1. Contingent citizenship
Mette rømer, iben nørup, Mie engen
Aalborg university
edinburgh, april 2018
Short presentation

2. Structure of our talk
Social policy reforms and transformation of social citizenship
Background: social policy changes
Consequences
Social policy reforms and the public care for adults with intellectual disabilities
Changes in the public care
Normalization vs institutionalized care
The pressure of being active

3. Social policy changes
Activation policy is permeating policy within the field of social and economic protection for adults with cognitive and intellectual disabilities, while it used to be a tool used in policies targeting unemployment.
Financial incentives to take up work = reduced benefits
Limited access to help & benefit = conditionality
Expansion of target groups in activation policies
Norms of “the good worker” / “the active citizen” / “the productive citizen”
Work or activities simulating work are seen as the key to inclusion

4. Changes in the perception of illness and disabilities
Illness & disabilities are seen as relative and ”individual”
”It doesn’t matter how you are – what matters is how you respond”
From functional limitations to coping and workability
The ability to be active are seen as depending on motivation rather than on functional ability

5. Changes in the understanding of social- and care work
The “activation regime” is also present in social- and care work targeting disabled individuals
From passive to active recipients of benefits / clients / patients
The social- or care worker as someone who is assiting or facilitating the individual’s proces towards becoming active
”Help to help themselves”
Organization and structure of social- and care work favours a certain client profile (the active or participating client)

6. Consequences
The political understanding of social citizenship has become heavily contingent on participation on meeting the good worker norm / active citizen norm
Disabled individuals who are unable to meet this norm are left ‘behind’
Help (benefits, care etc.) becomes more and more dependent on ability to become ‘active’
Result = marginalization of those who depend strongly on the help but are unable to meet the ideal of an active citizen

7. Public care for people with Intellectual Disability (ID) in Denmark
From institutional care to normalisation, integration in the community and equal rights
Results from a casestudy of professional practice in 3 accommodation facilities for people with ID
Participant observation for 270 hours of the interactions between professionals and residents, when care and support was delivered
I’m going to present you some key examples of what happens, when active welfare state reforms are implemented in relation to groups in society, who depend on help and support from others on a daily basis – 24 hours a day. What happens when ‘being active’ – formally or informally – becomes the condition for receiving social support that you are highly dependent upon?
I have investigated this by observing the professional frontline, where care and support is delivered for people with severer forms of intellectual disability. I have done a casestudy of how care is delivered and unfolded in 3 larger-scale accommodation facilities providing 24 hour supervision, care and support by trained staff. This involves 270 hours of participant observation of interactions between professionals and residents.
The overall development in public care for people with ID can be described as moving from institutional care – characterised by a medical discourse – to normalisation and individual care based on individual rights and delivered with respect for the autonomy and integrity of the disabled person.
Normalisation became the new guiding principle for services in the Nordic countries in the early 1960s and this principle has been an important contribution from the Nordic countries to the international policy and service development for people with ID.
The normalisation principle is the idea and overall goal that the living conditions of people with cognitive disabilities should be as close as possible to the mainstream of society and that people with cognitive disabilities should have the same rights as all other citizens.
This means that assistance, care and support provided by the staff in the accommodation units must be given with the resident’s consent and with respect for his or her right for asserting self-determination. Today the accommodation units are legally defined as the resident’s home – not as institutions – and the staff, who provide help and support, must act accordingly: they have a legislated obligation to respect the residents’ right to privacy and for making decision of their own will.

8. Institutional timeorders and effectivity
Depending on care and support and living in groups
A smaller group of employees have to distribute their time, attention and help on a larger group of residents
A time-order focused on effectivity
A focus on tasks to be done – instead of processes, possibilities of participation and the quality of social relations
Basically people with severer forms of ID in Denmark who cannot care for themselves are dependent on living in groups with other people with ID to get the support they need from staff. This also means that the staff has to distribute their time, attention and help on a larger group of residents – often 2 personal have to help a group of 6-12 residents. This means that certain periods of the day are particularly hectic for the staff, while the same periods means a lot of waiting time for the residents. This was especially the case in the mornings, where all residents needed help to get ready for the daytime activities; getting up; showering, getting dressed, eating breakfast ect. They were all picked up by a bus at 8.30 to go to their daytime activities outside the house, and because of lack of staffing, no one could stay at home or leave later, if they did want to go. At least it was problematic for the staff, if they did.
Because of this institutional organisation, a time order focused on effectivity was created. The staff focus was on how to get the residents to cooperate around doing their tasks as quickly and smoothly as possible. For example, a resident who ate very slowly was given a very small morning meal, so that he did not slow the process of getting ready down. Focus was very much on tasks to be done – and even though the staff tried to create a good atmosphere, as the departure of the buss got closer, they pressured the residents more and more, asking them to hurry up etc.

9. Being active as a pressure to conform
Residents, who are not easy to activate to do their tasks; who does not cooperate are perceived as problematic
Social work focus on modifying the residents’ behavior and developing their abilities to cope with institutional demands
Consequence: The functional limitations and problems that the residents have a right to be compensated for, are maintained and reproduced as problems
This way of organising care at the premises of the institution creates a pressure on the residents – they have to be able to actively cooperate with the program laid out by the staff. Some residents have troubles with this. One resident didn’t want to get out of bed. And when they staff had finally motivated him to, he sat on the floor – and did not want to shower and dress. This resident was considered very problematic by the staff, and they made a behavioral modifying program to motivate him to cooperate with the staff and the institutional demands. The point here is that difficulties with living up to this type of demand are one of the reasons why the residents are placed in the accommodation facilities in the first place, and that they have a right to be compensated for. In this way a social handicap is created and reproduced – behavior that would not be considered a problem in another social context is rendered problematic and the resident is put under pressure to conform.

10. Conclusions Dependency is considered problematic
Contingent citizenship and problems with individualised care – care and social support is rendered conditional
From the active state to the activating state
From individual centered goals to state centered goals
Iben: de to første punkter
While the state used to be active and take a large responsibility in procuring the citizens with the capacity for work, inclusion in society, i. e through training, care etc. the responsibility to be active, employable, etc. now rest on the citizen.
It is a shift in emphasis where the term active used to refer to actions taken by the state now refers to actions taken by the citizen.
In brief, the state now activates instead of being active.
Mie: de sidste to
My investigations show that today, in professional social work practice, there is an intensified focus on training and modifying what is considered the problematic behavior of residents that do not have the ability to cooperate with the plans of the staff. In this way the focus is also on creating specific behavioral changes in order du reduce dependency and need for help and support in order to reduce the pressure on collective resources.
This makes it more difficult to accept and find meaning in behavior that does not fit with the idea of the active citizen that shows a will to change, and to accept people who are not able to develop and learn in socially accepted ways. In this way, the right to individualised care and support for people with severer forms of ID are put under pressure, and so is their citizenship.

11. Thank you for listening!