Social Service Reform Research Articles

Making integration happen: managers’ views on multidisciplinary work in Finnish health system

Abstract Background In Finland, a large-scale health and social service reform was implemented in 2023. The structural reform centralised the organising of health and social services from some 200 organisations to 22 wellbeing services counties (WBSC). One goal of the reform was to promote service integration between and within health and social services. The reform offers a unique opportunity for investigating how such change unfolds. This study addresses the integration aspirations of those who are responsible for implementing the change, that is middle managers in WBSCs. We focus on micro and meso levels and explore how the aim of multidisciplinary collaboration is interpreted as part of advancing service integration by middle managers in one newly formed WBSC. Methods The data for this qualitative study were derived from 11 semi-structured interviews with senior and middle managers responsible for various fields of health and social care services in a single WBSC between October 2022 and June 2023. Inductive thematic analysis was applied. Results The managers framed multidisciplinary collaboration very positively and easier to achieve in the new organisation with health and social services united under the same management. The managers acknowledged the need to form collaborative structures (e.g. meetings) and processes at all levels of organisation. Leadership plays a crucial role in creating space for the professionals to form an experience of a shared every-day work. However, previous structures and patterns of work still seemed to limit these endeavours. Tensions between, for example, professional groups or units were left essentially untouched. Multidisciplinary collaboration will serve especially persons with complex and multiple needs and was framed key to cost savings. Conclusions While the structural reform opens a window of opportunity to new collaborative patterns, competing logics and interests as well as power imbalances may hamper the development if not addressed. Key messages • Middle managers had high hopes for multidisciplinary work after the health system reform, including effects on the difficult issues concerning costs and health workforce availability. • While the managers were prepared to promote multidisciplinary work, the prior organisational boundaries and logics hindered integration. Different tensions between stakeholders need more attention.

Is the EU steering national social and health policy making? A case-study on Finland's national reform

As part of the European Semester, Finland received country-specific recommendations (CSRs) in 2013–2020 that encouraged the reform of national social and health services. These recommendations were part of efforts to balance public finances and implement public-sector structural reforms. Finland has been struggling to reform the national social and health care system since 2005. Only on 1 January 2023 did the new wellbeing services counties become liable for organizing social, health, and rescue services. Studying the CSRs for Finland enables us to understand better what genuinely occurs at the EU member state level. This data-driven case study aims to disclose the relevance of the European Semester for Finland in the pursuit of a national social and health system reform. The mixed-method approach is based on the research tradition of governance, and the study contains features of data sourcing and methodological triangulation. Empirically, the research material consists of Finland's official policy documents and anonymous semi-structured elite interviews. The study highlights that although the received CSRs on the need to restructure social and health services corresponded to Finland's views, their influence to national reform efforts was limited. The CSRs were administered according to the established formal routines, but separately from the national reform preparations. The CSRs, however, delivered implicit steering, which were considered to affect social and health policy making in various ways.

Book Review: Critical Perspectives on Children’s Social Services Reform by Robin Sen and Christian Kerr (eds)

Book Review: <i>Critical Perspectives on Children’s Social Services Reform</i> by Robin Sen and Christian Kerr (eds)

Developing the Interprofessional MyTeam Model with Clients and Professionals in Social and Health Care Services

