Community-driven care initiatives: a draft social contract

The mighty @markomanka, after some lengthy discussions with others (including myself), has produced a very interesting document. It is an explicit social contract, of the sort we imagine is hovering over the best community-care initiatives we have seen in the two years of opencare. I find it very, very thought provoking; it seeks a way that we can promise to do our best, which is all that communities can do, while still taking responsibility. It somehow brings home the unwavering gaze at our human fallibility, our perennial underfunding, our precarious organisational structures, and still the excellence, still the empathy, still the grit to soldier on.

Reading made me think of the Helliniko Metropolitan Community Clinic, or of the Woodbine Health Autonomy Center, or of @alex_levene’s and the other volunteers’ work at the Jungle in Calais.

I am sharing it here, hoping for comments from all of you – starting from @gehan, @woodbinehealth, @winnieponcelet and @patrick_andrews. In fact, I am thinking of making a non-care specific version that would cover all community initiatives. But then again, maybe all community initiatives have an element of care.

A much longer, commented version is here.

The contract

  1. This form of care is designed to outlive the individual initiators, and has a clear strategy towards sustainability, or the necessary situational awareness to navigate through changes preserving the right to care of its beneficiaries.

  2. This form of care is designed to work as a catalyzer, it may remain available an arbitrarily short period of time, and it is explicitly meant at raising awareness and/or teaching coping or problem solving strategies and/or passing the responsibility of care onto well identified existing organizations, rather than offering outright care in the traditional, entrusting sense.

  3. Care offered by our team/s is designed with you based on information that has been, and will be tested for validity concerning both its effectiveness and safety. Our partners and we commit to publicly discussing our practices, to be transparent and to have the opportunity of discovering what could be done better/differently.

  4. We commit to transparency about our funding streams, and we commit to procuring and managing resources adhering to the ethical standards we apply in all our activities, and in measure to sustain the continuity of our action, designing adequate fallback strategies should causes of force majeure cut us short of planned funding.

  5. We have designed this initiative with our community in mind, we struggle to maintain space and opportunities for everyone of you to join us and use, or ethically misuse what we maintain, so that the forms and offers of care existing here could evolve with the community itself. We are aware we cannot do everything alone, but we can facilitate you doing your part.

  6. We put in place every measure within our means to support your conscious participation to the production of the desired outcomes, and to support you in behavior changing and maintenance. However, we will never deny your access to care from us, as long as fall within the community we care for, as it is transparently stated and advertised in our statute.

  7. We may enforce temporary restrictions to your access to care, under those circumstances in which your behavior represents an acute risk for the care providers (e.g.: violent or otherwise threatening behaviors), or whenever your behavior poses an absolute barrier to the achievement of the goal of said care, until modified (e.g.: requirement of discontinuation of alcohol abuse before accessing organs availability lists).

  8. We devote ourselves to care, and we are aware that the very objective and meaning of care evolve with the vision of the world of individuals and community. Thus, we commit to continuing independent evaluation of our activities, and to turning any breach or near miss consequently identified into the awareness of a changing landscape that would guide an evolution of our operations and governance. We invite all our members and users to raise a flag and report those instances in which needs required work-arounds, not because we aim to police the ethical dimension of your behavior, but because we want to rethink with you our rules and principles in order to find ways to accommodate the unmet needs you spotted in the most transparent and widely acceptable form possible.

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I’ve been a bit swamped with work, but I’ve gone through this. I can’t say much other than that it’s obviously complete and in line with our values. Drafting a text like this is hard work and definitely a help for projects that have no time for this kind of deep thinking.

As far as a communication tool towards patients/clients/community I’m not so sure. The contract is quite dense. It should be tested in different contexts I guess. My hunch is that you need to put this in an easily digestible format like a graphic or easier language, add examples etc for it to be useful to people who are not project leaders or deeply involved in the business of thinking about stuff.

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Hmmm. Not sure. I think this is not for communication. It is there to consult, when people are unsure on what to do. It is also a trust building device, not so much for people who read it, but rather for people who notice it’s there. This means someone’s gone through the exercise of actually wondering what sort of commitments they can actually make, and how that is still ethical and better than not bother with doing the project (or delivering the service) at all.

It’s always going to be communication though. The issue with dense material is that in my experience it is not conducive of a feeling of belonging. Especially if the topic is so fundamental, and claims to be the social contract, it can make people feel excluded.

People stumbling on it is just a random subset of all people (slightly skewed to the curious): smaller, not different. And only few of that subset will “get it”