Subsidiarity threshold

Subsidiarity curve - number of users/ hours of needed formal care per month

Subsidiarity threshold is the point on which someone relies on formal care instead of only care provided by his or her own means including the means of his own and immediate social network.

In other words: one asks or applies for formal help when his or her resources to help him- or herself are exhausted.

The threshold is up to certain point individually set. Its height depends on:

1. Amount of ‘spontaneous’ help or care available in his “natural” support or social network. i.e. from the relatives, friends, neighbours and others.  Such help can be direct – help, support and care activities, favours and informal service. It can be also indirect – e.g. relative pay for the helpers on the market. Probably most important moment that determines subsidiarity threshold is thus social capital.
2. Amount of ‘personal capital’ one has on his or her disposition. This can mean that a person has enough knowledge, skill, ingenuity and other personal traits (modesty, endurance etc.), so he or she can organise his or her life that in spite of distress needs less help. It can also mean that he or she has enough resources (income, property) to hire help – be it in his or her immediate environment or on the open market. 
3. Stigma perception and handling. One can perceive asking for formal help as a (self)stigmatising deed and this can influence the decision whether to ask for formal help. The degree of fear of stigma (shame, covering stigma) can be related to personal beliefs, attitudes and morality, expectations and attitudes of the immediate environment or general cultural patterns (we can assume that fear of stigma is lower in the universalistic welfare regimes than in the authoritarian, conservative ones of subsidiary nature). Subsidiarity threshold is in a way also a stigmatisation threshold. 
4. Social response to distress. Crossing the subsidiarity threshold is on one hand an individual decision or event, on the other is also socially determined. The height of the threshold depends on the degree of seamlessness of the response, its invisibility and thus less stigmatising. Measures to alleviate poverty, promoting solidarity, enabling social life) lower the threshold as well as community actions of solidarity and mutual help (communal transport, housing and care cooperatives, time banks, service and goods exchange etc.).

While the threshold is of an individual nature at lower intensities of need, we can assume that there is a statistical absolute subsidiarity threshold. This means that while there is on the end of low intensity of needed care great variability of individual threshold, the variability diminishes with the increase of needed care until it comes to the point that almost everybody, vast majority needs some external, formal help. A very rough empirical estimate (based on the Austrian figures for long-term care) would be for this absolute threshold to be just a bit over hundred hours of support (help, care) per month. Beyond this intensity, virtually everyone is in need for formal care.

Distribution of care can be seen on the receiving end as the tail of a normal distribution. We can presume, speculate that most the people have an equal share of receiving and providing care and help. At the extremes of this bell curve, we have a receiving end, people who receive more than give, and providing end, people who provide more care than receive. Usually in discussion of care provision, we give full attention to the former and little to the latter (and none of it to the middle). If we want to deal with the process of care as whole and take into the consideration informal care provision, we need to consider also the middle and providing part. First in having in mind the mutual help in the informal networks across the whole population; second, in giving the attention to the needs of carers as well as of the care procurement.

There are other moments that lower the subsidiarity threshold:

1. Economic reasons – e.g. unemployment, exhaustion and exploitation, lack of housing, lack of time available to help; 
2. Social and cultural – changes in patterns of care in conjunction with demographic trends – increasing rate of dependency, inversion of receiving and giving care ratio; 
3. Exposure to violence (family), increasing isolation and loneliness, poor social networks; 
4. Inappropriate professional intervention – stigmatisation, counselling when material support is needed and, opposite, too hasty referral to intensive forms of care (e.g. institutional care) because of lack of adequate services, etc. 
5. Inappropriate social and health services system: haphazard and unplanned response, not based on the needs of users, too many out of head solutions and aprioristic initiatives (dominance of some forms of care – e.g. self-help groups, day centres, group homes). Insufficient community participation and lack of community orientation.

Dancing between the advocate and guardian (Excerpt)

This blog is an excerpt from the chapter Social Work as a Science of Doing[1] which I have published in a book that Tom edited with me more than ten years ago. I got it out to help me preparing a workshop in Demir Kapija institution, in Macedonia. The workshop is on personal planning. And it is in an institution used for the people with label of intelectuall disabilities. That makes the notion of dance between the role of an advocate and guardian more important.

Social work is always about doubles, about Max and Maurice, Lolek and Bolek, Pooh and Piglet. It is about being the two at the same time. And it is about being able to dance between these two faces. The classic endowment of social work is that it has to safeguard the (virtual) interests of a person, who cannot do it themselves. On the other hand it is also the essential task of social work to advocate for the same person’s actual desires and necessities (that they can nevertheless express).