Background: Clients with complex life situations and increased health problems are often bounced between different services because they need services which are provided by different organizations and professionals (Manning &amp; Gagnon 2017, Blumenthal et al 2016). The client-oriented approach means that professionals are combining their competencies and working together based on clients’ needs. To strengthen the interprofessional co-operation it is necessary to develop practical model for professionals. Health and social service reform in Finland also aims to improve multi-sectoral cooperation for better quality of care, equality, and lower costs (Health and Social Services Reform 2022).&#x0D; Aim and implementation of the project: The aim of this project is to further develop a practical model for interprofessional cooperation to meet clients´ complex needs. The origin of this model is from geriatric health care. The project aimed to expand the original concept to wider customer groups.&#x0D; The phases of the project were following: &#x0D; A.Four working groups were formed which were led by the project manager.&#x0D; B.Education and workshops were offered for professionals and service managers to gain understanding about the interprofessional cooperation with clients and systemic approach in teamwork.&#x0D; C.Recruiting clients to pilot-test and evaluate the new model.&#x0D; D.Modify the model based on the experience from pilot-testing. &#x0D; The phases were overlapping, and the model was developed in all phases.&#x0D; Results: The clients who participated to test the model experienced that their situation and problems were taken more seriously, and they got more comprehensive assistance and support in their life. The professionals were relieved because the responsibility of complex clients’ situations became shared between professionals. The service plan was written in every meeting with clients and professionals. The customer-oriented, systemic MyTeam-practical model for interprofessional cooperation was established, as well as instructions for documenting the clients´ service planning, quality monitoring guide for MyTeam-practical model and material for clients.&#x0D; &#x0D; &#x0D; Conclusions: To promote fluent working between different professionals for the clients best, requires agreed working methods in client orientation, competence in interaction and skillful management to lead interprofessional working groups (Timperi 2022). The clients´ and professionals´ experiences are valuable, when developing interprofessional work. With interprofessional teamwork it is possible to avoid overlapping and separate plans, which are not promoting but hindering clients´ complex life situations. In the future it is necessary to explore the effectiveness of MyTeam-practical model.&#x0D;

A named General Practitioner (GP) is associated with an increase of hospital days in a single predictor analysis: a follow-up of 15 years

BackgroundContinuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system.ObjectivesThe aim of the study was to determine whether having a named GP is associated with hospital service use.MethodsThe data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 (n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 (n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register).ResultsA named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis.ConclusionA named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized.

What a journey! – A short history of the Finnish health care and social service reform and administrative integration of health care and social services

Abstract Finland is a Nordic welfare state with universal access to tax-funded health care. While the health system performs relatively well when measured in terms of avoidable mortality, several measures indicate that access to care, especially primary care, is poor. There are also relatively large geographical and socioeconomic inequities in access, utilization, and quality of services. To tackle these issues, a process to reform the health system was initiated in the early 2000s. However, it was not until 2021 when the large-scale reform of the system was enacted and not until 2023 when the new structure was implemented. The process involved several different reform proposals which all shaped the outcome of the reform. The key feature in almost all the reform proposals and in the final reform plan has been fostering vertical integration in health care and horizontal integration of health and social services both at the level of administration and organization as well as through processes and patient pathways. In this presentation we describe the history of the Finnish health and social care reform process and discuss, how integrated care as a policy idea and tool has shaped the reform agenda and reform proposals.

9.N. Workshop: It Takes Two To Improve European Child Health (Care)

Abstract Many societal developments have an impact on health care in general and on child health care, in particular. Internationally challenges include an aging population, more cultural diversity and a rising prevalence of chronic diseases among children and adolescents, revealing potential risks for child health care. A strong focus must be placed on prevention strategies that are effective, sustainable and equitable. Planning and implementing prevention strategies may require shifts in the organization of care, such as the forging and strengthening of interdisciplinary and intersectoral partnerships within a country. A promising example of such partnerships is the collaboration of public health with paediatrics. Both professional groups acknowledge the call for greater integration since prevention strategies can only be achieved and sustained by working together. The objectives of this workshop are to: • Provide a selective overview of three partnerships and plans for cooperation between public health and paediatrics. • To exchange experiences and possibilities with the audience to pave the way for further successful partnerships. In this workshop, we outline the partnership and plans for cooperation between public health and paediatrics in three European countries: Netherlands, Finland and Switzerland. In the first presentation, Danielle Jansen and Károly Illy will share the new vision towards the year 2030 of the Dutch Paediatric Society in which building blocks are presented to guarantee accessible, high-quality, timely and effective care for every child. One of the building blocks to be highlighted is the interprofessional collaboration between paediatricians and public health professionals. In the second presentation, Julia Dratva and Susanne Stronski from Switzerland will present a shared paediatric and public health vision of a digital child health booklet. The digital booklet will empower parents and adolescents, provide access to personal health irrespective of place or time, improve sharing health information among care professionals, thus ensuring continuity of care and limiting redundancy of investigations and in addition, and provide data for public health research and monitoring. Challenges and solutions will be shared with the audience. In the third presentation, Silja Kosola from Finland will present a Finnish vision for school health care where professionals trained in public health and medicine collaborate with each other as well as with teachers for the benefit of children and adolescents. This multidisciplinary collaboration across governing bodies is especially important as Finland undergoes a national reform of social and health care services. After the three presentations, we engage the audience by asking for their experiences and sharing the examples of collaborations between public health and paediatrics, as well as barriers and facilitators. At the end of the workshop, we would like to summarize the results of the workshop in an overview of preliminary best practices. Key messages • Global climatic, societal and politic developments reveal potential risks for child health cand health care, which must be countered effectively, sustainably and equitably. • Greater integration of prevention across sectors is elemental and can be achieved through interprofessional partnerships.

