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Saario S, Raitakari S. Contractual audit and mental health rehabilitation: a study of formulating effectiveness in a Finnish supported housing unitInt J Soc Welfare 2010: 19: 321–329 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare.Mental health NGOs in Western Europe are increasingly managed by contractual audit procedures. This article concerns how contractual audit and its emphasis on effectiveness of care impact on the practices of long‐term mental health rehabilitation. To demonstrate this, a case study of a Finnish NGO that provides supported housing is presented. The study looks at how service purchasing practices, as stated in the contract between the municipality and the NGO, are reflected in the meetings among practitioners. Documentary and meeting data were utilised together with Mitchell Dean's notion of technologies of agency. It was found that practitioners actively sought to show the effectiveness of their everyday work in terms of contractual audit by demonstrating both the economic and progressive aspects of care. Thus, professional competency in mental health rehabilitation appears to entail both the skills of care interventions and the ability to perform these interventions as efficient and financially accountable activities.

Cover; Title; Copyright; Contents; List of contributors; Acknowledgements; 1 Introduction; PART I Conceptual and methodological premises; 2 Responsibilisation in governmentality literature; 3 Responsibilities and current welfare discourses; 4 Analysing the management of responsibilities at the margins of welfare practices; PART II Managing client responsibilities; 5 Clients accounting for the responsible self in interviews; 6 Making active citizens in the community in client-worker interaction; 7 Negotiating risks, choices and progress in case-planning meetings.

By the end of the twentieth century, caring for vulnerable adults in the community had become a pervasive policy trend in the Western world. In this article, this policy is described in two phases: deinstitutionalisation and the 'home turn' that are reflected from the perspective of social inclusion. Deinstitutionalisation has meant large institutions and asylums being replaced by group homes and communal‐supported housing units in the community. In the second and current phase, the 'home turn' emphasises well‐developed community care, home‐based services, everyone's right to have their own home, and having a valued place in the community. In this semi‐systematic narrative review, the widely shared incentives, premises, and criticisms of deinstitutionalisation and the 'home turn' are mapped from the research literature. The special focus is on the possibilities of and hindrances to social inclusion in both policy phases. The research results are mixed and conflicting concerning social inclusion, but there exists a wide consensus that small housing units and supported housing with devoted workers enhance social inclusion better than big institutions. However, the prevalent view is that deinstitutionalisation has not fulfilled its promise of social inclusion, and although the 'home turn' is a step in the right direction, there are still problems in strengthening service users' involvement and creating inclusive and accepting communities.

• Summary: The article studies how professionals working in a Finnish supported housing unit explain the behaviour of clients which they define as troublesome in regard to rehabilitation expectations. The clients of the unit suffer from mental health and substance abuse problems. The research data consist of 23 meetings where clients' progress is discussed and were analysed using accounts analysis.• Findings: There were 225 episodes where the professionals explain clients' troublesome behaviour. Three ways of accounting appeared with similar frequency: 1) blaming clients for their behaviour, 2) excusing clients' behaviour, 3) excusing clients and blaming others for the clients' behaviour. Detailed analysis of the data shows how these ways of accounting are used in the meeting talk and how blame, excuses and responsibility are combined in different ways. Another important finding is that the same troublesome behaviour can be accounted for in several ways in the course of meeting conversations.• Applications : The analysis displays the complex ways in which policy imperatives and professional ethics are routinely managed in everyday situations. While concepts like self-determination and choice promote clients' control of their care, in practice client careers are affected by locally negotiated judgements. The study of policy implementation can benefit from discourse-oriented approaches.

This paper studies the creation of organisations via people processing (Prottas 1979), taking as its case study a new and developing family centre that aims to offer various social and health services under the same roof. The study draws on ethnomethodology, meaning that organisations are herein understood as being created and continuously produced in and through interaction. The data consist of 11 audio-recorded meetings from the centre's steering group, which includes managers from different service fields and welfare agencies. In analysing the creation of the centre through people processing, this paper scrutinises how the meeting participants orient themselves toward and produce the centre's client categories, what characteristics they connect to these categories, and how they do boundary work regarding which categories belong or not to the centre's target groups. The meeting participants produce three different family based client categories. The first category is ordinary families, those without any special problems who just pop into the centre to see other people. These families are distinguished from the second category, best matching families, who are defined as having problems that would benefit from the integrated, multi-professional work conducted at the centre. The third category, families with too specific needs, refers to client groups whose service needs are at least partly beyond the centre's expertise and resources. The centre needs these people-processing activities to make sense of its mission, clients and co-partners; this ongoing reasoning process allows the emerging centre to exist and find its place in the local service system.

Community care provided through home visits is an increasingly common way to respond to adult citizens' complex needs due to, for example, mental health and substance abuse problems. This study explores the activities and core premises that this work entails. The data contain six focus group interviews with practitioners in five service settings in Finland and Sweden at the margins of community care. Through a two-stage coding process, 11 activities and three premises – situationality, boundlessness and empathy – were identified. The findings show that home visit work at the margins of community care is comprehensive and flexible, requiring reflexivity.

