Cyber care and teleprompting: stimulating the socially isolated.
Chris Carter,
Researcher in Knowledge Management
Leicester University Management Centre
University of Leicester
and
Margaret Grieco,
Professor of Transport and Society
The Centre for the Study of Transport
University of Napier
Summary:
New technologies can offer means by which patients or other isolated individuals are enabled to
retain links with the outside world whilst spatially separated from it thus lessening the debilitating impacts of institutionalisation. Technologies such as web sites with video materials, electronic mailing facilities, video telephone services and intelligent caring systems (such as those already available in Scandinavia) can all play a very active part in enabling the transition from full separation from society consequent on nervous or physical breakdown to complete reintegration. Electronic tagging technologies can assist in the extending of the social experience available to those who encounter difficulties with short term memory - in the absence of such technologies certain categories of individuals can go missing without trace, with the availability of the technology such individuals can be readily located within a time frame that preserves their safety.The combination of social interaction technologies such as email and social tracking technologies such as electronic tagging offers mental health professionals an easy, cost effective, high frequency mode of communication with ex-patients - an early warning system in effect - and offers ex-patients a quality support service which can be harnessed for such routine activities as generating reminders to pay bills. New modes of communication provide a new opportunity to sustain competent social action by ex-patients. This article explores these various themes.
Thinning the walls: the relationship between social interaction technologies and institutionalisation.
On line freedoms: social tracking technology and ensuring the safety of the de-institutionalised
Cybersupport: sustaining the independence of the vulnerable.
Care in the community: balancing supervision and privacy.
Patient preferences and cyber care: building in user group feedback.
References:
Biographical Notes:
The literature on institutionalisation is well established (Goffman 1968, Terkel 1975, Foucault 1977): historically, the walls of total institutions played havoc with the ability of ex-patients to reintegrate into the social relations of the greater society. The world is changing and the physical walls of institutions need no longer constrain the social activities of their inmates so cohesively and hegemonically. Messages between the external world and the in-mates or in-patients of the most physically constrained environments are now possible without the endangering of public safety or patient health. New technologies can offer means by which patients or other isolated individuals are enabled to retain links with the outside world whilst spatially separated from it thus lessening the debilitating impacts of institutionalisation.
Technologies such as web sites with video materials, electronic mailing facilities, video telephone services and intelligent caring systems (such as those already available in Scandinavia) can all play a very active part in enabling the transition from full separation from society consequent on nervous or physical breakdown to complete reintegration. Similarly, these technologies can enable those physically and socially constrained to their own homes through frailty and diminished mobility such as the old-old to interact with others socially through electronic means. Such interaction is already part of an established social pattern amongst seniors in the United States of America ( http://www.aarp.org )
Traditionally, social interaction has been the outcome of physical proximity and spatial adjacency: those who lived in an environment densely populated with others had the greatest opportunity for intellectual and social exchange. Those excluded from such normal social circumstance and conversational flow were deprived of the behavioural opportunity to groom their own social identities. Electronic adjacency, a circumstance which is now available at very low costs and the domain of which can be extended to the most remote locations of global society, provides a new opportunity for social grooming and development. Through new technology the most obscure interest of the most socially isolated individual can be converted into the main conversational traffic of that individual's routine day: through the net like interested individuals and groups can be contacted and the electronic conversation converted into a daily routine which gives rhythm and structure to that life.
As interesting as developing virtual skilling arrangements for the deinstitutionalisation of patients is - and indeed on cost grounds alone it seems likely that this is the way new developments will go in the next millennium - , an even more interesting prospect is that of social interaction technologies providing patients and other inmates with the ability to continue the interaction with their original social context. Parents who have been institutionalised can maintain a contact with their children in the virtual mode which possesses a daily routine presence without distressing those children through daily visits to a disturbing institutional environment. As the education system skills youngsters in the use of the new technologies, so a corresponding adjustment is required in those institutions to which children connect. The social and physical separation of adults has consequences for the contact patterns of their children: recovering from ill health requires the recovery of old social identity and this in turn requires the maximum continuity possible in social patterns of relationships.
New technologies can provide a level of social tolerance necessary to identity repair rarely experienced in the speed and the dominance of the discourse of daily social life.
Recently, the United Kingdom has begun an experiment with the electronic tagging of offenders. Given this context the tendency may be to view electronic tagging as primarily a surveillance technology, however, there are a number of progressive grounds on which electronic tagging should be more gently considered. Frequently, persons with short term memory problems are required to be constrained for their own safety. The danger of these persons moving outside of the social world which they know and in which they are comparatively competent or in which they are known to the community is a real one. Electronic tagging can provide the opportunity for such individuals to move more freely in the local environment as their movement outside of that local environment can be tracked, with the consequence that they can readily located and returned to the locality within a safe time frame.
Electronic tagging technologies can thus assist in the extending of the social experience available to those who encounter difficulties with short term memory - in the absence of such technologies certain categories of individuals can go missing without trace, with the availability of the technology such individuals can be readily located within a time frame that preserves their safety.
