home-less & health-less permanent situation

Related image protocol       

When the solution of complex situations seems impossible:   how to listen  for a deepest  understanding ?   
When the body speaks through his silence and his wounds:   
who will listen and hear before intervening?   

1.      BACKGROUND and environment / context  of  profile of the person in relation to : the condition of ‘dignity’ and 'health' in which these people live.   What kind of interrelation between these dimensions: 
-   time
, in relation to the chronic situation;
-   abandonment
, in relation to the breakdown of any relationship and link;
-   refusal
, in relation to any institutional offer of care and assistance services?

2.      HEALTH:  physical  and  psychic conditions.
All additional information on the health situation,  information on hypothetic or declared diagnoses  including:
-  interaction between mental and physical condition; 
-  influence of the health condition on the lifestyle of a person;
-  history of interruptions and resumptions of medical services provided to the person,
-  orientation and opinions  of the medical  players  in respect to the person; 
-  interdependence of psychosocial distress in cases where two people of the same family circle are involved

3.       INTERVENTIONS  description  :  presentation and evaluation of the history of interventions with their difficulties, successes, failures, including the circumstances of the person’s first contact with the organized assistance; clarification of the objectives of the intervention in its various stages; description, if needed,  of specific operational solutions; stating the reasons for compulsory sanitary treatment .
What kind of intervention – in health + social field - success of non-success depends of …;
Highlight the correlations between the objectives to be pursued, programmed interventions and outcomes...
–    Innovative practices

One or many actors?   
-   Does the networking and cooperation between actors exist or not?
-   What kind of collaboration between public and private sector?
-   What kind of multidisciplinary performing synergies between social, health services and... others?
-   What kind of co-working and co-responsibility between Institutions - Associations - Administrations?

What are the institutional and legal barriers and limitations to providing adequate assistance (cumbersome, poorly
     defined procedures, “vicious circles”; resources and financing).
-   What obstacles could be overcome by “creativity” of the operators in the face of the unhelpful of confusing legislation?

5.       PROPOSALS: What proposals of possible and innovative interventions when the solution of complex situations seem impossible?
-   What pathways,  what specific priorities could be taken for priority recommendations?
Make the proposals as concrete as possible and  avoid generalities.

6.      Personal factors influencing the launching and continuation of assistance process:
-  possible stigmatization of person taking charge or applying for assistance;
-  sources of stress and burn-out for assistance workers;
-  changes in staff during assistance process; clashing cultural aspects.

7.      Overall assessment of the case: strengths and weaknesses of the support net and/or interventions provided;
-  synthetic judgment: the person's condition has improved/worsened or remained unchanged?
    (in relation to the assumed objectives relevant ethical issues related to the work;
-   final thoughts, free.

OPTIONAL: Complementary elements on the situation of gradual degradation in terms of both physical and mental health

DIVERS: ....


N.B.   The PROFILE more than a PHOTO  is  a  RADIOGRAPHY  which will facilitate  the comprehension of the inter - action and  the causes.  NOT MORE than 2 pages.  - Attention please PROTECT PRIVACY OF EACH ONE



The material that comes from reading the profiles is very rich.
One senses in the collection of stories the echo of the relationship between the operator has compiled her and the person whose profile speaks.
In some profiles this aspect it is felt in great measure, in some less, but everyone is still present the personal dimension, which sometimes also takes on a connotation of a relationship, necessarily involving and challenging (also seen references not explicit but present at the impatience and the burn-out of some working groups).

In the current format the indications (thin) provided for the collection of profile give to the same profile a narrative connotation. The material lends itself to assume this characteristic. Both the life stories, both the ups and downs concerning the interaction of these people with the system of services or with volunteers, require an articulated, hardly definable description, in survey instruments too standardized.

The key point is just that. Profiles can be combined at ' life stories ', a ' subject ' that has an important position – given its specificity – in social research methodology. Every survey on experiences and peculiar stories about important parts of a biography, it can be done through instruments that lie between two opposite polarities, represented by the degree of structuring these same tools.

On one side of this continuum lies the structured instrument, which guarantees a high level of standardization and uniformity of procedures for data collection, but at the risk of forcing complex topics in pre-defined schemes too rigid; the other is unstructured tool, which allows you to gather more information, but at the risk of requiring greater effort during interpretation and recoding of collected material, not necessarily uniform and homogeneous in the topics discussed.

The choice between these two polarities, or the balance between these two opposing needs, typically depends on several factors: the context of analysis, the greater or lesser familiarity with their respective approaches, people involved in the collection and interpretation of data.

In this particular case it is my opinion that we should prefer a formality collection of profiles in order to maintain open and discursive structure of individual tabs. Make the instrument too analytical – trying to translate into more or less dichotomous variables the individual topics (for example: absence/presence of a support network, absence/presence of other diseases) – appears in my opinion too reductive.

The same biographical information – basic data for each profile – are not always available, or at least not always have a high degree of reliability (being often second-and third-hand, or collected by voices of acquaintances and contacts of various kinds).

Don't stiffen the tool and lose a lot of information contained in the current rich profiles, trying at the same time taking into account the need to maintain uniform standards of compilation of the tabs, you can find some sort of compromise between the two polarities as above. Such compromise consists of discussing in shared way criterions of compilation of the most articulated profiles of the actual ones, in such way that those people who collect them have clear the thematic scope on which we wanted to focus the attention. What I propose here is a list of additions/new thematic proposals compared with mentions in the compilation of tab profile.

Each of the new issues, arising from reading the profiles, is located within one of the five macro-areas previously defined by the Protocol.

