instrument - Brief and was administerd the Brief Psychiatric Rating Scale-24 to assess psychiatric symptoms and the VADO Personal and social Functioning Scale to assess the level of functioning.ResultsThe population studied subjects showed an intermediate satisfaction on the overall QoL and health; these data can be juxtaposed to the national standard sample rates. QoL resulted positively associated to personal and social functioning, while it was negatively related to psychiatric symptoms.ConclusionThe QoL in our study is not extremely negative, though schizophrenia is an often an impairing chronic illness. Furthermore, the present research on social functioning, psychiatric symptoms and QoL in people with schizophrenia suggest that symptoms, but, above all, personal and social functioning are important elements to determine QoL. These studies point to the importance of looking beyond symptom-reduction strategies for improving QoL in schizophrenia.

S38-03 - Quality of care in longer term mental health institutions in Poland

ObjectiveDevelopment of Quality Indicator for Rehabilitative Care (QuIRC), experiences of Polish partner in implementation of the toolkit and preliminary assessment of care standards in longer term mental health institutions. Research constitutes a part of international project funded by European Commission.MethodsPolish version of QuIRC has been tested in 20 psychiatric units across 3 regions in Poland. Selected facilities differed in terms of employment profile, living standards as well as location and service users turnover. Managers of participating units were interviewed using the refined tool with 145 items regarding domains indentified during previous phases of the DEMoB.inc project. Each participant was questioned by a single researcher during face-to-face meeting. Lacking answers were completed on basis of service users’ medical files and account departments’ documents when necessary.ResultsManager of only 1 out of 21 units refused to participate in interview. The most common difficulties in data collection were in relation to the number of staff and staff training. These difficulties may be due to differences in the work patterns and training of staff in Polish units compared to other countries. In comparison to international results important differences in preliminary assessments of long term mental health care were found in several areas probably due to the early stage of deinstitutionalisation process in Eastern Europe. Development of the web based version of the toolkit will facilitate its implementation in research as well as internal assessments for units’ restructuring purposes.

The Decline and Fall of the Paris Salon : a Study of the Deinstitutionalization Pro cess of a Field Configuring Event in the Cultural Activities

This article examines the deinstitutionalization of a Field Configuring Event (FCE) and the consequences of this deinstitutionalization for an organizational field. To this end, we carried out a historiographical study of the deinstitutionalization of the Paris Salon. This pivotal FCE was the central event of the Beaux-Arts field in France for over two centuries before its progressive decline at the end of the 19th Century. From a theoretical point of view, our results show that the deinstitutionalization process of FCEs is the result of the interaction and dynamics of several factors, notably, the internal contradictions of the FCE, the emergence of alternatives resulting from institutional developments, and the constitution of a critical mass, followed by the development of institutional pressures that encourage the abandonment of the FCE. This study also enables us to analyze the impact of an FCE’s decline on the structure, distribution and nature of power, and especially on temporality within a field. Finally, it contributes to the study of the deinstitutionalization process in general. From a managerial point of view, this study suggests that promoters must organize themselves to integrate innovation, in order to avoid the decline of the FCE.

Liminoid religion: Ritual practice in alternative spirituality in the Netherlands

Alternative spirituality can be seen as a particular form of religious practice related to processes of de-traditionalisation and deinstitutionalisation. Although often regarded as a western, secularised phenomenon, such alternative forms of spirituality are becoming increasingly popular among the middle classes worldwide and in the Netherlands in particular. In this article I look at the distinction between institutional religion and spirituality through the lenses of liminality and the liminoid. I argue that religion is becoming a liminoid domain in society and, through an example from Christian spirituality in the Netherlands, I show how, in spirituality, religion itself becomes liminoid, suggesting a subjectivised approach to identity and meaning.

