Paper
A path to climb: resistances and curiosity for an innovative method
- issue: Issue 3 / 2008
- authors: Teresa Ammirati, Donatella Salerni
- keywords: care plan, instruments, professionals, Italy
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- downloaded: 0
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abstract
Background. The regional project "Experimentation of personalised plan for taking care of the needs of the person and the family" involved many different professionals: social workers of the Municipality of Chieti, professionals of the Health Districts of Chieti and Chieti Scalo, psychosocial professionals from counselling services, the interdisciplinary unit, the Mental Health Department, and the Department working on addiction.
Since the beginning (March 22nd 2005), it has been clear that the experimentation would have required an active participation of professionals. At the same time, its technical importance attracted professionals and generated an immediate and strong commitment.
Since the population composed of families and children is at the centre of our mission, the experimentation has been perceived as well-founded and stimulating, as well as a professional challenge on innovative working practices.
Eventually, we were offered the chance to give value to our social work by means of the description of global personalised care plan, for each family. We could use technical instruments allowing for quantitative analysis, and could monitor the intervention processes and evaluate the changes in terms of effectiveness.
The initial field training seemed an ambitious and attracting instrument, to develop our professional skills, even if the path to reach it appeared tiring. Difficulties and doubts showed by professionals concerned their experimental role in front of their colleagues, often after decades of work experience. It was not easy to be accountable of our job to other colleagues, especially using new working methods. For this reason, initially, the experimentation met some difficulties, delays, unaccomplished tasks and excuses.
As time goes by, our approach to family and children in difficulties changed. We passed from a fragmented care of family members in difficulties, sometimes characterised by overlapping or conflicting interventions, to a shared and global care of the family.
For each family enrolled in the experimentation, we selected the members of the multi-professional project unit (UMP). The care manager was an important part of the unit. The care manager was usually the social worker who already knew and had in charge the family. He/she had a facilitating role within the unit, activating and coordinating interventions described in the personalised care plan, assuring collaborations and integration at a professional and management level.
During UMP, professionals analysed and shared the content of evaluation instruments. The availability of information on child and family wellbeing, the exchanges among professionals sitting around a table, sharing responsibilities and involvement, has led to prepare a personalised care plan.
While writing down the personalised plan, it has been difficult to split complex need into simple ones, describe observable factors and examine the changes in a fixed period of time. This conceptual training has led to select the most important needs to the family.
Professionals, who were not familiar with the proposed instruments at least in the beginning, seemed to play a technical role in the administering of the instruments, neglecting the awareness of processes.
Traditional instruments of social work practice sometimes allow for a superficial examination of outcomes. On the contrary, thinking to social work in terms of method and process has led to relevant exchanges with other professionals, from different backgrounds.
The experience with the families initially refusing to participate to the experimentation has been particularly interesting. Those families with multiple problems were often characterised by deep sufferance, communication difficulties, and negative attitudes toward professionals. In addition to this, those families frequently rejected the idea of having problems, as a typical psychological defence mechanism.
Professionals who had to intervene with protection actins toward the children, experienced often a deep conflict between the needs of the children and those of the parents, and were often emotionally involved in the situations.
During UMP, the exchanges among professionals revealed that professionals' expectations did not match the family one. In this view, professionals decided to approach the family respecting its limits and tuning interventions on its needs, in order have their consent, that is a good starting point for a change.
Thanks to these new instruments made available by the experimentation, each professional felt not being alone, not overlapping other professional's intervention, to be able to measure outcomes over time. More than this, professionals perceived themselves as being able to take care of the family in a global and integrated way, considering the resources and not only the problems of the family.
Key references
Gioga, G. & Pivetti, M. (2008). Progetti personalizzati per i bisogni della persona e della famiglia. In T. Vecchiato e E.L.L. Mazzini (a cura di) L'integrazione sociosanitaria: risultati di sperimentazioni e condizioni di efficacia. Padova, Fondazione Zancan.
Gioga, G., Mazzini, L.E. & Pivetti, M. (2007). Progetti personalizzati per le famiglie multi-problematiche con minori: una sperimentazione promossa dalla Regione Abruzzo. Studi Zancan, 4, 181-198.
Contatti: Donatella Salerni, Comune di Chieti, p.zza Vittorio Emanuele I, 66100 Chieti, E-mail: donatella.salerni@virgilio.it.