Care farms in the Netherlands: Attractive empowerment-oriented and strengths-based practices in the community
Introduction
Recent decades show a shift in care characterized by the terms deinstitutionalization, socialization, and normalization. It is a shift from institutional to community care (Van Weeghel et al., 2005; Schols and Van Schriek van meel, 2006). It is not only transferring inpatients to services in the community but it is also sharing responsibility for client care across multiple and diverse agencies (Lamb and Bachrach, 2001; Baudain et al., 2002).
The successful socialization of care requires the provision of services that enable clients to participate actively in normal activities as long as possible and to live as respected citizens (Torrey et al., 2005; Bellack, 2006). The socialization of care should lead to a better quality of life for its users. Quality of life can be defined as the degree to which a person enjoys the maximum possibilities of his or her life in three areas: the areas of being, belonging, and becoming (Raphael et al., 2001). Community-based services should also lead to a good quality of life in the community. On the basis of various policy documents, Depla (2004) identified four different “good life” ideals for clients: it should be as ordinary as possible, as meaningful as possible, as integrated as possible, and as active as possible.
Various types of services and approaches have been developed in terms of socialization for a diversity of client groups such as clients with mental illness (Fisher, 1994; Resnick et al., 2004; Torrey et al., 2005), frail elderly clients (Sullivan and Fisher, 1994; Chapin and Opal Cox, 2001), and clients in child and youth care (Noble et al., 2000; Rosenberg and Knox, 2005). These services represent an alternative to the dominant medical model world view (Graybeal, 2001). This changing paradigm is characterized as recovery-oriented, empowerment-oriented, and strengths-based (Chapin and Opal Cox, 2001). The approaches that have been developed were mainly for clients with mental illness, showing similar focuses namely:
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Focus on community integration and involvement.
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Focus on strengths, self-direction, and empowerment of users.
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Recognition that change is possible.
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Individualized and person-centered.
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Recognition of the value of peer support and informal networks.
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Emphasizing that the relationship between user and helper is primary and essential.
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Full citizenship and nondiscrimination.
(Powell Stanard, 1999; Brun and Rapp, 2001; Bond et al., 2004; Resnick et al., 2004; Torrey et al., 2005; Bellack, 2006).
The fundamental premise is that individuals will do better in the long run if they are helped to identify, recognize, and use strengths and resources available in themselves and their environment (Graybeal, 2001; Chapin and Opal Cox, 2001). Bennett (2000) proposed employing non-professionals in working and residential projects because they can show clients the reality of normal life. The inclusion of non-professionals in services, however, has not received much attention to date. Despite all commonly accepted objectives, it is problematic to create services with the active involvement of society (Lamb and Bachrach, 2001; Brun and Rapp, 2001; Power, 2008). As a consequence, many clients who are placed in the community lead an isolated life, where health professionals are the most important members of their social network (Dewees et al., 1996; Borge et al., 1999).
Care farming is a growing movement that combines agricultural production with health, social, and educational services (Hassink et al., 2007; Hine et al., 2008, Elings and Hassink, 2008). It is an interesting phenomenon because the agricultural sector is actively involved in providing care for different client groups. Care farms offer day care, supported workplaces, and/or residential places for clients with a variety of disabilities (Elings and Hassink, 2008). Care farming aims to provide health, social or educational benefits through farming activities for a wide range of people (Hine et al., 2008). They can be considered as concrete examples of the desired socialization of care leading to greater independence and social status, taking the clients’ potential as a starting point, rather than focusing on their limitations (Driest, 1997; Hassink et al., 2007). Target groups include people with a mental illness, addiction background, learning disabilities, older persons, children, problem youth, and long-term unemployed persons (Hassink et al., 2007). The perceived benefits of care farms are improved physical, mental, and social well-being. Mental health benefits consist of improved self-esteem, improved well-being, and improvement in mood. Examples of social benefits are independence, formation of work habits and the development of personal responsibility and social skills (Elings and Hassink, 2008; Hine et al., 2008). Patients with dementia attending day care on farms have been shown to have fewer behavioral problems, greater levels of activity and fewer drug requirements (Schols and Van Schriek van meel, 2006). It has been reported that care farms achieve this by incorporating a range of meaningful values such as security, structure, routine, contact with plants and animals, and diverse range of activities (Schols and Van Schriek van meel, 2006).
The number of care farms in the Netherlands has increased rapidly from 75 in 1998 to more than 800 in 2008 (Elings and Hassink, 2008). In 2005, 10,000 clients made use of a care farm in the Netherlands, including 4000 clients with learning disabilities, 1500 with a mental illness, 1000 children and youths, and 900 older persons (Hassink et al., 2007). The number of care farms in other European countries is also increasing. (Hassink and Van Dijk, 2006; Goris et al., 2008; Hine et al., 2008).
On most care farms in the Netherlands the farmer him/herself takes care of the clients. Most farmers have no professional education in health care.
Care farms can be considered as a specific example of green areas or therapeutic landscapes that have gained increasing attention as environments promoting health and well-being (Conradson, 2005; Nielsen and Hansen, 2007; Maas et al., 2009). People involved in care farming claim that not only the green environment but also the meaningful activities, contact with plants and animals, and the informal non-medical atmosphere are important for clients (Berget, 2006; Hine et al., 2008). Focus group interviews showed that clients with a mental illness and addiction background especially appreciated the social qualities of care farms (Elings and Hassink, 2008). However, systematic research focusing on the opinion of participants about the qualities of care farms is lacking. The aim of this preliminary study is to find out which characteristics of care farms are important for different client groups and whether care farms can be good examples of empowerment-oriented and strengths-based practices for different client groups leading to an improved quality of life.
Section snippets
Materials and methods
Between March 2006 and April 2008 the authors interviewed 41 clients on care farms, 33 care farmers, and 27 employees of care institutions that collaborate with care farms. We selected these three types of stakeholders because they are involved in the process of matching demand, supply and client placement on a care farm. Many care farms have a subcontracting arrangement with a care institution. Different stakeholder groups are known to have different priorities regarding various aspects of
Results
We interviewed clients, care farmers, and employees (social workers and managers) of care institutions that collaborate with care farms. We present the views of these groups of respondents and compare three client groups: clients with mental illness, youth care clients, and frail elderly clients.
Combination of qualities appreciated
The results indicate that the combination of different types of qualities make the care farm an appealing facility for different client groups. These qualities can be characterized as the personal and involved attitude of the farmer, being part of a community, an informal context and the provision of useful and diverse activities in a green environment where clients experience space and peacefulness. Earlier studies mainly focused on the qualities of the green environment (Hassink, 2003;
Limitations of this study
This is a qualitative pilot study and not a quantitative study. The limitation of the present study is that we only interviewed clients who have chosen to remain on the farm and clients that were selected by the farmer. The selected clients might be more positively disposed to the setting than other clients. As a next step, it would be valuable to interview clients that have left the farm because they were not satisfied. We also recommend measurement of the effects of the care farm context on
Conclusion
This pilot study shows that the combination of a personal and involved attitude of the farmer, being part of a community, an informal context and useful and diverse activities in a green environment make care farms an appealing facility for different client groups. The combination of these qualities appears to be unique. Care farms can contribute to good life ideals and can be considered as innovative examples of empowerment-oriented and strengths-based practices in the community.
Acknowledgements
This paper is based on a project funded by Transforum. Additional funding was provided by Wageningen-UR Plant Sciences Group.
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