The aim of this thesis is to examine the current condition of ‘the field for working with clients struck by late brain injury in Denmark’. It is estimated that approximately 50,000 people in Denmark live with some kind of permanent consequences following a sudden brain injury. The scope is to examine what implications the present state of the field has on the working conditions for the executing professions in the field. The term ‘profession’ meaning the people who in practice work with clients struck by a brain injury, either in the process of rehabilitation or during counselling. The development in the structure of the field is examined from the genesis of the field in the middle of the 1970’s and onwards. The timeframe of the examination concludes with the recent reform of the Danish public sector – the ‘structural reform’ which took effect in January 2007. As a result of the radical reform of the public sector, the responsibility for the services (rehabilitation, counselling) aimed at clients with brain injuries are moved from the regional level (‘amterne’) to the municipalities (‘kommunerne’) – the local level. Consequently, the responsibility for the clients demanding highly specialised care caused by brain injuries are moved from the 14 counties to the 96 new municipalities. These municipalities have minor or no experience dealing with clients with these highly complex conditions. The above sums up the empirical framework for the thesis and the questions of interest are: What will happen to the ‘field for working with clients struck by late brain injury in Denmark’ in a new context where the municipalities are the main authority in the field? And in what way will it affect the executing professions in the field? By deploying as a theoretical and methodological frame the reflexive, sociological tools of Pierre Bourdieu, i.e. the concepts of field, habitus and capital, the field is constructed throughout the thesis and the contending positions in the field is brought to light. More precisely the thesis identifies that the main struggle for ‘how to work with brain injured clients in Denmark’ are between positions aiming at making the practical work either more orientated towards the bureaucratic field (the municipal economy and the ability to govern the care) or towards positions focused on the care and service for the clients. In the analyses it is suggested that the executing professions in the field have their own field specific habitus centered mainly on the care for the clients. This habitus focuses on the coordination of the complex work with the clients (involving different layers and institutions in the bureaucratic field and many different professions) and on structuring an optimal ‘case’ for the clients characterised by timing and flow in the care. This habitus is now put under severe pressure by external regulations. The ‘toolbox’ of Pierre Bourdieu is put to work in an empirical context. This toolbox is used for structuring the design of the thesis, which is based on: 1)4 qualitative interviews, so-called field analytical interviews, with 4 former advisers in the Danish public sector, each working in the field of public service for people with disabilities (mainly brain injury) in the former counties. All four have changed their jobs as a result of the reform. 2)Participating observations (and objectivations) with some of the advisers doing their daily job. 3)A thorough registrational (‘registrant’) analysis of the periodical ‘Fokus’ from 1995-2006. During the socio-historical construction of the field, it is pointed out that the field was relatively autonomous from the genesis and until the latest reform of the Danish public sector. The field was autonomous in the sense that it developed its own ways (forms of practice) to deal with, rehabilitate and council the clients in the field. The field, and the executing professions, distinguished themselves from other fields and from other clients with other handicaps. The struggle of how to work with the clients was mainly kept inside the field and among the internal hierarchies in the field meaning that the contending positions, represented by different professions working with different stages in the rehabilitation process, were struggling over field specific stakes but generally aiming at improving the care for the client. In the latest history of the field a shift in the orientation of the interest of the work for the clients is identified and made visible – now it is not the client’s need, but the economy of the municipalities that are the raison d’être of the activities in the field. This shift is mainly caused by the latest reform in the public sector. The reform is bringing a whole new institution, VISO, to life. VISO is an institution that can help the municipalities in the most specialized cases demanding the most specialized competences (which would be the case in many brain injury cases) if the municipalities decide to use VISO and pay for the suggested services for their clients. The municipalities are now fully responsible for financing the service for the clients that suffer from a sudden brain injury and thus it is up to them to structure this service and to decide which direction the service should take: Should it be based on the practical knowledge inherited in the habitus of the executing professions? Or should it rather be centered on initiatives that are more cost-efficient? Much of the empirical evidence in the thesis points in direction of the latter. The thesis also points out, that it is still a very open question if the municipalities will even see and recognise that clients are struck by brain injuries, due to the lack of specific knowledge about this handicap. If you cannot see the problem, you cannot deal with it.
|Uddannelser||Forvaltning, (Bachelor/kandidatuddannelse) Kandidat|
|Udgivelsesdato||15 sep. 2007|
- strukturreform, specialområdet, hjerneskade, handicappolitik, handicapforskning, udsatte grupper, feltanalyse, Pierre Bourdieu