Ruling relations in the intake assessment of a pregnancy outreach program
Date
1998
Authors
Siga, Vaida
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Abstract
This thesis uses Institutional Ethnography to examine how intake assessment in a British Columbia Pregnancy Outreach Program organizes worker-client interaction. The Pregnancy Outreach Program targets service to "high risk prenatals". The study argues that the epidemiological based intake assessment process creates a barrier to participation of the very clients it seeks to serve and limits the extent to which staff can establish a relationship with the client. It argues that classifying the client as "at risk" owing to social disadvantage is experienced negatively by the client, and constitutes social difference between staff and client. At odds with the scientific model that population health brings into the program is a community development approach that has been included in its organization. It is expected that this would allow clients to feel more comfortable with the service, and thus, the program to be successful. Inclusion of a community development approach, however, sets out two distinct and conflicting work processes within the program. The formal work as organized by the intake assessment is textualized and provides accountability measures. Specific work practices based on community development ideology organize the informal work of the program. Though these support staff/client relationships and client participation , the latter are subordinated to the formal work process. The study argues that because formal work practices are part of the management technologies of the Ministry of Health, they are dominant and supercede informal work practices. This creates troubles both for client participation and for workers.