Communities of Practice. Niches voor de samenwerking tussen ervaringswerkers en professionals bij gebiedsgericht werken

Abstract

Communities of Practice. Niches for cooperation between experts-by-experience and professionals in community developmentSince 2000, problems in the care of people with multiple complex problems have been on the increase. These people can often have problems in multiple domains of life which may reinforce each other in a negative way. Unfortunately, these people, who need care more than others, often do not receive appropriate care. This is due to the compartmentalized way in which care is organized. Caregiving is supply-oriented and not tailored to the needs and abilities of these people. Two studies, “Bridge building” by Kal (2001) and “A theory of presence” by Baart (2001) have helped to put this topic onto the social agenda.However, a method has been developed in mental health care to support people with psychiatric problems in everyday life. Beginning on a small scale in the 1990s, the use of a social support system involves a network of individuals and organizations that supports those with a history of psychiatric issues in their daily lives. The bridge builders (professionals who work towards an inclusive society) and the “experts-by-experience” are at the centre of this social support system. They try to eliminate any mismatches and to align the support needed with the support provided. To prevent the compartmentalization of the care, they seek to cooperate with the organizations involved in the household. Based on the principle of joint responsibility, they manage the care given in consultation with the people concerned.Since 2010, care in the Netherlands has increasingly become community-based. Professionals who were previously based in different institutions for people with mental illness, addiction or a mental disability, now organize themselves regionally. Their work has changed in two ways: firstly, they must now cooperate with professionals from different sectors working in a particular area, and secondly, their work takes place in a setting where communication is horizontal rather than hierarchical.It was in this context that the organization for mental health clients in Eindhoven launched a project to form Communities of Practice (CoPs) in different areas of Eindhoven and its surroundings in 2011. A CoP is a learning group of professionals with different backgrounds who work on the same case, and who improve their competencies by regularly sharing and exchanging knowledge and experience. The main aim of a CoP is to learn from and with each other (social learning). Good relationships form the basis for these learning processes and the development of competencies.The community provides a framework for the learning processes of the participants. Ideally, CoPs should be based on existing voluntary networks since these are informal and self-managing. Such networks can be found in the social support systems of Eindhoven and surroundings, and professionals and experts already have experience of working together in these networks.The contribution of experts-by-experience lends an extra dimension to the CoP. Their approach is known as the “recovery” approach. Recovery is a concept developed by clients in mental health care. According to Wilma Boevink, a prominent member of the recovery movement, “recovery means finding a meaningful life with or without the mental illness.” (Boevink, Prinsen, Elfers, Dröes, Tiber & Wilrycx, 2009, in Dröes & Witsenburg, 2012, p. 57)The motivation for the formation of a CoP is the idea that learning from each other’s practices can promote cooperation between professionals and between professionals and experts-by-experience. Cooperation within the CoP also promotes the professional development of the skills needed to work in the community.The programme of CoP meetings involves getting to know each other and each other’s work. Meetings in the learning group have a positive effect on cooperation and the most important aspect of the programme is case-based learning. The learning processes in the CoPs have resulted in several innovative notions. The first notion is the perception that the complex situation of the client should form the starting point for support. As such, cooperation between professionals from different sectors is inevitable, because the client’s problems are related to different domains of life.The second notion is that the complexity of the client’s problems and the question of what is appropriate support can only be understood from the life perspective of those involved. Expertsby- experience serve as an example in this respect. In every case study, they have focused on the way people experience their lives. Regularly, their contribution has led to a new perspective on the situation. Professionals often take an “outsider’s perspective”: this person has debts or that person has social problems, and so on. The experts-by-experience often challenge the professionals to look at the situation in the way the client experiences it.The third notion is that recovery-oriented care in community-based cooperation requires certain competencies. Professionals, who are used to being based at institutions, have to get used to the increase in their range of control. Three competencies are important: proactive behaviour, cooperative action and reflection. Proactive behaviour involves knowing that you can make the difference in a case. Cooperative action refers to the ability to deal with a range of different ideas on common goals and cooperation. Reflection is necessary not only because of the complexity of the problems and the effectiveness of the action, but also because of the value and meaning of the objectives that the action is intended to bring about.In conclusion, the formation of COPs strengthens the cooperation between professionals from different sectors. The learning groups provided the opportunity to become familiar with a different approach. The recovery-oriented approach proved to be more suitable when providing support for people with complex multiple problems. The professionals in the CoPs who had previously been used to working within institutions became more aware of the increase in their range of control in community-based cooperation and consequently their need to develop the competencies required Communities of Practice. Niches voor de samenwerking tussen ervaringswerkers en professionals bij gebiedsgericht werkenSinds de eeuwwisseling zijn er in Nederland steeds vaker problemen geconstateerd in de zorg aan mensen met meervoudige complexe problematiek. De zorgverlening is verkokerd, aanbodgericht en is niet afgestemd op de behoeften en mogelijkheden van deze mensen (zie Baart, 2001 en Kal, 2001). Met de transitie AWBZ-WMO komt een deel van de professionals uit de geestelijke gezondheidszorg, verslavingszorg en verstandelijk gehandicaptenzorg onder de regie van de gemeente te vallen. Gemeenten maken steeds vaker beleid op gebiedsgericht werken om de problemen in de zorg en de ontwikkeling als gevolg van de transitie te managen. Om de samenwerking tussen professionals en tussen professionals en ervaringswerkers te bevorderen, is in het project “werk voor ervaringsdeskundigen” het initiatief genomen voor het organiseren van “Communities of Practice” (CoP). CoP’s zijn leergroepen van professionals die hun competenties willen ontwikkelen, om een gezamenlijk vraagstuk in hun praktijk beter te kunnen hanteren. Een benadering die adequaat is in de ondersteuning van mensen met complexe meervoudige problematiek is de herstelondersteunende zorg. Door de deelname van ervaringswerkers aan de CoP’s zijn professionals bekend geraakt met deze benadering. Daarnaast hebben de leerprocessen in de CoP’s betrekking gehad op het ontwikkelen van competenties om de toegenomen handelingsruimte bij gebiedsgericht werken te kunnen hanteren.