Translations

Citation

Johnson, R. (2014), "Translations", Housing, Care and Support, Vol. 17 No. 1. https://doi.org/10.1108/HCS-12-2013-0027

Translations

Article Type: Editorial From: Housing, Care and Support, Volume 17, Issue 1

“In the voluntary sector, we are familiar with the way that funding opportunities can shape projects”, write Woodcock and Gill, in their paper on working with youth homelessness; and it is probably true that the voluntary sector has been most adept at adjusting its “offer” of services to the nature of the funding in the changing economic and services frameworks in which we must all now operate. As in many other western nations where the philosophy of New Public Management has developed, many functions previously delivered by the state are now provided, under contract, by the sector; and the terms of that trade shift continuously.

But it is not solely voluntary sector provision that is shaped and defined by its funding programmes. The same is equally true of mainstream government programmes, such as direct provision of healthcare, personal social services, criminal justice, public health, or homelessness prevention. Here, too, the original centralised organisation of services creates divisions of core responsibility between, for example, health and social care, or criminal justice and substance abuse services; and the irony is that governments then spend much of their time trying to find ways to get these sectors to work together after all.

Even so, it is not simply projects “on the ground” that are shaped by funding programmes. Human biology may be the same everywhere, as we have remarked before; but the research that is commissioned to tackle health and social problems is typically focused on locally funded programmes, and their priorities. The organisation of research funding, as much as the terms and terminology of services’ eligibility criteria, shapes the research which is undertaken, concerned to assess the value or impact of these services, as defined by the funding programmes that shape them. Pure research is a rarity here; all research funding is for applications.

For a journal which is committed to developing an inter-disciplinary and international approach to what is inevitably a complex and multifaceted issue, this raises particular challenges, in that we must take especial care to check the real transferability, the translation of research and development from one country or setting to another. Even the same word, used in one context, may mean something rather different in another. Constant vigilance is the price of comparative research, and the search for genuinely useful, generalisable terminology and typology also reveals another key aspect of research in this field: the need for care in translations of learning and experience from one area to another.

Yet every collection of papers here seems to develop its own underlying themes or threads that connect the issues. In this first collection marking the start of 2014, several of our papers are in fact specifically focused on identifying the essential features of particular aspects of housing with care and support services, that may lend themselves to a greater internationalism in approach.

In the first paper in this collection, Patricia Dearnaley continues and concludes her exploration of the nature of the emerging market for the provision of social care, within the policy and funding framework of New Public Management – characterised by commissioning and purchasing mechanisms, often devolved, alongside highly regulated services for the vulnerable, in which the state still plays a major role, in setting the rules and the terms of trade. Services are businesses now; but how far, Dearnaley asks, do the standard tools of business practice actually help, in understanding opportunities, assessing markets, and customising services, in this “contrived” market?

How far do the concepts of commercial business really translate into usable tools in this more complex economy, from the point of view of, for example, a social housing agency considering entering this rather peculiar “marketplace” for services? In this her final paper in the trilogy, she puts forward a new framework, the External Drivers Model for market analysis and strategy. Part case study, part conceptual critique, her paper shows the housing with care sector beginning to contribute new thinking on business practice, and no longer simply relying on frameworks derived from other sectors.

In our second paper, Teresa Atkinson and her colleagues also address the commissioning and delivery of social care in housing with care settings, focusing more explicitly on provision of care for an ageing population. They begin with a literature review on housing with care in the UK; but as soon as that literature review attempted, for comparative analysis, to trace comparable services for comparable needs in other countries, even within the English-speaking world, it was immediately confronted by a plethora of terms that confuse the effort at mapping.

It takes considerable care to elicit, within this “multitude of models”, the underlying threads and consistencies. As they also point out, it is important, when interpreting findings on, for example, the social contact of residents of retirement villages or extra-care housing, to recognise the possible influence of different cultures and geographies, even between the UK, the USA, and Australia. Once again, we must interpret findings from studies in any one country with a full awareness of the complex ecology of circumstances.

Yet this is no counsel of despair; they do begin to refine out, within the Babel of local languages, a range of essential issues in these integrated service models, features that could contribute to a more generalisable typology. These include, for example the nature and quality of the built environment, tenure and facilities, the relationship between the various component features. One issue they pick out is the style of delivery of care services, from protectively controlling to supportive; but this is a theme that we will find with other client groups, too.

Jon Burgoyne, in our third paper, has likewise addressed the settings of care and support, but with mental health as the client group; and here he considers the nature and quality of the housing that enables users to benefit from support, to achieve an improved quality of life. Thus he too aims to explore the housing itself – the built environment – as an element in its own right, and not just in the form of integrated housing, whether “with care”, or with “housing-related support” – this being a term, incidentally, that only makes any sense by historical reference to the original source of funding which, for a brief period, allowed the development of new services and approaches in the UK.

Burgoyne attempts to get underneath these funding programme-driven terminologies and typologies of housing, by selecting for study only accounts that directly relied upon or related to residents’ own accounts of what matters to them. Burgoyne's approach may be especially useful for more comparative study in so far as his proposed terminology, a “Tripod” model based on autonomy, “domain” and facilitation, carefully avoids the culturally and historically loaded, quasi-technical terms “care” and “support”.

