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Care management activities and integration policies in France: the weight of pre-existing dynamics and local negotiations

Abstract : Context and main issue: In France, the necessity to better coordinate health and social care interventions in elderly care has been a longstanding preoccupation of the state. Even if these policies date back to the 1980s, there has recently been a strong emphasis on them as response to persistent fragmentations. Since the beginning of the 2010s, various policies with similar objectives have been initiated. They introduced a number of new components – concepts, tools, and also new dedicated professionals – meant to be implemented by local institutional actors and impacting directly local managers and frontline professionals’ activities. One of these new professionals dedicated to coordination are case managers for elderly people with complex health and social care needs [gestionnaires de cas] introduced by the MAIA scheme – Method of action for the integration of health and social services in the field of autonomy [Méthode d'action pour l'intégration des services d'aide et de soins dans le champ de l'autonomie]. This paper proposes a comprehensive analysis of the activities developed by complex case managers in two local territories. Analysis is based on inputs from both public policy analysis and sociology of professions. Special attention is paid on the reception of those case managers by pre-existing care professionals developing similar coordination tasks, on the one hand, and acceptance strategies implemented by the new complex case manager, on the other. Methodology: The paper is based on the analysis of the local implementation of two MAIA schemes investigated in a postdoc research. It includes a review of available evidence including national and local official reports and research articles and original qualitative semi-directive interviews led between 2015 and 2016. Interviewees include the new professionals introduced by the scheme (n=8) and a selection of institutional, organisational and professional actors they are meant to interact with to develop their activities (n=22). Results: Two different levels of analysis are proposed. The first concerns the local reception of the MAIA schemes. Analysis shows strong resistance to their introduction at at least three interdependent levels: at the institutional level by the main institutional local actors, at the organisational level by the managers of other health and social care organisations, and at the care managers’ level by frontline professionals with similar coordination activities. The second level focuses on the care managers’ level. We show that they face difficulties to make emerge a common professional identity due to unclear professional status and lack of ‘pragmatic’ legitimacy. Despite this, they also need to develop strategies to facilitate their acceptance by the other frontline professionals and develop their activity. Whereas mobilising different skills to which the new care managers are more or less prepared, these strategies have in common to be deployed in situations of concrete and complex interactions in which time is needed to make themselves known and recognised in order to be able to delimitate locally their own field of action
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https://hal.ehesp.fr/hal-02180924
Contributor : Alis Sopadzhiyan <>
Submitted on : Thursday, July 11, 2019 - 5:03:28 PM
Last modification on : Tuesday, November 10, 2020 - 4:50:18 PM

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  • HAL Id : hal-02180924, version 1

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Alis Sopadzhiyan, Blanche Le Bihan, Arnaud Campéon. Care management activities and integration policies in France: the weight of pre-existing dynamics and local negotiations. 4th Transforming Care Conference "Changing priorities: The making of care policy and practices", Professor Tine Rostgaard, VIVE – Danish Center for Social Science Research, DK Professor Costanzo Ranci, Social Policy Lab, Polytechnic of Milan, IT, Jun 2019, Copenhague, Denmark. ⟨hal-02180924⟩

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