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Institutional Transformation - CARe Approach (Interview with Dirk den Hollander & Els Makaay)


"We are looking for a person, not a client!" 

Interview with Mr Dirk den Hollander and Els Makaay about CARe approach

Dirk den Hollander and Els Makaay from CARe network were guest speakers at the Component 2 Institutional Transformation Training for Social Care Homes for Mentally Ill Adults and their local stakeholders, where they presented the CARe approach (Comprehensive Approach to Rehabilitation).

This approach is based on the principles of recovery and psycho-social rehabilitation and is implemented in 10 countries and was developed by Jean Pierre Wilken and Dirk den Hollander. Els Makaay is a trainer in RhinoGroup from Utrecht  where she is leading programmes about CARe approach and is active in the area of employment of persons with mental disabilities. Dirk den Hollander is leading educational programmes in RhinoGroup regarding CARe approach and Strengths Model.  We spoke with Dirk and Els about CARe approach and challenges in employing persons with mental disabilities and their social inclusion.

Could you tell us a bit more about CARe approach? How was it made, what is it based on, what is its goal?

Dirk den Hollander: CARe is based on Strengths Model developed back in the 80's in American college Kansas. Els and I develop that approach in our everyday work.  The essence of this method is in using clients' strengths established before, e.g. talent, skills, environment, assistance of the neighbours, experts, everything we use to help them to achieve their goals and these are (like for everybody else): getting a job, life partner, own home.

Els Makaay: Main idea of the CARe approach is to help people whom you are working with,  see them like human beings, not clients.

So we are talking about changing the relationships between professionals and clients?

Dirk den Hollander: Yes, but that is not a goal, it is an instrument to get client to stop being a client – client of the system caring about persons with disabilities. They become fathers, friends and neighbours again. We do that by showing them we are those people as well, with the same roles.

How do you recognize strengths, is it through conversation with the clients?

Dirk den Hollander: We have common activities and we evaluate strengths we noticed, depending on the situation. We talk to their relatives, we observe and then we talk to the person himself/herself. So professionals learn how to be creative and come up with various ways to detect strengths. That is the main difference between CARe approach and other approaches with tight structure –they are mostly based on one method e.g. conversation. We believe you should follow the situation and listen to the client.  Most professionals know how to follow the situation. You can detect strengths through relationship between professionals and clients. You should not obtrude their wishes. They have to take control on their own life.   

Is CARe approach well developed in Netherlands?

Dirk den Hollander: CARe is well accepted in The Netherlands, it is implemented by various institutions throughout the country.   

Els, you work on inclusion of persons with mental disabilities in society through employment, do you use that in CARe approach?

Els Makaay: Yes, it helps me to meet the person, to find out what does he/she wants. Everybody is able to work if you move out his/her problems. I had one client who confused me when he told me he wants a famous job as a Pope. After long conversation I realised he meant Pope in a way being in his own glass cage while people are far away. So he doesn't want to be obstructed by others. He can work on his own.  That is CARe approach – we never say: "what a silly story". We listen, we are curious and we want to help. 

Dirk den Hollander: Part of the method is using all achieved successes, we don't ignore things, we analyse everything – why client reacted good to some things and then we develop more of these things. It sounds simple but it is not easy to achieve. Yet it is very effective.

How hard is it to find a job for a persons with mental disabilities in The Netherlands?

Els Makaay: It is hard at the moment but things are changing rapidly. Our government is considering implementing obligation to the employers where they have to employ a certain number of persons with disabilities. It is important to have someone who will negotiate in the name of persons with mental disabilities – convince employers but also prepare the clients.  Personally I spend one day a week with employers, I make contacts, report on persons looking for a job…  

Do you employ them in companies or in social entrepreneurship?

Els Makaay: We try to find them a job in companies because social entrepreneurship doesn't fit in Individual Employment ans Support Model of individual employment with support. We try to find them a job in a normal environment. That is their wish too. They want to have a steady job and get a salary.  

Dirk den Hollander: 80% of persons with mental disabilities have job in EU. It is wrong to think there are no possibilities for their employment. We are talking about 20% of them who probably have more severe disabilities.

What is the main obstacle in employing persons with mental disabilities in The Netherlands? Society attitude or existing social system - institutions?

Dirk den Hollander: I believe it is social system. When institutions do their tasks, everything is O.K. but when they do not succeed, they say: "Society is not ready for employment of these persons". Entrepreneurs are willing to employ persons with mental disabilities but we have to know how to present these persons to employers. We cannot just 'deliver' the client. That is why changing the perception of the professionals working with persons with mental disabilities is crucial, even more than changing general attitude in the society.  

Els Makaay: Again we see the advantage of CARe approach because it fits in the direction which is taken by our society.

Dirk den Hollander: More and more, we have to do things on our own, relying on natural resources: families, friends, neighbours and environment in general… And we try to help our client to make these natural resources for themselves because they will always be there while institutions will vanish sooner or later. 

Component 2 Institutional Transformation Training for Social Care Homes for Mentally Ill Adults and their local stakeholders, Hotel Panorama, Zagreb.

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