Drug use is defined as a criminal activity in Finland, and a cultural stigma is attached to it, which also raises the threshold for asking for help. Lowthreshold services aim to provide easily accessible support to prevent exposure to these kinds of vulnerable life situations.
In the four sub-studies of this doctoral thesis, MSc Johanna Ranta examines institutional practices and interactions in two low-threshold services for people using drugs. The data consist of 41 audio-recorded client-worker encounters and field notes, which were used as background material. The data were collected in various meeting places from an outpatient clinic (2012) and from a harm reduction project that offers support for housing and everyday life issues (2017). In the outpatient clinic setting, meetings are arranged in office spaces: the data consist of multi-agency meetings (Publication I) and outpatient clinic’s client-worker meetings (Publication II). The harm reduction project encounters take place in the clients’ homes (Publication III) and joint living room spaces during on-call meetings and group meetings (Publication IV).
The methodological basis of this study relies on ethnomethodology and discursive analysis. The aim is to obtain knowledge on the everyday practices and encounters of low-threshold services for people using drugs, especially multilevel relations and their consequences for clients’ and workers’ agencies. The following questions are asked: What kinds of social relations are constructed in client-worker interactions in the different meeting places of low-threshold services? How are these relations intertwined with the clients’ and workers’ agencies? The encounters are approached as relationship-based support work, in which agency is constructed in and through client-worker interactions and multilevel relations. In this study, relational agency refers to the understanding in which an individual’s ability, capacity and power to act are dependent on interactions with other individuals and wider relations.
This study points out that simultaneous and interdependent social relations are constantly present in the client-worker encounters of low-threshold services, which either reinforce or weaken the participants’ agencies. These relations consist of service system relations (such as service-related factors), societal relations (such as politics and values), spatial relations (such as meeting places), and personal relations (such as human relationships). The consequences of these relations are realised as a result of both client-worker negotiations and the interdependency of different relations. Relations are intertwined with participants’ interactional orientations. This makes both institutional interaction and agency complex.
Relations affect participants’ abilities to act autonomously in service systems. Clients’ (service) choices are connected to both client-worker interaction and broader relations, such as the ways in which local services are organised. These ways, in turn, are influenced by nationwide policies that are linked, for instance, to international homelessness policies or to Western marketised practices. Spatial relations play a central role in agency. In public office spaces, verbal and non-verbal interactions are mostly worker-driven. In these situations, clients’ agency is strengthened especially through verbal interaction. Organisations’ shared living room spaces offer more possibilities to strengthen clients’ agency in spatial relations, as clients can move around freely and define topics for discussions themselves.
In the context of this study, clients’ homes are the best environments for strengthening their agency in spatial relations. If the home is accompanied by traumatic experiences, the workers’ actions to reinforce the client’s agency are important. Agency is intertwined with its temporal context: past relations in clients’ lives influence how they make choices in the present and how the consequences of these choices are evaluated in relation to the future.
This study highlights how the agency of people addicted to drugs is dependent on multilevel relations and how strongly these relations can weaken their agency. The possibility of them having strong agency is dependent on trustful personal relationships with low-threshold service workers, who strengthen clients’ agency in situ through interaction. The possibility of the workers having strong agency in relations is better than that of their clients. However, the marketisation of drug addiction treatment and housing support services, for example, appears to be a factor that weakens workers’ agency and professional autonomy.
The results underline that the relational agency of people addicted to drugs can be strengthened through flexible service structures and situationally reactive interactional approaches. When clients are given space to determine institutional interaction, it is possible to strengthen their agency, despite it being weakened by other relations. Relations to service systems and a society that supports workers’ agency and autonomy also strengthen clients’ agency, as workers have the power to define their working practices in a flexible manner that meets their professional ethics and their clients’ individual needs.
The doctoral dissertation of MSoc Johanna Ranta titled Suhteellinen toimijuus huumeita käyttävien matalan kynnyksen palveluissa: Tutkimus institutionaalisesta vuorovaikutuksesta will be publicly examined in the Faculty of Social Sciences of Tampere University on Friday 14 August 2020 at 12 o'clock, Main building lecture hall A1, Kalevantie 4. The Opponent is docent Riitta Granfelt from Y-Foundation. Professor Kirsi Juhila will act as the custos.
Only a limited amount of persons can participate in the event and the participants need to register by email to the doctoral candidate. You can also follow the event via a remote connection, meeting ID: 667 4921 3153.
The dissertation is available online at
http://urn.fi/URN:ISBN:978-952-03-1627-3
Photograph: Jonne Renvall