The Digital Capital of Social Services Consumers: Factors of Influence and the Need for Investment

Digitalization is one of the strategic directions taken in the reform of social services and a prerequisite for improving their quality and accessibility for various target groups in modern society. In recent years, the problems of digitalization occupy a significant place in social research; however, insufficient attention has been paid to the consideration of the digitalization process from the point of view of the social services clients themselves. The purpose of this article is to partially fill this gap. The article presents the results of a study aimed at developing the concept of the 'digital capital' of current and potential customers of social services, which comprised an analysis of their digital literacy, Internet use as well as the technical capabilities and willingness of Russian citizens to receive online social services. Our analysis of the digital capital of consumers of social services draws on data of the Federal Statistics Service and Unified Social Security Information System as well as on the results of a survey on social services conducted among residents of St. Petersburg and Yekaterinburg in 2019. The results of the study suggest the existence of various barriers to the development of the digitalization of social services provision. In addition to infrastructural problems, the existence/absence of digital communication tools and ICT competencies among citizens, primarily socially vulnerable sectors of the population, it is necessary to highlight the socio-psychological barriers: a lack of understanding and distrust among certain social groups – primarily among older age groups – towards digital technologies, i. e. insufficient digital capital. Overcoming the identified barriers can be achieved by investing in the digital capital of consumers of social services.

The Local Governments as a Subject of the Child Protection System in the Local Community

The article examines the organisation of local governments in the system of social protection of children in the process of decentralisation of power and the formation of united territorial communities. The biggest challenge for the authorities, after agreeing with communities and approving long-term plans, is to create a safe environment for children, who have risks and might need social assistance. As the analysis of scientific and theoretical-practical material shows, the state is now actively cooperating in this direction with international organisations and non-governmental organisations that develop projects such as «Together. Social services for families in the community» (Semikina, 2020). So, directions of the reform of social services are accessibility, overcoming difficult life circumstances, guardianship and care of children. The term «community» can be defined as an area, community of interested of people and local government and administrative-territorial unit. In the Law of Ukraine «On Social Services», the description of relevance of social services in the community and the purpose of the centre of social services as central and local authorities are specified. To conclude, the interdepartmental activities of state and public organisations related to children’s protection systems, the establishment of an interdepartmental commission aimed at identifying the children affected by violence and circumstances that may threaten their lives and health have been revealed. Thus, local governments can be considered to be part of the system of social protection of children. the establishment and development of interaction and partnership between local governments, the executive social institutions and public organizations that strengthens protection of children can be considered to be the necessary conditions for the effectiveness of the aforementioned activities.

Problematising Disability: A Critical Policy Analysis of the Australian National Disability Insurance Scheme

ABSTRACT The National Disability Insurance Scheme (NDIS) is the most significant social and disability service reform in Australia since Medicare. It has received significant funding from national and state governments and received support across a diverse range of competing interest groups. Social work research in the area of disability can make a significant contribution to progressing a rights-based agenda in disability policy. This article provides a critical analysis of the NDIS using the “What's the Problem Represented to be?” (WPR) framework developed by Carol Bacchi. The WPR analysis identifies ableist assumptions and principles informing the problematisation of disability in the NDIS, reinforcing the marginal status of specific groups of people with disability. The WPR approach can contribute to social work knowledge in the field of disability because it deconstructs policy discourses and social barriers facing people with disability and it provides for a more inclusive approach to acknowledging silences in policy and voicing differences. IMPLICATIONS The NDIS is promoted as the main plank of disability reform in Australia and considering core social work values about social justice and human rights, it is critical that social work critically engages with the NDIS. Ongoing social work engagement with disability reform and the NDIS will be essential in highlighting the silences in disability policy and working alongside people with disability as critical participants in advocating for the voices of marginalised groups of people with disability.

