Towards person-centered and community-based social services in the Päijät-Häme region

The person-centered and community-based approaches can help social services to be more integrated and holistic by reducing gaps in the social service system, meeting the needs of people in vulnerable situations, and thus making the services more effective. The care model based on person-centered and community-based approach is already more or less adopted at least in some parts of the social service system in Päijät-Häme, but it still has more to offer for the development of social services in the region.

Authors: Taija Nöjd & Emma Rautava

Introduction

More than one in five people within the European Union were at risk of poverty or social exclusion in 2012-2019 (European Commission 2021). In 2023, over 94 million – an equivalent of 21.4 % of the total EU population – were at risk of poverty or social exclusion (Eurostat 2024). Lack of connection and coordination between services challenges holistic perspective in the care of people and responding to the needs of citizens, especially those in most vulnerable situations (NEAR 2023a). These challenges could be tackled by adopting more holistic and integrated models of care based on both person-centered and community-based approaches in the social services.

This article presents an analysis of the current situation of social services in Päijät-Häme region from the perspective of person-centered and community-based approach. The analysis provided an overall picture of the regional context, characteristics of the social services system, and an examination of the current situation of the model change towards person-centered and community-based care model (Rautava et al. 2024).

The analysis in Päijät-Häme is one among four conducted in different regions within the European Union: Navarre, Spain, Vysočina, Czech Republic, Mechelen, Belgium, and Päijät-Häme, Finland. These regional analyses, produced by the NEAR (NEw sociAl seRvices: innovative tools and skills for person-centred and community-based social models) -project, provide essential information for not only developing practice but also policy development towards person-centered and community-based models in social services. The NEAR-project, funded by Interreg Europe programme, identifies approaches and methodologies facilitating change towards person-centered and community-based models of care and transfers good practices between regions. (NEAR 2024.)

The results of the analysis offer an interesting view on social services in the newly established wellbeing services counties. Internationally, the regional analyses enable comparison between regions and act as a tool to assess and promote cohesion between regions. This article also describes an example of current-state-analysis that involves the local stakeholders and that uses an international framework.

Central concepts and theoretical framework: Person-centered and community-based approach and model of care

The core of person-centered care is recognising the uniqueness of each person, their preferences and values, self-determination and autonomy, and importance of person’s active participation in their care. Further, person-centered and community-based comprehensive approach to care identifies the significance of the environment, for example, families and communities. This aims for development of capacities of the individual and support the individual receives. (NEAR 2023b.)

In social services, the change towards a model of care, that is based on the person-centered and community-based approach, implies change in professional roles: from expert to an accompaniment, supporter, and motivator. The person-centered and community-based models of care require participatory planning and coordination, trust, and flexibility. To respond to individual, multifaceted needs, the services should be integrated and interdisciplinary, including the client and their close ones. (NEAR 2023b.)

Methods

In the NEAR-project a situational analysis, here called regional diagnosis, is used as a tool to capture the current state of person-centered and community-based approach and models in social services, provide good practices, and identify the needs for development in a certain region. Here, situational analysis does not refer to a research approach (e.g., Kalenda 2016) as such, but uses a SWOT tool and instructions to structure data collection.

Conducting this regional diagnosis also involved the local stakeholders of the NEAR-project, such as the disability services and client participation coordinator from Päijät-Häme wellbeing services county, inclusion, and wellbeing service unit in the city of Lahti, and third sector organizations, such as the Lahti Diaconia Institute, Harjula Settlement Association, and Mente-services (Päijät-Häme social-psychiatric foundation).

Stakeholder meetings were held in April 2023 to introduce the regional diagnosis task, in June 2023 to identify possible good practices from the region, in September 2023 to prepare for the SWOT analysis, and in February 2024 to evaluate the results. A workshop for stakeholders and service users was held as a learning café in November 2023, followed by content analysis of the workshop materials to derive opportunities and threats from the strengths and weaknesses discovered in the workshop.

Existing policy papers and reports used were, for example, Inclusion Program in Päijät-Häme (Wellbeing Services County of Päijät-Häme 2022a) and the wellbeing report of Päijät-Häme (Wellbeing Services County of Päijät-Häme 2022b). A lot of additional sources – statistics, studies, reports, and websites – were used to conduct the regional diagnosis. Also, the author’s knowledge of the local service system based on working in social services in the region was an advantage in the process of data collection and analysis.

Results

In Päijät-Häme region, the socio-economic challenges are characterized by decreasing share of children and youth, increasing share of aged population, high morbidity and use of intoxicants, high alcohol mortality rate and mental health challenges of children and youth. The unemployment rate is decreasing, but it is still above the national average. The financial situation of the region’s population is also challenged by these issues. (Wellbeing services county of Päijät-Häme, 2022b, 2022c.)

Since January 2023, the responsibility for organising healthcare and social welfare was transferred from municipalities and joint municipal authorities to the regional wellbeing services counties, Päijät-Häme wellbeing services county in the region of Päijät-Häme. In the region, the social services are organised into services for families with children, services for adults, services for elderly, and services for people with disabilities.

Current state of person-centered and community-based approach in social services in Päijät-Häme

There are features in the strategies and services that could be considered as referring to a change towards the person-centered and community-based model of care. The strategy and the service strategy of wellbeing services county of Päijät-Häme highlight, among other things, supporting people in doing health and wellbeing promotion by themselves, and appreciating and assessing service user experience. Also, integrated services, co-operation between service providers, and developing services and access to them with service users and residents are increased, and services are carried out in service user driven way. (Wellbeing services county of Päijät-Häme 2022c & 2023.) One example of integrated services is the teamwork model in health and social centres, which has been developed in recent years.