The guardian role in the human professions (medicine, health care, education, social work) is historically based on the pledge of the feudal masters to take care of and protect their subjects, to be their patron and protector. It is the basic relationship of the feudal society. The bourgeois society in turn is based on the sovereign, autonomous, independent individuals forming contractual relations. For those who are not capable of doing this or are not acknowledged as such, a special institute is needed which insures them a place in the social process. This gap is filled to a certain extent by the philanthropic professions who have taken on the guardian (patron, protective) role for people lacking in contractual power. Basic characteristics of this role are that, on the grounds of presupposed knowledge, somebody takes care of the virtual interest of an individual; in doing this, security and care are of paramount importance, mandate from the society is given on the basis of the deficiency of the individual to be cared for; the underlying model of treating a person in care is one that of a child or a stranger, both being helpless and ignorant, in a need of help and patronage.

The advocate role is based on the tradition of the struggle for social emancipation of marginal groups (workers, women, ethnic minorities…). In principle it is intended to present the interests of the people who have lost their voice; it intends to make up for the deficiencies and lacks and to recreate the people as fully invested members of the society. It is a professional stance that takes into account the perspective of power and strives to strengthen the social position of the individual. Basic characteristic of this role are to start from the actual interests and desires of an individual, to create knowledge on the basis of analysis of reality, to stress rights and prevent injustice, to get a mandate from the individual or a concrete social group, to concentrate on the irregularities and injustice in the society and to let the person regain the lost advantage. This is done on the principle of exchangeability of the roles (Prince and the pauper)[2].

	Guardian	Advocate
Interests	Virtual	Actual
Knowledge	Beforehand, prior	After, situation based
Mandate	From the general society	From the individual, concrete group
Deficiency	Inside the individual	In the social order
Figure of the user	Stranger, child	Absent individual, Prince and the pauper

Contradiction between guardian and advocate roles is resolvable in different ways: by separating the roles (one member of the team takes one and another member the other role), by abstaining from the role of guardian (in case the court or any other instance has that role anyway), or by synthesis of both roles.[3] 

Synthesis is possible if we follow both roles, continuously negotiate (in dialogue) our mandate and the possible outcomes, having in mind the interests and benefits of all the actors involved, especially of the user; if we consistently employ the least restrictive necessary measures and, together with the users, strive to reach the optimal solution.

For example, in removing a child from the parents, we can imagine the procedure as being twofold: moving in the direction of removing the child – at the same time checking the possibilities that will prove the removal unnecessary. Optimally we would create an alliance; the worker also on the side of the parents. Walk the path together, examining the possibilities of the child staying, eventually realising that the child cannot stay and has to be (temporarily) removed.

It is of vital importance to make decisions experientially. Sometimes we deem the desires of the users to be unattainable and impossible. However, we are not the advocates of reality; reality is strong enough to speak for itself. We, together with the user, have to test it. The experience will tell us what is possible and what is not. Social workers need not know in advance what is “real” and what is not. The user’s desire is a hypothesis to be tested. Life is an experiment anyhow.

Synthesis is possible also, because assessment, planning and happening are interwoven. In social work it is useless and even harmful to follow traditional scientific pattern of reasoning. Social work is not bound to assess first and intervene after. Concrete actions that we take from the start, go beyond pure assessment as they immediately change situation (a young offender gets a job, finishes school, the father changes his communication patterns with his children). Good and concrete plans for the future change the present.

We can act as both - advocate and guardian, also because we can make things happen. If we as social workers can really sort things out and change something, the synthesis in action is possible. In this ability we assume the role of commissioner, integrating the user’s actual desires and necessities with their perceived virtual interest. We can plan and construct the arrangements (services, settings, resources, etc.) that will satisfy both – what he or she really wants and is supposed to be good for her or him.

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[1] Flaker, V. (2006) Social work as a science of doing : in the praise of a minor profession. V: Flaker, V. (ed.), Schmid, T. (ed.). Von der Idee zur Forschungsarbeit : Forschen in Sozialarbeit un Sozialwissenschaft. Wien: Böhlau Verlag, pp. 55–78. The excerpt is on pp.: 68–71.

[2] N.B.: These general roles and stances should not be confused with the concrete roles of an advocate or a guardian.

[3] Separation and abstinence are reasonable and productive in some situations, but we give up power invested in deciding. And this power can be the power to be used for the solution, desired by the user.