THE ROLE OF MONITORING AND EVALUATION OF SOCIAL PROJECTS AND PROGRAMS IN IMPROVING THE QUALITY OF SOCIAL SERVICES

Introduction. Improving the quality of social services financed from regional budgets and provided by non-governmental social organizations is directly related to improving the efficiency of social programs and projects. Both the governing bodies and executors of the project and the target audience to which the project or program is directed are interested in the effective work of social projects and programs. Thus, providing feedback from beneficiaries on their satisfaction with the services provided under the project or from the expert community on the effectiveness of the program greatly encourages NGOs and governments to improve the quality and effectiveness of their work. Management of social projects is carried out directly by non-governmental public organizations, but state and regional authorities that finance these projects should also take part in this process. At the same time, the state is generally responsible for social policy, so the implementation of social projects, regardless of who implements them, ultimately fits into the system of public administration. One of the most important mechanisms that ensure the quality of management components in general and project management in particular is monitoring and evaluation. Goal. The purpose of the article is to determine the mechanism for improving the quality of social services provided by the private sector at the expense of regional budgets using methodological approaches to monitoring and evaluation. Method. The theoretical and methodological basis of this article is based on the use of basic provisions of economics, public administration and social work, legislation, as well as the main provisions of scientific developments of Ukrainian and foreign authors on the market of social services in Ukraine, monitoring and evaluation of social programs and projects. financed from regional budgets and implemented by non-governmental organizations. Methods of system and structural-functional analysis are also used (theoretical and methodological generalizations, study of the essence of the monitoring and evaluation process). Results. It was found that one of the priorities of the state policy of reforming social services is to create a market for social services and participation in this market of organizations of all forms of ownership, including non-governmental social organizations. It is proved that non-governmental organizations have a strong potential for the implementation of state policy in the reform of social services. An analysis of methods for monitoring and evaluating the quality of social services in Ukraine. Methodological approaches to assessing the effectiveness of social projects financed from regional budgets and implemented by non-governmental organizations are proposed.

The transposition of the Patients’ Rights Directive in Finland—Difficulties encountered

The Directive on the application on patient rights’ in cross-border healthcare (2011/24/EC) was transposed in Finland by the Act on Cross-Border Health Care (1201/2013), which entered into force on 1 January 2014.A new reimbursement model for cross-border health care costs was designed. The Finnish legislator considered the chosen reimbursement model to correspond both with the aims of the Directive as well as to the functioning of the national health care scheme. The European Commission, however, initiated the first infringement procedure against Finland already in January 2014.In spring 2015, the Government launched a Regional government, health and social services reform, which would fundamentally transform the organizing, production and financing of health care services in Finland. Consequently a Government bill (HE 68/2017 vp) to change the existing reimbursement model for cross-border health care costs was delivered to the Parliament on 1 June 2017.In this article, Finland’s implementation process of the Directive is reviewed. Special attention is drawn to the argumentation concerning the reimbursements of cross-border health care costs. The differences of views on reimbursements can generally illustrate the conflicting objectives to expand access to cross-border health care services and to ensure financial sustainability of states thereof.

Health and social care leaders’ self-rated competence and learning needs in small and medium-sized enterprises

Objective: The study is a descriptive survey based on quantitative and qualitative data. Its purpose is to describe leaders’ self-assessed competence and learning needs in small and medium-sized health and social care enterprises as part of a larger research and development project in Finland. The information produced will be used in planning a simulation-based coaching intervention. The project partners are a health technology enterprise and two educational institutions.Methods: Data were collected in late 2017 from 23 leaders of 20 enterprises using an internet-based questionnaire. The quantitative data were analyzed using SPSS for Windows and the qualitative data using inductive content analysis.Results: The leaders felt confident about their ability to organize day-to-day activities, but reported learning needs related to interaction and entrepreneurship. Training was required in supporting staff in challenging situations, in understanding group dynamics and in developing dialogic interaction and emotional intelligence. The leaders were interested in learning how to market their services and improve the competitiveness of their enterprise with help of digitalization and networking, and how to prepare for the reform of health and social services. Most leaders were involved in practical care work and reported a need to update their clinical skills.Conclusions: Increasing self-management contents and fostering an entrepreneurial attitude in nursing and social work curricula may provide one answer to the learning needs reported in this study. Simulation-based education can provide an effective learning environment for both students and professionals in health and social services.