In Päijät-Häme, there is a long tradition of person-centered and community-based approaches especially in the disability services. For example, an art collective and the practice to use peer coaches and peer instructors have been established. Peer coaches and peer instructors are clients in the disability services who are trained to work as a partner for professional work coaches or activity centre instructors. In the elderly services, the new concept of communal housing is a sign of a change in care model. In Päijät-Häme, new communal housing solutions are planned in close cooperation with the local municipalities (Wellbeing services county of Päijät-Häme 2024).

Regarding the services for families with children in Päijät-Häme, the family centre model and the implementation of the systemic practice are examples of the change towards holistic and integrated care model. The systemic practice model incorporates systemic family therapy orientation, methods, and tools as part of the child protection and family social work (Aaltio & Isokuortti 2019).

Also, in adult social services in Päijät-Häme person-centered and community-based approaches are developed in practice. There have been development projects focusing specially on strengthening client participation and inclusion of people in most vulnerable situations. For example, the experts by experience have had an important role in the development of the social and health care services and client panels have been established – as well as in the services for the disabled people and for the elderly. In 2024, the wellbeing services county is carrying out a project to pilot outreach work among adults.

It is case-by-case if both person-centered and community-based elements are incorporated in the provided social services. The person-centered approach is more often identifiable in the services. In addition, the characteristics of the care model can be recognised in the public social services, but even more so in the services of the third sector organizations. Third sector organisations usually have more freedom and chances to develop and test different services, whereas the public sector is tied to provide statutory services.

Many good practices and training experiences manifesting the change towards person-centered and community-based care model were identified in Päijät-Häme region during the regional diagnosis. The Experiences of Inclusion Scale (ESIS) is a brief survey instrument developed by the Finnish Institution for Health and Welfare to assess self-reported experiences of social inclusion. Kids’ Dialogue developed in the city of Lahti is a method to rehearse children’s skills for dialogue in a school environment and to present their thoughts and experiences. The Dila Block or Dila Campus (Dilakortteli) is a city block in the centre of Lahti, which bring together people in different life situations to promote social inclusion. The Dila Block, run by the Lahti Diaconia Institution, offers a home for the elderly, youth employment services, events, and volunteering. Peer coach or peer instructor is a trained partner for a work coach or an instructor in supported employment or activity centres in the disability services of the wellbeing services county of Päijät-Häme. As a successful training practice, the systemic practice model is systematically trained for professionals twice a year in child protection and family social work in the wellbeing services county of Päijät-Häme.

Factors enabling or hindering the change towards person-centered and community-based model of care

In the SWOT analysis, the internal factors – strengths and weaknesses – reveal that there are willingness, skills, and tools in social services to apply person-centered and community-based approach, and that the general valuing of service user participation and multiprofessional cooperation support this. Nevertheless, especially lack of continuity and challenges in communication between services challenge the application of the approach.

External factors – opportunities and threats – reflect that generally, person-centered and community-based services are considered a possibility to promote both wellbeing of the service users and the efficiency and effectiveness of the social services provided. Structural issues, such as complexity of the service and social security systems, and deficiencies in available staff and resources, present a challenge to both client wellbeing and the functionality of the service system.

Dialogic approach, strengths-based approach, community-based and/or systemic approach, ethical competence, and the ability and tools to “think across the silos” of services and organisations were recognised as key professional competences to support to enable change towards the person-centered and community-based care model in Päijät-Häme.

Discussion

Especially person-centered but community-based approaches too, are already being applied in the region at some places and levels. They are perceived as a possibility to promote both wellbeing of clients and efficiency of services, but the complexity of the service system presents a challenge for realisation of the person-centered and community-based approach.

The person-centered and community-based approach requires a shared understanding of the approach, its benefits, and its possible practical applications in different social services. Practical applications should be supported via, for example, peer support, coordinated and synchronised development work and training. Many of the competences identified essential for applying person-centered and community- based approaches are common among social services practitioners, but the competences could nevertheless be strengthened.

To promote community-based approach, there’s potential in identifying and developing social services roles and practices in enabling and mediating social relationships of individuals. This would strengthen the recognition of the significance of close ones and the local community for service users and expands the focus outside of individuals.

The discourses of cost efficiency, staff shortage and digitalization rule the conversation concerning social and health care both in the national level and in the region. However, person-centered and community-based approaches could offer ways to respond to those challenges also in social services. The approaches could provide ways to respond to the service needs of not only the aging population, but also to the needs for support among families with children, to mental health challenges of youth, and employment challenges of the working-age population.

The next steps in the NEAR-project to support the person-centered and community-based approach in social services in Päijät-Häme

With the knowledge gained from the regional diagnosis, the NEAR-project partners together with their stakeholders and key agents will agree and develop a regional roadmap with the aim of improving the policy instrument selected by each region. In Päijät-Häme, this policy programme is the Inclusion Program of Päijät-Häme wellbeing services county. The program aims to increase the inclusion and participation of the residents and service users and the co-operation in this among different actors (Wellbeing services county of Päijät-Häme, 2022a). The Inclusion Program of Päijät-Häme should embody the person-centered and community-based approach: it should recognise not only the importance of participation of individuals, but also especially those with challenges in participation, and the significance of communities – and provide practices to do this. The Inclusion Program should be developed as a mutual policy, extending outside of public services.

In the NEAR-project, a guide ‘Towards person-centered community-based social models in Europe’ will be published. The regional policy change road maps will set strategic priorities for transferring good practices from other regions and for the implementing the tools and training that are necessary for social services to adopt the person-centered and community-based approach.

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