4. Themes, case examples, and questions for reflexivity

4.2. Historical awareness

The second theme builds upon the socio-structural level of reflexivity, and concentrates on the importance of health and social care professionals’ historical awareness of how their professional identity and public mandate has been conceived and defined. INORP’s comparative literature review on participative practices in European countries shows the importance of paying attention to the respective historical, socio-political, economic, and cultural contexts in which practice, education, and research evolve and have been developed.

“Having a voice” has become a core attribute of modern citizenship, as the idea of participation has emerged since the era of the enlightenment. After the second World War in Europe, the welfare state was constituted (Marshall, 1964). Since the conception of post-war welfare states, the symbolic vehicles of citizenship and civic, political and social rights were introduced and institutionalized, which settles a public responsibility of the state for the welfare of citizens. Rights-oriented approaches commonly imply that citizens in European societies are entitled to welfare benefits, resources and services that are redistributed by the welfare state (Lister, 2004). As part of the institutionalization of welfare state structures and arrangements, social work has acquired a relatively autonomous professional position and a public mandate of the welfare state to strive for social justice and human rights (Dean, 2017). The professional role of social work has thus been situated as an actor shaping the interplay between the interests and concerns of citizens at the individual level, and the acquisition of civil, political and social rights at the structural level (Bouverne-De Bie, 2015).  

However, historical reflections and contemporary transformation of the welfare state make clear that all versions of citizenship and rights were established only gradually, and remain only partially granted to certain sections of the population (Kessl, 2009; Dewanckel et al., 2021). Citizenship and rights were extended as consequences of historical, social and political struggle in which social movements like the labor, the feminist, the civil rights, the children’s rights, and the disability rights movements played a key role. However, forms of insecure citizenship, or so-called ‘denizenship’ (Turner, 2016) currently refer to how the state contributes to the erosion of protective structures and solidarity towards citizens who have formal citizenship rights, yet especially towards people who migrate and are not protected due to a territorial logic.

During these transitions, participation still carries features of conflict and agency that challenges and confronts norms, power structures and relationships, and systemic inequalities, and thus contains a pedagogical element: the articulation of “voice” to transform private concerns into public issues necessarily involves a public and democratic learning process (Grunwald & Thiersch, 2009). One of the hallmarks of professional social work is the recognition of the rights of service users, as citizens in their own right. As a key example, a social pedagogical approach can be seen as giving recognition to the life knowledge and capacities of service users, which professional interventions need to build upon rather than “correct” their behaviors (Köngeter & Schröer, 2013), and thus reproducing the question who is deserving or not (Krumer-Nevo, 2016; Garrett, 2019).

For professional social work, this raises the question to which extent excluded, marginalized and powerless people can make use of the required resources (such as knowledge, power, and means) and services, raise their voice, and claim rights without becoming dependent on support. This ambiguity at stake in the public mandate of social work requires a crucial reflexivity. How to deal, for example, with the paradoxical positioning of survivors and self-advocacy initiatives sharply criticizing public institutions and services, while knowing they might simultaneously need support to bring social transformation and change? Self-advocacy movements, service users and survivors groups nowadays continue to play an important role in shaping the social and health service landscape. However their agendas, modes of operating and engagement with formal political structures still vary considerably according to the prevalent political cultures within countries. Many social work initiatives realized only gradually that their efforts could easily turn into tokenistic forms of participation due to new, often more powerful and paternalistic, forms of oppression and exclusion.

Case example 1: Adult safeguarding practices in cases of coercive control: by promoting service users' autonomy and participation can reflexive social work practice be a catalyst for change in the cycle of abuse?  (Ireland) 

In one of the Irish case studies, it became clear that an understanding and discussion of the historical context of Irish health service is crucial to develop reflexive ways of engaging in participatory approaches with health service users. The Irish health service has seen a radical shift in the past 50 years, moving from a legacy of Catholic subsidiarity towards a ‘mixed economy of welfare’ combining voluntary sector and state provision of health and social care services (Fanning, 1999, p.67). The traditional Catholic ethos enshrined in the state constitution has been steadily eroded by social movements which have successfully enshrined equal rights to LGBTQ+ citizens and abortion rights to women. Notwithstanding this radical improvement in citizenship rights, the provision of services to disabled and older adults still operates within a medicalized model of care which traces its origins back to the dual influence of the Catholic Church and the medical profession on Irish social policy (Iredale 1999). The Irish case study reflected on the practice of safeguarding social work in Ireland and on how social work practitioners negotiate the power imbalance that situates them as expert purveyors of advice and guidance to citizens with a lived experience of harm. The ‘safety zones’ or spaces utilized by those experiencing coercive control is well documented in the literature (Stark 2007, p.216; Johnson, 2008). In the context of this case study, the researcher asks whether safeguarding social workers take cognizance of this ‘insider knowledge’ when developing safety plans for adults at risk of harm? What happens when service users adopt safety strategies that challenge the professional assessment/normative view of harm as conceptualized by the state and their agents? The provision of safeguarding social work in Ireland is based on the premise that harms can be irradiated or minimized on a micro-familial level without challenging the socio-structural inequalities that result in older and disabled persons being left reliant on their families to provide for their care and support needs. Therefore social workers’ attempts to promote democratic and participatory practice is often stymied by the Irish state’s inadequate provision of care and support services to those in greatest need.

Critical questions for reflexivity

  • Many case studies refer to the aim of participative approaches to play a key role in supporting ‘the best interest’ of the service users. However, several case studies point to potential tensions between health and social professionals having/wanting to work in the best interest of the service user and the (historical) expectations from legislative and policy frameworks. What strategies can be used in these instances? What can be supportive for professionals and health or social organizations in these instances? 
  • As a health or social professional, it is important to develop an awareness of the historical (re)configuration of one’s professional identity and public mandate. Part of this awareness is to also think through in what ways these historical processes impact how society at large and citizens as (potential) service users perceive specific health and social professions and services. Is there stigma attached to getting social services or is it considered a right and entitlement of all citizens? How might this impact your practice and how do you then deal with this?