Power and disabled people : a comparative case study of three community care services in London
The main research question addressed is how the perceptions and experiences of people with disabilities around what is termed 'quality of life' are enhanced or modified by differing service delivery systems. This approach is based on the assumption that people with disabilities have unique knowledge about services, providing a core understanding of the power around decision making and its effects on their lives. The perspectives and methodology used are underlined by concepts of user autonomy, social control, independence, interdependence, advocacy, respect and citizenship. The case study methodology provides an in-depth focus on both 'positive' and 'negative' ethics in social science. The research area was examined within a multi-professional framework and aimed at a triangulation of perspectives from participant observation, user and professional interviews, tailored vignettes and organisational documentation from services formally designed to empower their users following the latest government policy. The research, following the principles of grounded theory, examined to what extent care management and advocacy, residential support and service brokerage and a more traditional day centre system were achieving these primary aims. The qualitative data generated by the research gives rise to a socio-organisational power analysis of 'service forums'. The service forums are constructed from 'service postures' and 'service cultures'. Service posture refers to the set of formal values and beliefs owned by an organisation. The service posture for the residential consortium is summarised as 'normality', the day centre's as 'respect' and the care management organisation's as 'advocacy'. The organisations' service cultures are the unofficial presentation of the service, shown to come from the service posture, either being complementary, its antitheses, or quite separate. It is clear that the behaviour of the workers and the structure of the three organisations studied have both distinct and profound effects on their users' senses and experiences of power. The conclusion explores the elements of disability, choice and decision making which make up the socio-organisational power structures with respect to each organisation. Finally ways in which a participatory service delivery system could be constructed are considered in the context of training, policy and organisational structure.