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Paper

Access regulation to human services. Recommendations on method and contents

abstract

Background. Human and family services are usually within the competence of local municipalities, which represent the closest territory governing level/system to services clients. This enabled each territorial system develop organizational forms, evaluation tools ad access regulations to distinct services. Among its goals, national and local law on human and family services, which has been recently agreed, aims at boosting a more equal service availability within the territory and defining access and evaluation criteria to grant equal care levels. At the same time, the Italian government recognizes and values municipalities autonomy as a common criteria for allocating functions and provides them with competences in organizing local services and managing their functioning. To grant the right to access services as well as the equal access to them, it is necessary to find a balance point between agencies autonomy when organizing and regulating services as well as define standard service content and equal evaluation/access. The presence of adequate regulative infrastructures allows outcomes implementation as human and family intervention, especially if specific process limits - the use of given care models or the realization of outcome evaluations - are imposed through the regulation of organizations.

Purpose. The research, carried out by the Fondazione Zancan during several collaborations with regions and groups of municipalities in the years 2002-2007, was aimed at:

  • Analysing administrative documents regulating service evaluation and access by gathering the chosen selection criteria as well as the prescribed evaluation tools, the structure of institutional, organizational and professional responsibilities, and the expected administrative pathway;
  • Confronting analyses results by comparing the regulations of municipalities belonging to homogeneous territorial groups - the same district and region - and those of municipalities belonging to different areas but sharing, however, common characteristics, such as population size and service structure;
  • Verifying the correspondence between evidence contained in the analysed texts and professional and administrative municipalities practice by confronting them with workers involved in the evaluative process aimed at accessing services;
  • Developing intervention proposals regarding regulated access to services to grant equal conditions, tools and evaluation criteria, qualify local regulations and finally promote a more equal use of services.

Method. This paper is a qualitative and quantitative research carried out on 4 samples of norms adopted by Norther-central Italy local authorities. Norms were collected and delivered by authorities referents and analysed by using an evaluation instrument all organizations involved agreed about. Document analysis focussed on formal and substantial aspects; the former relates to the way a norm is formalized and finally passed, how service addressee get to know it, and its accordance degree with the current legislation. Contents were explored to gather information on the aspects related to the defining of referral and addressee services, which the applied criteria are, the specification of the instruments used to evaluate social needs as well as the analysed economic situation, the identification of administrative and professional responsible for service access, the prediction of complaint tools and of those aimed at protecting the addressees' rights. Results were presented and discussed with groups composed by professional and administrative workers belonging to the organizations involved, in order to verify the correspondence level existing between such prescriptions and practice and to evaluate the sustainability and feasibility of the intervention proposals formulated.

 

Type of norms

1st

Sample

2nd

Sample

3rd

Sample

4th

Sample

Total

Local authorities resolutions

19

2

 

41

62

Agreements with third sector

10

2

 

47

59

Agreements between public bodies

8

5

 

42

55

Local rules

5

8

10

65

88

Managerial decision

3

0

 

 

3

Resolutions passed by Local Health Department General director's (with a regulative content)

3

0

7

 

10

Chart of Services

1

0

 

1

2

Agreements among municipalities

0

23

3

 

26

Other

5

8

4

7

24

Total

54

48

24

203

329

 

Findings. Norms analyses highlightened only a partial acceptance of the innovations introduced by referral legistlations, together with a major attention paid to the most recent local legislation content. The most frequently used types of norms are local resolutions and regulations, while the less used are agreements and protocols, or administrative acts made by 2nd level authorities, such as groups of local authorities which introduce a unitaria regulation. Very often service evaluation and access are regulated in accordance to agreements between public and private managerial agencies. As a consequence, there appears to be a well differentiated framework regarding how to access services, with significant existing differences even between very closed municipalities.

From the point of view of the regulated theme, there appears to prevail sectorial interventions, i.e. interventions which refers to a sole or a few services. Specifically, there are many norms which regulate youth service access and evaluation (particularly home care services) as well as those for the older people (home care and residential services). In some troublesome and also severe cases no regulation was found; or there have been ad personam intervention cases, related to the delivery of interventions addressed to a single person. Part of the regulation examines the introduction of instruments which evaluate individual and family economic situations, both as a selective criteria towards service access and as a measure of the ability to take part to expenses while using some services. In both cases economic conditions refer to the origin family of the person the intervention is addressed to.

As regards the instruments and type of evaluation used, the predominant ones were those necessary to the administrative evaluation of those people asking for services, which is related to bureaucratic elements (residence, module compilation, the providing of requested accounting or administrative documents, etc.); on the contrary, referrals to professional instruments and accomplishments were uncommon. Such a thing reflects also on the responsibility profile, which is mostly considered as administrative one, thus linked to procedure legitimacy rather than to global validity (administrative and professional) and to the efficacy of the evaluative process.

Recommendations. This research highlightens the need to intervene on the legislation related to service access for individuals and families, in order to implement its function as instrument which grants transparency, accuracy and equality in the way administrations manage the evaluation process preceding service access and which implements care essential levels in terms of content and process.

In particular, unique regulation to evaluate service access within local authorities should be promoted, by introducing criteria and homogeneous threshold levels which can be applied to all interventions. As regards equal access to services, this grants an equal treatment not only in using services but more generally in evaluating the needs and access requirements.

Similar considerations are important for the introduction of instruments and threshold levels useful to evaluate the economic situation of family units asking for services; actually each municipality uses different instruments and threshold levels for service access on the basis of the economic situation - this is very different according to the area considered. Even in this case homogeneous criteria and threshold levels should be defined, at least by municipalities belonging to the same district and in particular in regard to integrated social and health services, where the co-participation fee paid by people to use a complete service - which is the same for the whole district - can de different because of the place where assisted clients live.

In regard to the administrative and professional dimension related to evaluation processes, boundaries which limit organizations and make them grant an adequate professional evaluation of family needs should be introduced, in order to balance administrative aspects with those more professional and qualify service access as a complex evaluation stage of intervention requests. The specification of evaluation modalities and criteria as well as of service access according to the elements presented above provides the regulation with a real function - protecting service addressees. As a consequence there might be an increase of possible outcomes in respect of the current situation, particularly through the introduction of regulations which limit service actions according to various treatment criteria - transparency, certainty and equality - in respect of the evaluation of all factors involved in recognising the right to access services.

Key references

Canali, C., Innocenti, E., Pozzobon, G., Vecchiato, T. (2007). Studio di fattibilità per un nuovo modello di gestione unitaria dei servizi alla persona nel territorio feltrino. Studi Zancan: 4.

Fondazione E.Zancan (2005), Bisogni sociali e priorità per la programmazione della Regione Abruzzo, Padova: Fondazione Zancan.

Innocenti, E., Vecchiato, T. (2007). Servizi per le famiglie con figli e "livelli essenziali: prove di fattibilità e sostenibilità in Politiche di sostegno alle famiglie con figli, Bologna.

Vecchiato, T. (2003). Livelli essenziali di assistenza e servizi alle persone. Studi Zancan: 2.

Vecchiato, T., a cura di, (2005). Sistemi regionali di welfare: profili e analisi comparata, Padova: Fondazione Zancan.

Contacts: Elena Innocenti, Fondazione Zancan Via Vescovado, 66 35141 Padova, Phone, 049 663800 E-mail: elenainnocenti@fondazionezancan.it.

 

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