Joint decision making in a mental health rehabilitation community: The impact of support workers’ proposal design on client responsiveness

Abstract

Using both statistical methods and conversation analysis, we examined how support workers in a mental health rehabilitation community encourage clients to participate in joint decision-making processes. Drawing on video-recordings of 29 community meetings as data, we considered support workers' proposals (N = 449) and clients' responsiveness to them. Support workers' proposals were coded for their linguistic and other features and clients' responsiveness was assessed by three independent raters. Multiple linear regression (MLR) analysis was carried out. A significant regression equation with seven predictor variables accounted for 24% of the variance in the data. Four variables predicted a higher level of client responsiveness: the use of explicit recipient address term, "quasiopen" proposal form, support worker's long work experience, and the average level of client participation during a session. Three variables predicted a lower level of client responsiveness: grammatical complexity of proposal form, modal declarative proposal form, and the presence of only one support worker in a session. The qualitative conversation-analytic investigation highlighted the advantages of the careful fine-tuning of openness vs. closedness of proposal form, the reflexive awareness of which, we argue, may help mental health professionals to encourage clients' responsiveness in joint decision-making processes and thereby their participation in communal life.

(How) are decisions made in child and family social work supervisions?

“…These examples fall into Collins et al’s (2005) bilateral decision-making categorisation, meaning that decision-making outcomes were dependent in part on the social workers’ contributions. These mostly take the form of ‘proposals’ in first position, whereby the supervisor proposes an action whilst conveying that it is contingent upon the worker’s acceptance (Stevanovic et al, 2020).…”

Mental health rehabilitees’ agency construction and promotion in community-based transitional work programme

“…Stevanovic et al ( 2020b , 2020 , 2020a ) have studied joint decision-making in the Clubhouse context and identified the practices by which the Clubhouse staff promote mental health rehabilitees’ agency in joint decision-making processes. First, the staff encourage rehabilitees’ responsiveness to the proposals they make.…”

“…For example, the staff may remind the rehabilitees of their prior experience and knowledge, which enables them to comment on the proposal (Stevanovic et al, 2020b ). The staff may also fine-tune the openness as opposed to the closedness of the form of their proposal, to provide the rehabilitees with genuine opportunities to contribute to the content of the decisions, while making participation easy enough for them (Stevanovic et al, 2020a ). Second, in cases in which the rehabilitees make proposals, the staff may encourage further participation by enthusiastically elaborating on these proposals (Stevanovic et al, 2020 ).…”

The grammar of proposals for joint activities

“…In the realm of children's interaction, Goodwin (1990: 109-113) and Stivers and Sidnell (2016) study how children at play formulate proposals for what they will jointly do next, while Asmuß and Oshima (2012) and Stevanovic (2013) consider proposals in meetings in Danish and Finnish respectively. How proposals are responded to is a key consideration in this body of work (see especially Asmuß & Oshima 2012;Barnes 2007;Houtkoop 1987;Lindström 2017;Stevanovic 2013;Stevanovic & Peräkylä 2012;Stevanovic et al 2020), and responses to proposing actions also figure in the argument we develop here.…”