Boundary work in inter-agency and interprofessional client transitions.

This article analyses the accomplishment of boundary work performed by professionals engaged in inter-agency collaboration. As a means of building authority within a particular field, boundary work is found to be a common feature of most professional practices. By analysing the talk of Finnish professionals who work in the field of supported housing in mental health, the article investigates the ways professionals--as collective representatives of their service--talk about doing boundary work when transferring their clients to another agency. The study drew on the principles of exploratory case study design and ethnomethodology. A key finding from the analysis of professionals' focus groups and team meetings indicated that boundary work is employed when disputes arise between supported housing and collaborating agencies. The article goes on to suggest that professionals accomplish boundary work by rhetorically presenting themselves as holders of "day-to-day evidence" of clients' mundane living skills and serious ill-health. The paper concludes by arguing that in inter-agency collaboration, boundary work building on day-to-day evidence is used to influence the decision on the most appropriate living arrangement for the client. Boundary work is also used for boosting the authority of professionals as representatives of a relatively new and fixed-term agency in the service system.

Causal accounts as a consequential device in categorizing mental health and substance abuse problems.

Professionals in human service work are at the centre of complicated client cases. The ways client cases are constructed and the problems explained form the basis for professionals' assessments, decisions, actions and interventions. In this article the ways professionals make sense of dual-diagnosis client cases are examined. Applying the concept of causal accounting, it is argued that 'theories of cause' are embedded in professional discourse and profoundly shape professionals' understandings of social and health problems, as well as of their own roles and responsibilities and of what interventions and outcomes are possible. The data consist of 48 tape-recorded weekly team meetings among professionals in a supported housing unit targeted for clients with both mental health and substance abuse problems. It was found that professionals reason about the relationship between these two problems in four different ways: (1) substance abuse causes or makes mental health problems worse; (2) substance abuse eases mental health problems; (3) mental health problems cause or make substance abuse worse; or (4) good mental health reduces substance abuse. Causal account research makes visible the ways professionals do institutional work by categorizing clients, accounting for responsibilities as well as assessing their work and clients' achievements according to moral expectations of a 'good'professional and a worthy client.

Inter-professional electronic documents and child health: a study of persisting non-electronic communication in the use of electronic documents.

Information and communication technologies are widely used in health and social care settings to replace previous means of record keeping, assessment and communication. Commentary on the strengths and weaknesses of such systems abound, thus it is useful to examine how they are used in practice. This article draws on findings from two separate studies, conducted between 2005 and 2007, which examined how child health and welfare professionals use electronic documents in Finland and England. Known respectively as Miranda and CAF, these systems are different in terms of structure and function but in their everyday use common features are identified, notably the continued use of and reliance on non-electronic means of communication. Based on interviews with professionals, three forms of non-electronic communication are described: alternative records, phone calls and letters, which facilitate the sharing of the electronic record. Finally, the electronic documents are further analysed as potential boundary objects which aim to create common understanding between sites and professionals.

Managerial reforms and specialised psychiatric care: a study of resistive practices performed by mental health practitioners.

Throughout Western Europe, psychiatric care has been subjected to 'modernisation' by the implementation of various managerial reforms in order to achieve improved mental health services. This paper examines how practitioners resist specific managerial reforms introduced in Finnish outpatient clinics and a child psychiatry clinic. The empirical study involves documentary research and semi-structured interviews with doctors, psychologists, nurses and social workers. The analysis draws on notions of Foucault's conception of resistance as subtle strategies. Three forms of professional resistance are outlined: dismissive responses to clinical guidelines; a critical stance towards new managerial models; and improvised use of newly introduced information and communications technologies (ICTs). Resistance manifests itself as moderate modifications of practice, since more explicit opposition would challenge the managerial rhetoric of psychiatric care which is promoted in terms of positive connotations of client-centredness, users' rights, and the quality of the care. Therefore, instead of strongly challenging managerial reforms, practitioners keep them 'alive' and ongoing by continuously improvising, criticising and dismissing reforms' non-functional features. In conclusion it is suggested that managerial reforms in psychiatric care can only be implemented successfully if frontline practitioners themselves modify and translate them into clinical practice. The reconciliation between this task and practitioners' therapeutic orientation is proposed for further study.