Bitno je da nam ciljeve ne postavljaju drugi :)

Dok sam spremao obuku ličnog planiranja u Demir Kapiji zamolio sam ’kolešku’ iz skopskog univerziteta (Kirila i Metoda, dakako) da mi prosledi materijale koje su koristili u uvođenju individualnog planiranja pri uključivanju đaka s poteškoćama u učenju u obične osnovne škole. Kada sam hteo da se zahvalim ispao je ovaj blog.[1]

Koliko sam mogao da shvatim ima sličnosti i razlika između dve metode planiranja.[2] One delomično proizlaze iz razlike u kontekstu (ramki) – pošto se radi o uključivanju (radije koristim tu reč nego ’inkluzija’ – u biti je značenje isto – samo što se inkluzija čuje kao nešto više stručno J - neki moji kolege sa slovenskog pedagoškog fakulteta time se ne slažu i kažu da postoji razlika – ali nikad mi je nisu suvislo obrazložili) u školu, na jednoj strani, dok se na drugoj međutim radi o preseljenju iz institucije u zajednicu, običan život (ili za početak za personalizaciju usluga u nekoj ustanovi, odnosno organizaciju usluga da neko ne treba da uđe u ustanovu. U prvoj situaciji se radi u uključivanju u ustanovu koja prilično strogo definira kriterije uspeha (vrednosti) i pravila ponašanja i općenja. U drugoj radi se o polivalentnoj situaciji uključivanja u mnoštvo različitih situacija sa različnim vrednosnim sistemima, različitim pravilima i većem broju nositelja društvene moći i vlasti.[3]

Sličnosti između dva metoda, da se radi o metodu koji omogućuje individualni pristup, krojenje usluga prema potrebama pojedinca odnosno stvaranja individualnog programa vaspitanja i obrazovanja. Nadalje je sličnost o tome što jedan takav plan objedinjuje na jednom mestu više različitih radnji više stručnjaka i drugih učesnika s namerom usklađene akcije za postizanje ciljeva ličnog plana. „Ciljevi“ su treća, i možda najbitnija, poveznica i sličnost između oba metoda, njihov osnovni pojam koji u svojoj biti omogućuje i individualizaciju i ujedno zajedničku, koordiniranu akciju. Ali baš u poimanju ciljeva možemo videti bitne razliku između ta dva pristupa.

Od razlika koje sam primetio tri su mi bitne. Ko i kako formuliše ciljeve, sintaktička veza između poteškoća odnosno problema i ciljeva te celokupnost – holistička narav pristupa. To su naime bitne paradigmatske razlike.

Planiranje uključivanja u obične škole naravno pre svega obuhvaća školu i njene zahteve, a lično planiranje celi spektar života bez obzira na pojedine ’sektore’ koji u njega zadiru. U tome je bitna paradigmatska prednost holističkog pristupa – njime uspostavljamo uvek dinamiku i dijalektiku između delova i celine. Ako nisam dobar u školi ili na poslu barem imam puno prijatelja i dobre odnose sa rođacima i suprotno. No, ne radi se samo u utehi ili kompenzaciji nego i relacijama između pojedinih oblasti života i sinergije među njima. Imati naime više prijatelja nije klasično vaspitno, još manje obrazovno, postignuće, no može biti bitno da se moj uspeh u školi ili na poslu poboljša. I radi se o tome da se sagledavajući celinu možemo strateški bolje postaviti, videti što je važnije i što je proizvoljnije.

Sintaksa ciljeva i poteškoća koje ljudi imaju, na prvi pogled se čini proizvoljna, što ćemo dati na prvo mesto može izgledati stvar izbora ili slučaja. No, međutim nije tako. Ako stavljamo na prvo mesto poteškoće ili probleme oni će ne samo intonirati nego i voditi našu akciju, naše delovanje. Postaju naša polazna tačka.[4] A ciljevi koje formulišemo postaju sintaktički odgovor na probleme: imam problem XX → što iziskuje akciju (i cilj) YY. To su znači ciljevi naših problema, a ne ciljevi naših želja i vrednosti. Ako postavimo najpre ciljeve, postaviti ćemo ih iz naših želja, iz onoga što nam je u životu bitno. Poteškoće prestaju biti subjekt naših ciljeva, postaju njihov adverb. Važne su samo onoliko koliko nas sprečavaju pri postizanju ciljeva. Samo su jedna od prepreka koje treba prevazići da bismo postigli ono što želimo (a možda i to nisu). I lakše ćemo razmišljati o alternativnim rešenjima – cilj se naime postiže ili eliminacijom poteškoće ili njenom kompenzacijom.