A inclusão da família na atenção psicossocial: uma reflexão

doi: 10.5216/ree.v12i4.6812O presente artigo reflete sobre a inclusão da família na atenção psicossocial, novo modelo proposto na área de saúde mental, que tem como objeto de cuidado a unidade familiar em toda sua complexidade, a partir de seu território social. A família é entendida como parceira no cuidado ao indivíduo que sofre psiquicamente, mas também necessita receber o suporte adequado para superar situações de desgaste físico, emocional, mental e psicológico, devendo encontrar junto aos serviços substitutivos em saúde mental o acolhimento de suas necessidades e apoio para sua reestruturação. Entendemos que as tecnologias relacionais, especialmente o acolhimento e a escuta, são estratégias fundamentais para efetivar a inclusão das famílias nos serviços substitutivos em saúde mental. Essas tecnologias fortalecem a produção de saúde, proporcionam a criação de vínculos que possibilitam ao núcleo familiar o alcance de uma nova organização, facilitando o processo de reabilitação psicossocial e a desinstitucionalização, pressupostos da Reforma Psiquiátrica. Descritores: Família; Saúde Mental; Atenção à Saúde; Enfermagem Psiquiátrica.

Deinstitutionalisation in Norway: the process, challenges and solutions

This article looks back on the process of deinstitutionalisation in Norway, which took place over 20 years ago and which led to a comprehensive system of community‐based services. It outlines the process and examines the issues which had to be addressed during the process of change.

Trends on schizophrenia admissions during the deinstitutionalisation process in Spain (1980–2004)

The deinstitutionalisation reform in Spain started after 1980 with the aim of reducing the need for hospitalisation, length of stay and the number of psychiatric hospital beds, as well as fostering psychiatric patient's involvement in the community. The aim of this study was to review how this reform process has affected the management of schizophrenic patients from 1980 to 2004. Longitudinal (1980-2004) study describing variables related to hospital morbidity in schizophrenia patients. Hospital admission rate has gradually increased from 1980 to 2004 from 3.71 admissions per 10,000 inhabitants to 5.89, respectively. Considering the type of admission, emergency or elective, whilst the latter has slightly decreased from 2.24 in 1980 to 1.72 in 2004, the first has almost tripled from 1.47 to 4.17. The point-prevalence of schizophrenic patients receiving inpatient treatment each year has decreased 78% in this period. Length of stay, in days per admission episode, has also decreased from 148days in 1980 to 35days in 2004. One of the main impacts of the psychiatric health care reform in Spain has been the considerable reduction in hospital capacity devoted to schizophrenic patients, based on the significant decrease in point-prevalence. Thus, it seems relevant to design new studies to quantify the resource reallocation to other areas of care, such as pharmacological treatment and community services.

The geography of institutional psychiatric care in France 1800-2000: historical analysis of the spatial diffusion of specialised facilities for institutional care of mental illness.

As in other European countries, specialised psychiatric hospitals were established throughout France during the 19th Century. The construction of these hospitals can be considered as the concrete expression of a therapeutic innovation which recognized insanity as an illness that could be treated in such specialised institutions. The spatial diffusion of these innovative institutions through 19th and 20th century France is analysed and we explore how far this can be understood through theories of diffusion of innovations including geographical models of hierarchical and expansion diffusion (or whether other conceptual models are more appropriate).The research reported here particularly focuses on the period 1800–1961. It involved the construction of an original historical database of both psychiatric hospitals and information on the cities where these institutions were located. This was used to examine and interpret the different phases of development of psychiatric institutions and the parts of the country and types of geographical setting where they were concentrated. A multiple correspondence analysis was then performed to examine the connections between different aspects of the diffusion process.The study shows the limitations of classical models of spatial diffusion, which are found to be consistent with some, but not all aspects of the development of psychiatric institutions in France. An alternative political ecology approach seems more appropriate to conceptualise the various processes involved; national policies, social representations, medicalisation of care of mental illness, and urban and economic growth all seem to be associated with the emergence of a variable and complex pattern. This paper also opens a large field of research. Compared with other western countries, the geography of French psychiatric care is relatively under-researched, although there has been a strong spatial dimension to mental health policy in the country. This analysis provides a context for studies of more contemporary processes of French deinstitutionalisation, which is strongly structured by the past heritage of these large asylum facilities.