Abstract
This article focuses on how clients' self-determination is accomplished in social worker–client conversations when discussing choices of clients' future services in a low-threshold outpatient clinic in Finland targeted at people who use drugs. Self-determination is approached from the point of view of relational autonomy, meaning that choices are never made completely independently but within certain societal and interactional contexts. The article applies interactional analysis to data from ten social worker–client conversations, which include forty-eight instances of 'choice talk'. The results demonstrate how social workers work hard to promote clients' self-determination, and how this is carried out with different emphases within the frame of relational autonomy. Social workers do not perform ethically questionable manipulation practices. Quite the reverse, their contributions in the conversations can be interpreted as endeavours to increase clients' self-confidence and autonomy competencies. However, a concern from an ethical point of view is that real service options are rather scarce for the clinic's clients. This considerably reduces the clients' capacity for self-determination. Furthermore, it also reduces the autonomy of social workers, who have limited opportunities to organise the services their clients desire and that the social workers themselves consider are the best options.

AbstractThis study focuses on how clients using illicit drugs are supported in managing the boundaries of their homes to avoid the risks that social relationships may have on their daily lives at home. The data consist of 14 client–worker encounters audio‐recorded in 2017 in a Finnish home‐based service for people using drugs. Discursive interaction analysis and geographies of home were applied to examine how boundaries of homes are negotiated in relation to social relationships and how the home is constructed as a risk environment in the interactions of the service. The results highlight that the tensions between home and social relationships can be complex in the context of illicit drug use. Managing the boundaries of the home and social relationships deserves special attention among welfare services to promote their client's right to privacy and attachment to a home environment. This is also important for preventing the risk of homelessness.

AbstractAcross Western welfare regimes, policies emphasize that service users should have more choices regarding their services. This article examines how service choices are presented, responded to and decided in interactions between service users and professionals in mental health transition meetings. Choice is often associated with consumerist user involvement ideas, but in mental health choice also relates to the democratic user involvement approach and to shared decision making between professionals and service users. The results of the study show that professionals construct service users as consumers by offering service options in choice making sequences, expecting users to make appropriate choices. Service users mostly act like consumers by responding to these choice options. However, the study also demonstrates that the professionals do not always accept the user's first choice but respond to them as non‐preferred. Sometimes, they also suggest choices on behalf of the users. In these 'non‐accepting' sequences, choices are negotiated in interaction between the parties, rather than users acting as autonomous choice makers. The sequences are based on two kinds of professional reasoning: first, the professional‐led needs assessment and, second, the structure of the service package that the user is being offered. This negotiation has elements of shared decision making and the 'logic of care'. But it also has elements of paternalist control which challenge both consumerist and democratic service user involvement and suggests consideration of more collectively oriented service user actions.

In this book [titled Home, welfare work and vulnerability] the authors take the reader on welfare workers' home visits to clients in need of support in their living. Welfare workers refer to professionals in health and social care who in the book are represented among others by social workers, social care workers and nurses. The main concepts of the book are home, welfare work and vulnerability and these are contemplated from different angles. Welfare work entails encountering people who are in vulnerable situations in the midst of their everyday lives. They may need support in coping with their mental health, with physical illnesses, with the challenges of achieving sobriety and recovery or perhaps with the difficulties accompanying old age. On the one hand their ability to act is limited and weak but on the other they have many kinds of strengths and resources.

The book addresses a significant turning point in welfare services and work at which the objective is defined as the right of every individual to their own home and making living at home feasible for as long as possible. In the last fifty years or so many societal factors have made possible the dismantling of institutions, the reduction of places and the shortening of stays in institutions, the further development of care in the community, the construction of small residential and care facilities and most recently the further development of services to be taken into people's homes. The last stage of this dismantling of institutions is referred to in the book as the "home turn". As a societal change the home turn is complex – and that is how it is approached in the book. When one's own home is the main place in which welfare policy and work are implemented, it is important to scrutinize more closely what actually occurs there and what special issues are connected to this given context.

The book offers a timely point of view on the development of welfare services and the grass-root level welfare work done in the homes. It draws on interaction research based on ethnomethodology and human geography. Research data consist of recordings of home visits, researcher's field diaries and interviews with clients and workers. The work includes both chapters providing conceptual and theoretical overviews and empirical research on the encounters between client and worker(s) on home visits. Welfare work accomplished in people's homes entails many tensions and ethical issues which are analysed in the book and made visible through the means of research.

This book brings together contributions from a range of social welfare settings, including child welfare, unemployment, mental health and substance abuse treatment, to examine how interprofessional collaboration and service user participation are realised or challenged in multi-agency meetings. It provides empirically grounded analyses of specific aspects of multi-agency work and offers a distinctive conceptual framework for understanding and analysing interaction during meetings in various social welfare settings. Based on audio and video recordings, the authors provide clear examples of actual practices of social welfare professionals and demonstrate how the realisation of collaborative and integrated welfare policy is contingent on effective interactional practices between professionals and service users