Suchergebnisse

Social inclusion and exclusion are buzzwords in today's political discourse. While there are many causes of social exclusion, one of the factors repeatedly shown to lead to social exclusion is mental illness, which may hinder people in developing themselves in accordance with their wishes and abilities. Participation is a key dimension of social inclusion—and one that we particularly seek to increase understanding of in this volume. We focus on participation taking place in face-to-face social encounters, seeking to get to the root of the preconditions and consequences of participation by unraveling the interactional processes that underlie what makes it possible. We presuppose that participation in any social or societal sphere presupposes social interaction, which in turn requires the capacity to coordinate with and make sense of others' actions. Thus, drawing on joint decision-making as a specific arena of social interaction, where the participants' collaborative management of the turn-by-turn sequential unfolding of interaction can have tangible consequences for the participants' social and economic circumstances, we seek to increase understanding of the specific vulnerabilities that individuals with mental illness have in this context. ; In occupational therapy, a therapist and client engage in shared activities that they perform collaboratively during therapeutic sessions. An important part of this joint performance involves providing the client with the opportunity to make short-term decisions on the activities they wish to perform. Analyzing 15 occupational therapy encounters at psychiatric outpatient clinics, in the chapter I explore the functions of these small-scale decisions. The analysis demonstrates that therapists (1) make room for the client's proposals by shaping the activity context and (2) make proposals themselves on the ways the performance should be accomplished. To summarize, clients are given decision-making power over the content of the activity, whereas therapists use their decision-making power to assist the client's performance. The analysis shows how small-scale decisions can be employed to construct the occupational performance as shared endeavors and to position the clients as active subjects rather than objects of the professionals' performance. ; Peer reviewed

We draw on interaction oriented focus group research and conversation analysis to study the conversation analytic data session as a pedagogical institution. Drawing on focus group interviews among conversation analytic experts and novices, we considered (1) the degree of sharedness of different normative orientations among the conversation analysts regarding the data session and (2) possible differences in how novice and expert conversation analysts orient, perceive and evaluate data session normativity. We found both the experts and novices to engage in adelicate act of balancing between two normative ideals — that everyone should contribute to the joint analysis and that everyone who contributes to the joint analysis should be constructive. The experts displayed a strong consensus that all data session participants' contributions should be treated equally — given that all of them are competent language users. Th enovices, thenagain, emphasized the different levels of experience between the data session participants and sought for recognition of their own lower competence in relation to that of the experts. It thus seems that the collaborative, democratic practices, which are seen as empowering by the experts, invoke anxiety in the novices. Making this tension visible can enable the development of conversation analytic datasessions from the pedagogical perspective. ; We draw on interaction-oriented focus group research and conversation analysis to study the conversation-analytic data session as a pedagogical institution. Drawing on focus group interviews among conversation-analytic experts and novices, we considered (1) the degree of sharedness of different normative orientations among the conversation analysts regarding the data session and (2) possible differences in how novice and expert conversation analysts orient, perceive and evaluate data-session normativity. We found both the experts and novices to engage in a delicate act of balancing between two normative ideals—that everyone should contribute to the joint analysis and that everyone who contributes to the joint analysis should be constructive. The experts displayed a strong consensus that all data-session participants' contributions should be treated equally—given that all of them are competent language users. The novices, then again, emphasized the different levels of experience between the data-session participants and sought for recognition of their own lower competence in relation to that of the experts. It thus seems that the collaborative, democratic practices, which are seen as empowering by the experts, invoke anxiety in the novices. Making this tension visible can enable the development of conversation-analytic data sessions from the pedagogical perspective. ; Peer reviewed

Sosiaali- ja terveyshuollon digitalisaatiokehityksen yhdeksi keskeiseksi tavoitteeksi on nimetty osallisuuden edistäminen. Tässä tutkimuksessa tarkastellaan sosiaali- ja terveydenhuollon asiakkaiden, työntekijöiden ja johtajien käsityksiä asiakkaiden osallistumisesta digitaalisiin palveluihin. Tavoitteena on lisätä ymmärrystä asiakasosallisuuden ja digitalisaation välisestä suhteesta sekä siihen liitettyjen käsitysten yhteneväisyyksistä ja eroavaisuuksista asiakkaiden ja ammattilaisten keskuudessa. Tutkimusaineistona ovat 86 henkilön teemahaastattelut viidessä julkisessa sosiaali- ja terveydenhuollon organisaatiossa. Menetelmänä on laadullinen, teoriaohjautuva sisällönanalyysi.
Käsitykset asiakasosallisuudesta digitaalisissa palveluissa jäsentyivät viideksi luokaksi: asiakas palveluiden piiriin kuuluvana, asiakas palautteen antajana, asiakas vuorovaikutuskumppanina, asiakas itsenäisenä toimijana vastaanottojen ulkopuolella ja asiakas kehittäjänä. Analyysi toi esille jännitteisyyden luokkien sisällä: kuhunkin luokkaan kytkeytyi digitalisaatiokehityksen mukanaan tuomat mahdollisuudet asiakkaiden osallistumisen ideaaleista sekä toisaalta digitalisaatiokehityksen esteet, realiteetit ja sen mukanaan tuomat uudenlaiset haasteet. Erityisesti asiakkaat korostivat digipalveluihin liittyviä huolia: pelkoa taitojen ja tuen riittävyydestä sekä vuorovaikutuksen kaventumisesta. Johtajat korostivat digitalisaation mahdollisuuksia erityisesti yhteydenpidossa, palautteen antamisessa sekä palveluiden kehittämisessä. Työntekijät toivat esille sekä esteitä että mahdollisuuksia, korostaen erityisesti palveluiden piiriin pääsemistä, palautteen antamista ja etävastaanottoja.
Digitaalisissa palveluissa asiakkaan rooli itsenäisenä toimijana ja tiedonhakijana korostuu. Samalla asiakkaan tekemät valinnat ja päätökset jäävät helposti ammattilaisilta piiloon ja dialogi asiakkaan ja ammattilaisen välillä vähäiseksi. Tähän liittyy monenlaisia huolia niin asiakkaiden kuin ammattilaisten keskuudessa. Eri osapuolten osallisuuskäsitysten ymmärtäminen onkin tärkeää, kun suunnitellaan ja kehitetään digitaalisia sosiaali- ja terveydenhuollon palveluja.

AbstractGoal setting is at the heart of mental health rehabilitation, but its joint negotiation by clinicians and clients has proven to be a challenging endeavor. This paper investigates goal setting decision-making in the context of Clubhouse Communities: non-profit organizations designed to pave the way for the recovery of individuals diagnosed with mental illnesses. Using the method of conversation analysis, we demonstrate how clinicians make and account for proposals to involve clients in the discussion as more equal partners. In these accounts, clinicians highlight the client's potential in terms of either competence or interest. Clients, in turn, resist clinicians' proposals by invoking the opposing factor: when clinicians highlight clients' competence, clients appeal to their lack of interest and vice versa. In this way, clients are able to reject clinicians' goal-proposals without disagreeing with the rationalizations of their competence or interest. By contrast, jointly formulated decisions are best reached when clinicians focus the talk on the characteristics of the desired activity rather than on the characteristics of the client. In so doing, clients are able to claim personal ownership of the goal.