Presenting the status of project SIFT – Research of the patient flows and structures in health and social services in three Finnish cities in 2009–2015

The date of Finnish health and social services reform is fast approaching. The reform, planned to step into force on 1 January 2020, includes transferring responsibility of these services from municipalities to newly formed, autonomous regions. In addition to coordination, the regions shall form effective service and care chains. To carry out this task successfully, more information is needed about the critical points of integration of different services. We have for a while been working with a project called SIFT, which focuses on the heavy users of health and social services. We have obtained register-based data from three cities (Lohja, Karkkila, Vihti) in Southern Finland, with a total of approximately 85 000 inhabitants. Based on this data, we are studying the distribution of services used by those clients that occur in three registers: primary care, secondary care and social services. Interest is laid especially on the service processes. What kind of links are there within and between the health and social services? Are there certain phenomena to be found concerning the combinations, timelines etc? What is the level of health and social care integration before the reform? The study design is extraordinary in many respects. All sub-sets of data – also the social services sub-set – are large and numerical, allowing a quantitative research approach, as well as an integrated analysis concerning the co-occurrence of different services. Data includes some information on the family members of the clients, which is important from the point of view of child protection and family work services. Furthermore, the time span is relatively long, from the beginning of 2009 to the end of June 2015. Analysis methods include e.g. decision trees, SOM (a neural network), genetic algorithms, K-nearest neighbours and Markov chains, applied in various steps of the process. Spatial analyses can be carried out based on the postal number of the customers. It is already clear that the heavy users of health and social services can be classified into groups based on some factors, e.g. the dominant services and frequency of the service use. Certain dependencies can be pointed out in the service processes. Furthermore, spatial differences can be seen even in this relatively small geographical area. Using information of the family members has also proven to be useful and brings new perspectives into the client processes of social work. Because of the ambitious aim of combining observations from several branches, there have been plenty of issues related to completeness and internal integrity of the data. The operations situated at the interfaces of health and social services seem to be problematic from the point of view of our data collection. We do not have access to services given by the private sector. However, the heavy users of the health and social services mainly rely on the public sector in Finnish conditions. During 2018, a tool will be built, with which a person’s probability to become a heavy user of different health and social services can be predicted.

Austerity in the making: reconfiguring social policy through social impact bonds

Social impact bonds (SIBs) are spreading worldwide in the absence of public debate and proof that they improve social outcomes, despite claims to advance evidence-based policymaking and transparency in government. A critical policy reading of SIBs elucidates this conundrum. We argue that SIBs are part of a neoliberal political project that uses austerity as an economic and moral symbol to manufacture consent for social service reform. The intent of this research provocation is to identify future avenues for empirical research on SIBs to further assess how the tool reconfigures social policy in a profoundly neoliberal direction.

New Labour’s Joined-Up Government and Social Service Reform

New Labour’s Joined-Up Government and Social Service Reform

座長論文: 社会保障改革と地方自治体 : 論点の整理と今後の課題( 社会保障改革と地方自治体 : 2015年問題の現状)

座長論文: 社会保障改革と地方自治体 : 論点の整理と今後の課題( 社会保障改革と地方自治体 : 2015年問題の現状)

地域における生活支援の現状( 社会保障改革と地方自治体 : 2015年問題の現状)

地域における生活支援の現状( 社会保障改革と地方自治体 : 2015年問題の現状)

高齢期の生活保障と地域包括ケア( 社会保障改革と地方自治体 : 2015年問題の現状)

高齢期の生活保障と地域包括ケア( 社会保障改革と地方自治体 : 2015年問題の現状)

社会保障制度改革と自治体行財政の課題( 社会保障改革と地方自治体 : 2015年問題の現状)

社会保障制度改革と自治体行財政の課題( 社会保障改革と地方自治体 : 2015年問題の現状)