Prospective research into de-instutionalization and regionalizing responsibilities on social relief and protected living in municipalities

Since 2015, the large municipalities have been responsible for sheltered housing and social welfare and all municipalities for extramural mentoring (including daytime activities). Although municipalities have been experimenting with ambulantisering for some time (e.g. the Housing First programme, Maas et al., 2012), the structural embedding of it has not yet taken place. However, the duty of municipalities is to reach 30% living in facilities, and as much social inclusion and participation as possible (UN convention). For this reason, the Committee of the Future of Sheltered Housing advocated shifting the budget originally allocated on the basis of historical costs – from 43 municipalities to 388 municipalities via an objective distribution model. While these factual criteria seem hard to quantify, it is particularly important for clients how this transition affects their quality of life, and to what extent they, as care users, gain influence and have a more direct say in the phase of implementation and policy.

For municipalities, the numbers and characteristics of the population, the opening up of the Long-term Care Act (Wlz), the macro budget, the phasing out in the judicial domain and the mental health care (GGZ) and the more complex problems in cities (APE, 2017) are currently vague. Sector parties (Federatie Opvang, GGZ Nederland, RIBW Alliantie and MIND – National Platform on Psychological Health) wrote a letter to the Chamber on 30 August 2017 stating that they would embrace the motion towards an inclusive society and would actively take part in it. However, they would like to see more time spent on the preparation and the realisation of pre-conditions.

On 5 October 2017, it has been decided to postpone the decision and to allow as pre-conditions for ambulantisering: the availability of affordable rental housing and variety of types of housing; debt assistance, income and participation to support recovery; recovery-oriented treatment in the area; ensuring a quality and reactive support; presence of a system of (early) identification and nuisance approach; sustainable cooperation between municipality and insurers and commitment to self-management, expertise and informal care.
The goal of this research is to follow, along with clients and experts, whose quality of life is concerned, and other relevant stakeholders, the preparation for this decentralisation and the improvement of these pre-conditions in municipalities, in order to learn together on the basis of experience gathered from the start, and to reflect on it and take action. Maximum participation means actively taking into account the say and perspective of the clients as end users as well as professional perspectives during this transition.

Research questions
Since the purpose of this research is to ultimately find out what it takes to administratively facilitate this cultural innovation change and to achieve inclusive living or ambulantisering in order to improve the clients quality of life, we asked ourselves the following questions:

  1. To what extent can ambulantisering be implemented locally in 388 municipalities (e.g. training place among care users; collaboration with users)? This database is a source of learning and knowledge sharing.
  2. In what way do local authorities and involved stakeholders (Social support acts, policymakers, housing companies, mental health care, police) could implement the ambulantisering?
  3. What are the outcomes at this local level? How are they valued from different stakeholder perspectives and clients/care users?
  4. To what extent do these contextual processes and the cooperation (participation and partnership) between local authorities and affected stakeholders explain the outcomes of the policy? What works ‘well’ and which ‘best practices’ can be separated?

Stakeholders, including experienced clients, are actively involved from the start in the concept of the research (sharpening the objective and the questions, design) and the formulation of additional outcome measures, in addition to the measures in the second and third columns of the model below. This participative, learning and appreciative method supports the transition by constantly providing interim feedback so that adjustments can be made. Answering the question of whether the way of local guiding makes a difference to what is proposed and what the results are, will contribute to more knowledge about managing in the care domain. The theoretical model below provides an overview of what we know so far about these processes and their outcomes (figure from Boesveldt, 2015).

1. From January 1st2018, guidelines description of the characteristics of the regional visions (explicitly and including the perspective of end users), which are then written together with regional municipalities (data collection for management purposes).
2. Selection on the basis of the main characteristics of a number of these regions and cities for thorough analysis (interviews) based on population, population density (urban/rural) with an eye for specific cases such as the municipality of Ede (a lot of m2) and Apeldoorn (a lot of clinical mental health care). During the review of the regional visions, it may appear that additional characteristics such as control philosophy and degree of participation of users are important as extra eligibility criteria.
3. From September 2018, discussing and establishing the intended results, monitoring and evaluating of the outcomes (and non-expected side effects) from different stakeholder perspectives.
4. Interim evaluation and repeating these steps with case studies by other municipalities, cooperatively determining what works ‘well’ and describing and sharing the best practices.
The research suggested here has a length of action of five years and can count on the support of municipalities, suppliers, insurers and clients.

Time investment requested
The time investment requested is as minimal and effective as possible. Annually, one hour per interview, and attending 2 meetings. In the same way, the design of the study is interactive. As part of the yearly reports, the University of Amsterdam can organise conversational presentations, based on the initial data, in which there will be room to clarify points for researchers. The final report of all municipalities and the observed trends are also shared by means of digital forms and quizzes, so that it will stick.

The funding structure is that each municipality or region commits on an annual basis. The final amount will depend on the number of municipalities cooperating and the time frame. The amount will also clearly depends on the number of clients or if few communes/regions participate. The budget will be specific to the concerned municipality(ies)/region(s).

Team members and roles
The team and Dr. Nienke F. Boesveldt for the University of Amsterdam collectively secure a generous network among municipalities, and a considerable expertise and experience in research in the local cooperation and client participation’s sphere. Having worked for municipalities for 15 years, Dr. Boesveldt is well experimented on these processes for social care, day care and assisted living. The ultimate responsibility for this research belongs to the University of Amsterdam, Dr. Boesveldt.

For more information, please contact Dr. Nienke Boesveldt
06 42 12 80 51