The Perils of Comparison

1
The Perils of Comparison

• Roles and Tasks,
• Structures and Processes
• in
• Comparative Social Care Research

2
Aims

• To present a work in progress, a case study of
  a case management service for older people in
  Berlin
• To outline some of the difficulties and
  challenges of determining the equivalence of
  roles and tasks, structures and processes in
  cross national research
• To illustrate problems of translation and
  conceptual equivalence using the example of
  Assessment

3
Why am I researching Case Management in Berlin?

• CM developed in USA, spread internationally
• Influence in UK care management in Community
  Care
• Interested in
• how do policies and practices translate from
  one national welfare context to another?
• is it possible to learn from experiences in other
  countries?

4
All about AgeA city wide CM service in Berlin
5
Opportunity

• Award of TH Marshall Fellowship in European
  Social Policy, Sept-Dec 2007 (LSE and VW
  Foundation)
• Opportunity to explore CM within German social
  policy and legislative context
• 3 days of every week spent in a local borough
  office of Rund ums Alter
• 2 days spent in the Katholische Hochschule für
  Sozialwesen Berlin (HEI)

6
BerlinOst und West
7
1. KST Office 2. KHSB
8
Methodology

• Case study appropriate approach to phenomenon
  in context
• Usually incorporates several methods
• Combination of interviews and documentary
  research most typical in cross-national research
  (Mangen 1999)
• Significant ethnographic element in this study,
  central to understanding case management in
  context from front line

9
Case/Care Management in Context
Wider Cultural Context
National Legislation and Policies
Local/Regional Policies
Service Network
Personal Network
Case Manager
Service User
10
Key Problems inCross National Research

• Issues of conceptual equivalence and
  interpretation and the potential impact of the
  researchers own cultural background (Hantrais
  1999)
• The equivalence of policies, structures, systems
  and professional roles the linguistic and
  conceptual equivalence of terms, e.g. community
  care (Baistow 2000)
• Social work, services, and policy not necessarily
  homogenous within countries ideas and ways of
  working not necessarily transferable between
  countries (Askeland Payne 2001)

11
Enchanting voices, hidden rocks

• Navigating similarity and difference
• Similar or different to what?
• Tacit knowledge and comparison

12
Roles and Tasks 1Researcher and Researched

• Identity issuesWho am I? (and what am I doing
  here?)
• Researcher or (researching) professional?
• Interpreter, translator (Temple 1997)
• Insider, outsider
• (and one-man band!)

• Questions of language, culture and relationship
• Ossies und Wessies
• Du oder Sie?
• Research Subjects or Collaborators?

13
Roles and Tasks 2What does a social worker do
here?

• Beratung
• Case Managementein deutscher Begriff!
• Wohnungs-anpassung

• From advice to counselling
• Case managementa German expression!
• Adaptations in the home

14
Structures 1 Germany
15
Structures 1 UK
16
Structures 2Funding and Legislation
17
Structures 3Subsidiarityother Actors in the
System

• Die Freien Trägeran untranslateable concept?
• Die Krankenkassen und die Pflegekassen

• Third sector provider organisations with
  constitutionally protected priority role in
  welfare
• The health and care insurance fund organisations

18
Processes 1Formal Definitions of Case/Care
Management

• Dept. of Health 1991 guidance
• Providing information
• Assessing need
• Care planning
• Implementing the care plan
• Monitoring the care plan
• Reviewing the need and altering the care plan if
  necessary

• From 2007 leaflet Konzeption
• Intake (sic)
• Assessment (Bedarfsanalyse)
• Hilfeplanung
• Implementierung (Organisation und Koordination)
• Monitoring (Leistungsüberwachung)
• Evaluation der Ergebnisse
• Entpflichtung

19
Processes 2Assessment and access to care
services

• First port of call MDK (the Medical Service of
  the Health Insurance Funds)
• SGB XI 18 Verfahren zur Feststellung der
  Pflegebedürftigkeit (process for determining the
  need for care), Pflegestufe (care level) 1, 2, 3

• Rund ums Alter additional low threshold
  service commissioned by the Land-level govt under
  duty to develop infrastructure
• Service users mostly already had care level
  determined by MDK

20
Translation and Equivalence of Concepts the
Importance of Context

• English
• The assessment
• The CCA looks more like SGB XII
• Assessment under CCA equates to the procedure for
  determining the level of care

• German
• Das Assessment
• Different term used to describe the procedure for
  determining the level of care die Begutachtung

21
Final thoughts

• Terminological difficulties inherent in social
  science, with diffuse, imprecise and constantly
  changing terms (Grayson Gomersall 2003)
• General problem of ascribing entity boundaries,
  i.e. carving up the social world (Dunne et al.,
  2005 Smith, 2006)
• Which problems arise from cross national or cross
  cultural contexts in particular and which arise
  from working across different languages?

22
References

• Askeland, G. A. Payne, M. (2001) Broadening the
  mind cross-national activities in social work.
  European Journal of Social Work, 4(3), 263-274.
• Baistow, K. (2000) Cross-national research What
  can we learn from inter-country comparisons?
  Social Work in Europe, 7(3), 8-13.
• Dunne, M., Pryor, J. Yates, P. (2005) Becoming
  a Researcher A Research Companion for the Social
  Sciences, Maidenhead, Open University Press.
• Esping-Andersen, G. (1990) TheThree Worlds of
  Welfare Capitalism, Cambridge, Polity Press.
• Grayson, L. Gomersall, A. (2003) A difficult
  business finding the evidence for social science
  reviews. Centre for Evidence Based Policy and
  Practice. Queen Mary College, University of
  London, ESRC.
• Hantrais, L. (1999) Contextualization in
  cross-national comparative research.
  International Journal of Social Research
  Methodology, 2(2), 93-108.
• Mangen, S. (1999) Qualitative research methods in
  cross-national settings. International Journal of
  Social Research Methodology, 2(2), 109-124.
• Smith, B. H. (2006) Scandalous Knowledge
  Science, Truth and the Human, Duke University
  Press.
• Temple, B. (1997) Watch your tongue Issues in
  translation and cross-cultural research.
  Sociology, 31(3), 607.