Najbitnija razlika je razlika u tome ko postavlja ciljeve. Da nešto bude moj lični plan moram JA postaviti ciljeve. Ako ih postavi neko drugi onda to nije moj lični plan, nego je to nečiji plan za mene. S jedne strane radi se o etičkom pitanju – dali neko može da odlučuje o mome životu, i pogotovo o tome što ja želim u njemu napraviti; s druge strane pitanje je i sasvim pragmatično. Ako su mi ciljevi nametnuti moja motivacija da ih ispunim je upitna, ako podrška koju primam ne odgovora mojim autentičnim ciljevima ona nije relevantna pa ni odgovarajuća. Radi se greška, zapetljavaju se stvari – tera se kozu u rog. Povezujući etički i pragmatički aspekt – radi se o pitanju osnaživanja ili obesnaživanja, i to onog bitnog – što da u životu radimo.

Mogli bismo reći da ove paradigmatske razlike stvara okvir (ramka) delovanja. Škola je jak okvir, postavlja zahteve pred školarce, njihove roditelje – nemilosrdno J Radi se o jednom ukrućenom sistemu. Tu smo u procesu dezinstitucionalizacije u prednosti – prvo što se radi o, uistinu još krućem sistemu, ali o njemu postoji popriličan stepen suglasnosti da je štetan i da treba prevazići. A izlazak iz institucije z druge strane znači da stupama u neke nove sisteme bilo postojeće (npr. porodica, komšiluk) ili pak stvaranje novih sistema podrške, zbrinjavanja (zgrižuvanja) – u oba primera radi se o sistemima koji su mekši, fleksibilniji, a pogotovo manje formalizovani.

Ali to nije pitanje samo ramke, okvira, konteksta već je i pitanje paradigme, o paradigmatskom pomaku od pristupa koji temelji na deficitu, problemu, segmentaciji života i moći stručnjaka ka pristupu koji je zasnovan na moći, vrlinama, celokupnosti života i osnaživanju korisnika. Naravno, da okvir stvara način rada, organizacija stvari i hrani dispozitive. Međutim i u uključivanju se radi na neki način o dezinstitucionalizaciji škole – kao sustava isključivanja. Uključivanje đaka koji su dosad bili u posebnim školama mora menjati školu, njezin vrednosni sistem, pravila i kriterije uspeha. Dakle paradigma mora menjati i svoj okvir zbivanja.[5]

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[1] Zato je blog napisan na jeziku koji je nešto između slovenskog i makedonskog J

[2] Radi se o individualnom planiranju nastave (IEP – individual educational plan) i ličnom planiranju koje smo razvili na temelju rada Dejvida Brendona u Sloveniji. Videti: Siegel, Lawrence M. (2005) Nolo's IPE Guide : learning disabilities. 2nd ed. Nolo; i Brandon, D., Brandon, A. (1994), Yin and Yang of Care Planning. Cambridge: Anglia University, također Flaker, V., Mali, J., Rafaelič, A., Ratajc, S. (2013) Osebno načrtovanje in izvajanje storitev. Ljubljana: Fakulteta za socialno delo.

[3] Neki bi rekli, da je razlika također u tome da se u prvom slučaju radi o deci, a u drugom pretežno odraslim ljudima. No, s time se, međutim ne bi složio da su te razlike bitne. Radi se naime u oba primera o ljudima koji nemaju poslovne sposobnosti i pod starateljstvom su, formalno i neformalno. Jest razlika u tome, da je sasvim normalno da se roditelji brinu o školovanju svoje dece i u tome su glavni partneri učiteljima u školi, a da se neko brine o odrasloj osobi kao da je dete i nije baš normalno.

[4] Koleška me upozorila da nije baš sasvim tako. Individualno planiranje obrazovanja u velikoj meri uzima u obzir vrline, sposobnosti koji neko ima (strength perspective) i plan gradi baš na tim jačim aspektima života pojedinca.

[5] O tome sam pisao već davno ali još uvek aktualno: Flaker, V. (1993), Kdor je z majhnim zadovoljen, ne zasluži velikega (teze k normalizaciji). V: Dekleva, B. (ur.), Življenje v zavodu in potrebe otrok - Normalizacija. Ljubljana: Inštitut za kriminologijo pri Pravni fakulteti (42-48). Engleska verzija: Flaker, V. (1994), On the Values of Normalisation. Care in Place 1/94 N. 3: 225-230.