The recognition that electronic tagging or social tracking technologies can expand the limits of safe experience for those in need of social protection requires careful policy thinking on the appropriate design of electronic tagging systems. Considerations such as the use of more frequent electronic checks on the location of vulnerable individuals in cold weather conditions or at night are obvious candidates for the policy makers' attention. Similarly, the crisis needs of particular individuals can be recorded, registered and responded to through electronic systems. Historically, ensuring the safety of the vulnerable meant either providing a permanent escort - an expensive option - or constraining the mobility of this category - a very comprehensive constraint on privacy and personal identity.
The information management capabilities of new technologies and new technical systems are such that caring surveillance is now possible without the individual experiencing physical chaperoning which constrains the development of personal identity. Simultaneously, the behaviours of those most at risk can be readily monitored and recovery action put into process where necessary whilst the individual gains confidence in engaging in the incremental engagement with the environment.
Taking together the message of the two previous sections, it is clear that the combination of social interaction technologies such as email and social tracking technologies such as electronic tagging offers mental health professionals an easy, cost effective, high frequency mode of communication with ex-patients - an early warning system in effect - and offers ex-patients a quality support service which can be harnessed for such routine activities as generating reminders to pay bills.
It is clear from the current discussions of returning to the care to the community and the equally noisy discussions about the failures of this initiative - mental patients discharged into the community without adequate support or supervision - that new systems of supervision and support for the vulnerable are required. The financial pressure on the old provisions of the welfare state is severe - the search for cost cutting approaches which continue to provide safety and support is on. The instant tracking capabilities of the new technical systems do not of themselves provide the solution. In order for these systems to work efficiently, particular auditing and response protocols have to be developed.
The failure of a vulnerable individual to pay a telephone, electricity or gas bill should trigger an investigation in the social welfare department - for this to occur, the electricity board or telephone company have to come to arrangements with the social welfare services about communicating such information. In this way, social welfare is not monitoring the whole of the social behaviour of its client base but rather is alerted at significant trigger and threshold points. The development of such intelligent social welfare alert systems seems a likely outcome of present commercial developments in the information communication technology arena.
New modes of communication provide a new opportunity to sustain competent social action by ex-patients: the involvement of social workers and other relevant agencies in precluding and preventing energy cut offs and other similar distressing social events which push the individual's development backwards is clearly a positive good. However, there is clearly a balance to be drawn between electronic supervision and the entitlement to privacy. The calculation must be undertaken with respect to the extent to which the individual requires protection in the search for as independent a life as is possible and the extent to which the community requires protection from the individual who when overly challenged over reacts. Within this framework, the electricity board can be required to provide the same information to the client as it provides to the social welfare agency: the obligation in a world in which service accounts are increasingly managed through centralised, computerised telephone banks and other connected systems must be upon the service providers to make appropriate provision for the vulnerable. Electronic reminder systems which deliver their message simultaneously to both the client and the social welfare agency may be one such innovation that can be undertaken.
Sustaining a secure infrastructure for the vulnerable who have been returned to the community may very well mean developing specific information protocols between service agencies and welfare services: the technical auditing, accounting and alert signalling systems are already present to make this a reality. The politics of provision remain to be resolved.
In the recent press coverage of the failures associated with returning care to the community agenda, a repeated pattern emerges of the individuals who have gone into crisis, and subsequently inflicted harm upon themselves and upon the community, raising the alert about their need for professional intervention. Typically the view of the end user of the care services - the patient - is disattended to: the ontological standing of the individual - the definition of being in need of care - is used to rule out the value of his or her assessment of his or her own condition. The patient's statement of acute need for professional intervention is often not even recorded.
The new technology opens up the prospect of support groups in which patients can record their needs. The recording of the patient's assessment of own state can thus become a matter of record and can be compared with eventual outcomes: the technology permits patients and experts to compare their diagnostic and predictive competences and enables a fine tuning on signals of disturbance in the caring system and the development of a better form of social alert.
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CHRIS CARTER is Researcher in Knowledge Management at the University of Leicester. Prior to this Human Resource Management at the University of North London Business School. Chris has recently submitted a Doctoral thesis which is an in-depth investigation of organisational change. This work has a particular focus on the dynamic of power/knowledge discourses within organisational settings.
MARGARET GRIECO is Professor in Transport and Society at the University of Napier and Senior Visiting Fellow at Cornell University. Until recently Margaret held the chair in Organisation and Development Management at the University of North London Business School. She has held a number of academic and policy making positions, in recent years these have included working as a social scientist at the World Bank and as a sociologist with the Transport Studies Unit at the University of Oxford. Margaret has published widely across a range of disciplines: recent books include `Maintaining the momentum of Beijing: the contribution of African gender NGOs' (Co-edited: Ashgate, 1998) and `Worker's dilemmas: recruitment, reliability and repeated exchange' (Routledge, 1996). Her current research is within the organisational studies and concentrates on exploring the possibilities that tele-technologies provide for tackling social exclusion at an individual and community level in both the U.K. and the developing world.