The proposed themes could be object of discussion and sharing in the next workshop, so that to assure a great coherence in the formalities of collect of data of the profiles and compilation of the tab ; such sharing, at the same time, it already represents by itself a sort of selection of the remarkable thematic nucleuses both for the final interpretation and for the editing of a possible conclusive report.

In addition to the supplements placed within each macro-area, it may make sense to propose two additional thematic areas: a more explicitly related to the evaluation of the pathway taken and one designed to detect the representations of discomfort and stigma emerging from the job of taking charge. These themes, currently present implicitly in the tabs, they could/should take a relevant autonomy.

Hypothesis of integration of the protocol for the compilation of the sheets /profile


The tri-partition of the size indicated in the Protocol (time, abandonment, refusal) seems effective because the presentations contained in the background section are generally short but rich collection.

Maybe we should emphasize more the need to provide basic information on net family constellation, which in some tab / profiles do not seem adequately into account (quite apart from the problem of unavailability– evidently unsolvable – of information about family relationships and presence/absence of their nature).

2.      HEALTH

In this section the aspects on which to focus more attention, in the integration of the Protocol, seem to me to be three:

a.   the theme of comorbidity, namely the overlap between mental health and other health problems, as well as the relationship between co-morbidity and social disadvantage (in some cases people don't seem to have any health problems, despite the kind of life they lead);

b.   the fragmentary nature of the patterns of care and taken into care: the profiles in some cases underline the interruptions and resumptions of the interactions with the system of services or with the world of volunteering; on this issue, and the orientation of the different players towards the person we should focus a little more attention (see after the topic on the attitude of the working team and on representations); the interdependence of psychosocial distress or otherwise in cases where it involves two people of the same family circle (the case of the mother and son; that of two sisters).


For a more accurate reconstruction of the history of the operations or attempts of intervention implemented focus more attention on these issues:

·    the circumstances giving rise to the first contact between a person and an organization (voluntary, public etc.) bears – at least in intention - to help; this part is already present in many ways, but it's still important that the Protocol if they stress the importance of understanding the way in which it has developed or is developing the relationship of help or care;

·    the clarification of the objectives of the intervention in its various stages, ever changing – necessarily – from case to case. The objectives vary not only from person to person but also between the different phases; It must be said here that in the current version of the profiles this theme is already present, but it should be made explicit and made clearer in completing, with a view to clarifying what – specifically – can aim the intervention;

·    where will be question of compulsory sanitary treatment, underline the reasons of these (or the equivalent procedures used in other countries are described in some cards; the prosecutor's order which is discussed in a profile I think is some sort of TSO); this looks like an ethics question of huge relief;

·    the description of specific operational solutions (net-working in the case of ASL in Rome, the family coach mentioned in the profile of Polish woman).



This seems to me the most interesting section of the protocol in terms of possible thematic areas to be developed. List them for points and sub points:

A.   The operation of the network of relationships

o   The Net-working: it exists or doesn't exist?

o   The project is managed by a single actor?

o   This possible ' unique ' actor is public or private?

o   In case there are more parties, the coordination between the actors there or not?

o   This scope is in fact a premise than the added section concerning the final assessment; availability of community resources to enable informal/team (neighborly relations, informal networking);


B.   The institutional context of reference

o   whether there are limitations in access to services due to regulatory barriers, cumbersome procedures or poorly defined;

o   whether there are ' vicious circles ' and administrative problems (often arises the problem of documents, up to the limit case of Serbian man declared dead at home for which you can't get to the bottom of the issue of a passport or identity card);

o   the issue of resources and the possible impact on the financial sustainability issues practice therapeutic path (ex: impossibility to practice some options deemed useful or important).

C.      The discretion of the operators

o   presence of practices employed on the basis of discretionary guidelines (in access to certain provisions or administrative procedures); the ' creativity ' of the operators as a possible solution to the ' empty ' or confusing legislation.



In any listing may be useful to leave the generality of proposals: it is better to indicate concretely hypothesis related to the case described that formulate descriptions of desirable but little concrete paths.


Possible additional scopes (to sift through & discuss with other operators)

In each of these two themes I would dedicate a specific section of the Protocol and of the card:

1.      representations and self-representations having influence on taking charge

·    possible forms of stigma having incidence on taking charge or on application for assistance services (which also concerns the TSO);

·    the orientation of the operators and the support team: description of the main orientation towards the person taking charge and from others who follow the case (the person's source of stress or even burn out; opening/closing towards cooperation with other entities that are part of the support network); any changes of orientation of staff over time;

·    possible presence of cultural aspects held remarkable from those people that follow the taking in charge of the person (ex: in the history of Nigerian woman refers to symptoms that seem to be expressed as a culturally oriented); the issue is complex and to probe very carefully, but a nod to this size wouldn't tab;


2.      overall assessment of the case

Precisely because the protocol has a narrative structure and therefore strictly qualitative, I think it's okay to close it with a section more evaluative. The assessment is of course subjective, but induces who evaluate to take responsibility to describe the profile in terms of strengths/critical points of both the context of the actions taken/foreseen.

The points at which you articulate the section might be these

·    Strengths and weaknesses of support NET enabled and/or interventions/projected;

·    synthetic judgment: the person's condition has improved/worsened or remained unchanged?
The application must be placed in relation to the objective that we have prefixes (see above) and commensurate with the achievement or otherwise of this objective;

·    any relevant ethical issues related to the work;

·    final thoughts, free (leave an open space of a few lines to formulate any further evaluations).

      Fondazione Devoto – Jacopo Lascialfari      DRAFT for discussion


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