Focusing on the personal meaning of housing and support, Burgoyne also contrasts more quantitative with more qualitative approaches, suggesting that an apparent preference for quantitative studies in the US literature, as compared to the UK, may reflect stronger roots of housing research in the social sciences in the UK, rather than more clinical approaches in the USA. It would be valuable perhaps to hear this dichotomy explored in depth, from both sides of the Atlantic – and beyond.

Funding everywhere seems to favour quantities, and estimates of cost savings. But it is only at local level, very often, that the full value of complex interventions is really appreciated in depth. Also looking at mental health and housing, but from a more historical perspective, in our next paper David Abrahamson looks back on a long career working with local housing services to create homes for the high-dependency population that used to find their lives consigned to the “long stay” or “back wards” of our old, Victorian mental hospitals.

Abrahamson's paper thus deals with translations of a different kind: the ways that the patients in his care – long-term patients, institutionalised and supposedly withdrawn and apathetic as feature of their illness – could be seen to behave and to relate to each other, when given the opportunity to form more natural relationships and affinity groups, via shared housing. Changes in the real life situation of Abrahamson's patients allowed changes that the more institutional environment had disallowed and suppressed.

In our day, we have seen more attention and resources devoted to allowing and supporting the chronically sick and disabled to live an ordinary life. Underlying his paper we glimpse another significant transition, taking place slowly, over a generation, from the older orthodox bio-medical psychiatry that had characterised so much of the twentieth century, to a more psycho-social model, and what we then called “normalisation”. There are valuable lessons in this; and in Abrahamson's paper we can see also the urgency in his concern to see the experience of one generation passed on to the next, and a fear that an excessive concern for safety and control can again take precedence over support and individuality, with disastrous effects.

Woodcock, in their paper on developing a PIE – a psychologically informed environment – for young homeless persons, are also involved with translation of a kind. Much of the earlier descriptions and analysis of PIEs in homelessness resettlement was drawn from examples of hostels, shelters, refuges and outreach services working with adults, and the kinds of problems and complex needs that they brought, the challenges for the services to address. But young people present with rather different problems, other histories, and especially, opportunities and potential for change that are no less complex for being less entrenched.

The general framework of the PIE philosophy – a “psychological” model, attention to the built environment and the social spaces and opportunities for interactions it creates, attention to staff training and support, the “rules of engagement” around participation and sanctions, and the need for “evidence generating practice” – are all in evidence here, but carefully translated into the issues that may present with the more protean sense of self and personal identity that comes with youth.

One rather striking innovation in the concept here is the idea that the built environment can mean not just the use of the buildings that the project itself owns, but enabling and encouraging their young clientèle to make use of other environments and social spaces that ordinary citizens use. The need to find or create a passport to ordinary adulthood also shows in their development of mentoring. Offering role models and perspectives outside the world of services may be seen, for troubled youngsters, as an age-specific form of “normalisation”.

Our final paper is perhaps the most adventurous yet in seeking an international comparative perspective on homelessness resettlement work. Claude Chevrier's paper is a transcript of a speech given to a symposium of psychotherapists, describing the recent development of homeless reception and resettlement centres in one district in Paris, where the hostel team have been deeply influenced by the thinking of the French psychoanalyst, Jacques Lacan. It is an approach to the notion of a hostel as potentially a psychologically informed environment that seems to have sprung up, entirely independently of the current interest in this possibility, emerging in the UK.

Here though we have further challenges of translating: of an original text, from French to English; of the distinctive terminology of different legal frameworks, and their care and support agencies; and of the perspective of psychoanalysis, and especially that of translating the radically post-modern (and notoriously obscure) Lacanian thinking, into the more familiar Anglo-Saxon mindset. Finally, we have Chevrier's own concern to apply the sophistications of psychodynamic analysis to the more rough-hewn world of homelessness. Nevertheless, outside the English-speaking (and writing) world, Lacan is now probably one of the most influential of thinkers within the psychoanalytic community; it will be very interesting to see how far this different language and perspective may strike a chord.

Under the circumstances, then, it is remarkable how easily recognisable is the picture of the service Chevrier describes: the remodelling of the building, the shift from a culture of wariness, control and “surveillance” to one of support and enrichment, the emotional charge of the relationship work, the support needed, and offered, for both service users and staff. All-too-recognisable, too, are the deep misgivings he expresses of those who have clearly worked hard to re-shape the nature of homelessness reception, and indeed of therapy, in the name of “humanisation”, when faced with the challenge posed by the adoption of a more rights-based approach, and the principles of “Chez Soi D’Abord” – Housing First. This is a question we must return to, in future issues.

Different government programmes, for differently funded services, are now expected to try to find ways to work together, across unhelpful institutional boundaries, to meet complex and changing needs. Likewise, the different national and international research communities and their various vocabularies need more fluid boundaries, as we move research and evidence generating practice outside the laboratory and the clinic. In this journal, we provide at least a meeting place for a wide range of approaches to understanding, to tackle the complexities of applied work in a complex world.

Robin Johnson