La collaboration interprofessionnelle à l'interface des institutions socio-éducative et psychiatrique. Jeux et enjeux de l'intervention auprès de personnes en situation de handicap mental et de troubles psychiques

La prise en charge et le suivi de personnes en situation de handicap mental souffrant de troubles psychiques et se trouvant donc à l'interface des domaines socio:éducatif et psychiatrique, constituent des défis complexes en matière de collaboration interprofessionnelle. Dans le canton de Vaud, les acteurs concernés par ce problème s'efforcent depuis de nombreuses années de créer des réseaux pluridisciplinaires visant un meilleur échange entre professionnels et le développement de compétences et de connaissances permettant d'améliorer le bien:être des bénéficiaires. Ce travail se propose ainsi d'étudier et de questionner ces modalités de travail dans une perspective socioculturelle (Vygotski, 1934/1997), afin d'en comprendre le fonctionnement, d'en éclairer les mécanismes et de fournir des pistes de réflexion aux professionnels. Il repose sur un travail de terrain mené auprès des membres du Dispositif de Collaboration Psychiatrie Handicap Mental (DCPHM) du Département de psychiatrie du CHUV, dont la mission principale est de faciliter la collaboration entre les institutions socio:éducatives et psychiatriques spécialisées dans le suivi des personnes en situation de handicap mental et souffrant de troubles psychiques. Le travail empirique est basé sur une approche qualitative et compréhensive des interactions sociales, et procède par une étude de terrain approfondie. Les données recueillies sont variées : notes de terrain et récolte de documentation, enregistrement de réunions d'équipe au sein du DCPHM et de réunions de réseau, et entretiens de différents types. L'analyse montre que le travail de collaboration qui incombe à l'équipe est constitué d'obstacles qui sont autant d'occasions de développement professionnel et de construction identitaire. Les résultats mettent en lumière des mécanismes discursifs de catégorisation concourant à la fois à la construction des patients comme objets d'activité, et à la construction d'une place qui légitime les interventions de l'équipe dans le paysage socio:éducatif et psychiatrique vaudois et la met au centre de l'arène professionnelle. -- Care and follow:up for people with mental disabilities suffering from psychological disorders : therefore at the interface between the socio:educational and psychiatric fields : represent complex challenges in terms of interprofessional collaboration. In the canton of Vaud, the caregivers involved in this issue have been trying for years to build multidisciplinary networks in order to better exchange between professionals and develop skills and knowledge to improve the recipients' well:being. This work thus proposes to study and question these working methods in a sociocultural perspective (Vygotski, 1934/1997) so as to understand how they operate, highlight inherent mechanisms and provide actionable insights to the professionals. It is based on fieldwork conducted among members of the Dispositif de Collaboration Psychiatrie Handicap Mental (DCPHM), of the Psychiatry Department at the CHUV University Hospital in Lausanne, whose main mission is to facilitate collaboration between the socio:educational and psychiatric institutions specialising in monitoring people presenting with both mental handicap and psychiatric disorder. The empirical work is based on a qualitative and comprehensive approach to social interactions, and conducted based on an in:depth field study. The data collected are varied - field notes and documentation collection, recordings of team meetings within the DCPHM and network meetings, and various types of interviews. The analysis shows that the collaborative work that befalls the team consists of obstacles, all of which provide opportunities for professional development and identity construction. The results highlight discursive strategies of categorisation which contribute both to the construction of the patients as objects of activity and to building a position that legitimates the team's interventions in the socio: educational and psychiatric landscape of canton Vaud and puts it in the centre of the professional arena.

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The life-design paradigm is among those rooted in Guichard's (2009) life self-construction model that describes the identity processes underlying the development of multiple social selves. In this chapter, which is a tribute to the major contribution of Jean Guichard to the field of educational and vocational guidance and counseling, we will try to explicate the links between career adaptability and subjective identity forms. Both highlight two different and important processes that are interdependent and which should be simultaneously considered in the life design paradigm. These processes allow people to behave as active agents in their environment and are of high importance in the contemporary socioeconomic context, characterized by globalization, an increase in employment insecurity, the destructuralization of one's life course, and individualization. This chapter argues that both career adapt-abilities and identity processes rely on reflexivity and self-awareness abilities. For this reason the system of subjective identity forms, as defined by Guichard, can be considered as a meta-competency allowing adaptation, meaning making, but also the allocation of process resources.

Is Transnational Private Regulation Potentially an Effective Means of Promoting Collective Industrial Relations?

This paper asks whether collective industrial relations can be promoted by means other than seeking change in public policy. Recent research points to the increasing significance of transnational private regulation (TPR) in developing economies. There is an emerging consensus that market incentives to improve wages and conditions of work can have a modest positive effect on measurable outcomes like hours of work, and health and safety. However, it appears that TPR has little impact on the capacity of workers to pursue such improvements for themselves via collective action. The paper takes a closer look at the potential of TPR to enhance worker voice and participation. It argues that this potential cannot be properly evaluated without understanding how local actors mobilise the social and political resources that TPR provides. The case studies presented show how different TPR schemes have been used by unions in Africa as a means to pursue the interests of members. The authors found that the scale of the impact of TPR in all of the contexts studied depended almost entirely on the existing capacities and resources of the unions involved. TPR led to the creation of collective industrial relations processes, or helped unions to ensure that certain enterprises participated in existing industrial relations processes, but did virtually nothing to enhance the political and organisational capacity of the unions to influence the outcomes of those processes in terms of wages and conditions of employment. The paper concludes that the potential of TPR to promote the emergence of collective industrial relations systems is very low.