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社区精神卫生服务的联合生产:丹麦公共服务与公民社会之间的互动组织

Co-production of community mental health services: Organising the interplay between public services and civil society in Denmark.

作者信息

Vaeggemose Ulla, Ankersen Pia Vedel, Aagaard Jørgen, Burau Viola

机构信息

DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark.

Unit for Psychiatric Research and Department S, Aalborg University Hospital, Psychiatric Hospital, Aalborg, Denmark.

出版信息

Health Soc Care Community. 2018 Jan;26(1):122-130. doi: 10.1111/hsc.12468. Epub 2017 Jul 2.

Abstract

Co-production involves knowledge and skills based on both lived experiences of citizens and professionally training of staff. In Europe, co-production is viewed as an essential tool for meeting the demographic, political and economic challenges of welfare states. However, co-production is facing challenges because public services and civil society are rooted in two very different logics. These challenges are typically encountered by provider organisations and their staff who must convert policies and strategies into practice. Denmark is a welfare state with a strong public services sector and a relatively low involvement of volunteers. The aim of this study was to investigate how provider organisations and their staff navigate between the two logics. The present analysis is a critical case study of two municipalities selected from seven participating municipalities, for their maximum diversity. The study setting was the Community Families programme, which aim to support the social network of mental health users by offering regular contact with selected private families/individuals. The task of the municipalities was to initiate and support Community Families. The analysis built on qualitative data generated at the organisational level in the seven participating municipalities. Within the two "case study" municipalities, qualitative interviews were conducted with front-line co-ordinators (six) and line managers (two). The interviews were recorded, transcribed verbatim and coded using the software program NVivo. The results confirm the central role played by staff and identify a close interplay between public services and civil society logics as essential for the organisation of co-production. Corresponding objectives, activities and collaborative relations of provider organisations are keys for facilitating the co-productive practice of individual staff. Organised in this way, co-production can succeed even in a mental health setting associated with social stigma and in a welfare state dominated by public services.

摘要

共同生产涉及基于公民生活经验和工作人员专业培训的知识与技能。在欧洲,共同生产被视为应对福利国家人口、政治和经济挑战的重要工具。然而,共同生产正面临挑战,因为公共服务和公民社会植根于两种截然不同的逻辑。这些挑战通常由提供者组织及其工作人员所面临,他们必须将政策和战略转化为实际行动。丹麦是一个福利国家,公共服务部门强大,志愿者参与度相对较低。本研究的目的是调查提供者组织及其工作人员如何在这两种逻辑之间进行协调。本分析是对从七个参与的市政当局中选出的两个市政当局进行的关键案例研究,因其具有最大的多样性。研究背景是社区家庭计划,其旨在通过与选定的私人家庭/个人定期联系来支持心理健康服务使用者的社交网络。市政当局的任务是启动并支持社区家庭计划。该分析基于七个参与市政当局在组织层面产生的定性数据。在两个“案例研究”市政当局中,对一线协调员(六人)和部门经理(两人)进行了定性访谈。访谈进行了录音,逐字转录,并使用NVivo软件程序进行编码。结果证实了工作人员所发挥的核心作用,并确定公共服务和公民社会逻辑之间的密切相互作用对于共同生产的组织至关重要。提供者组织相应的目标、活动和合作关系是促进个体工作人员共同生产实践的关键。以这种方式组织起来,即使在与社会污名相关的心理健康环境以及由公共服务主导的福利国家中,共同生产也能够取得成功。

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