Deinstitutionalization in Ontario, Canada: Understanding Who Moved When

The results of deinstitutionalization are well known, but less information is available on the process of deinstitutionalization itself. This study sought to understand the process of deinstitutionalization in Ontario by examining the timing of individuals' transitions to the community and the characteristics of individuals who experienced a change in the timing of their move. Data used were based on census information collected between 2005 and 2008 using the interRAI Intellectual Disability assessment instrument on all persons residing in Ontario's specialized institutions. Analyses of characteristics at baseline by the anticipated transition year revealed the existence of significant differences between the groups. Comparisons of anticipated and actual transition years revealed that about 40% of individuals experienced a change in their transition year. Age, bladder incontinence, and number of medical diagnoses were associated with increased likelihood of moving earlier than anticipated, whereas family contact, presence of a strong and supportive relationship with family, psychiatric diagnoses, destructive behavior, and aggression were associated with higher likelihood of moving later. Careful attention to characteristics and level of need was paid at the onset of the deinstitutionalization planning process; however, the timing of transitions to the community was not “set in stone.” In the future, studies should not only examine the individual's outcomes and quality of life in the community, but also should seek to qualitatively describe the individual's and family's experiences of the transition process. This type of information is invaluable for other jurisdictions in which deinstitutionalization is planned or under way.

Institutionally Individualized Volunteering: Towards a Late Modern Re-Construction

In this article, it is argued that the ongoing debate on new and more individualized forms of volunteering is too one-sidedly focused on the processes of de-structuration and de-institutionalization. Individualization is a complex and ambivalent macro-structural process towards ‘institutionally dependent individual situations’. To fully understand the emerging forms of volunteering, we thus need to ‘reconstruct beyond de-construction’. The concept of ‘institutionally individualized volunteering’, developed in this article, induces such a paradigm shift. It refers to the growing institutionalization of more individuated forms of volunteering, that is, to new forms of collective organization based on individual assignment and choice. It is argued that the institutionalization of individualized volunteering occurs through ‘primary’ and ‘secondary’ processes of re-structuring. Re-embedding in primary contexts is facilitated by voluntary associations that offer more attractive and flexible volunteering menus to (potential) volunteers. Secondary forms of institutionally individualized volunteering, on the other hand, are emerging as new spaces of fundamental ambivalence. They represent new forms of highly rationalized top-down production of volunteer opportunities in hybrid organizational settings.

Personal Accounts: Tall Paul

Personal Accounts: Tall Paul

Toward Successful Postbooking Diversion: What Are the Next Steps?

Toward Successful Postbooking Diversion: What Are the Next Steps?

A reforma e os hospitais psiquiátricos: histórias da desinstitucionalização

Esta pesquisa investigou como o processo de Reforma da Política de saúde mental repercutiu no mais antigo hospital psiquiátrico público de Belo Horizonte, o Instituto Raul Soares, resultando em iniciativas institucionais que procuravam responder à crítica aos asilos e à cultura manicomial que emergiu desde os anos 60 (século XX, em Minas Gerais). Trata-se de um esforço historiográfico, realizado em 2007, que trabalhou com fontes documentais e orais (entrevistas com psiquiatras, psicólogos, enfermeiros e outros), recuperando informações sobre as décadas de 60, 70 e 80. O referencial teórico foi o da Análise Institucional. Foram enfocadas iniciativas instituintes que tomaram a forma de projetos assistenciais e de formação que objetivavam a reestruturação do hospital: o Ambulatório Central Roberto Resende; a Residência em Psiquiatria, o Projeto Guimarães Rosa e o Hospital Dia. São evidenciados os paradigmas de referência e o contraditório processo de desinstitucionalização.

Counterpoints of care: two moments of struggle

This paper examines the history of care in modern society and seeks to expose how deep transformations in care arise from wider social relations. From historical survey we may discern a series of transitional points, where the practice and the experience of care was greatly, sometimes suddenly, redefined. Each betrayed deeper political and ethical struggles that went to the core of social relations, and which weren't merely therapeutic in nature. This paper explores two such 'moments'. I first examine the emergence of a new institutional landscape during the middle industrial era, in the wake of a series of legal and political reforms that sought to settle a social order uprooted and distressed by raw modernisation. I provide a composite, yet incomplete view, of how this transformation proceeded in one urban setting, colonial Melbourne. In the second instance, I review the ambitions and process of deinstitutionalisation in the late 20(th) century. Ostensibly, this reform sought, inter alia, to collapse the great division between 'fit' and 'unfit' established in 1834. Again, empirical reference is made to the reconstitution of care in Melbourne, Australia, this time during its late 20th experience of institutional reform. The focus in this case is the process of downscaling and closure for a major congregate facility, Kew Cottages. The major conclusion is that periods of intense transition in the ideology and mode of care are reflective of wider social transformations not merely of therapeutic or institutional shifts.