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  • Knechtel, Maricel L, 1968- (författare)
  • Categorization Work in the Swedish Welfare State : Doctors and social insurance officers on persons with mental ill-health
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • This dissertation contributes to the debate on street-level bureaucracy, which highlights how the decisions made by workers in public bureaucracies effectively become public policy. This debate has paid relatively little attention to the study of how professionals carry out their work by means of institutional categorization, a knowledge gap that this study helps to close. Moreover, this study contributes to the understanding of how persons with mental ill-health are matched with institutional categories.The aim of this dissertation is to shed light on the institutional categorization process involving persons with mental ill-health in two interrelated areas of welfare settings: primary healthcare and sickness insurance. To pursue this aim, 27 in-depth interviews with 30 participants (18 doctors and 12 social insurance officers) were performed. The interviews, which were based on vignettes – short hypothetical scenarios – made it possible to get insight into how doctors and social insurance officers would reason in a situation similar to that depicted in the vignette.This study emphasizes how discretion is exercised when individuals are matched with the institutional categories that doctors in primary health settings and social insurance officers have at their disposal. Ideally, this process is a rational process through which clients’ objective traits are assessed against the criteria that define the various institutional categories. However, the process is not straightforward; thus, different kinds of social mechanisms are linked to the processes of institutional categorization, such as signaling, screening, the logic of appropriateness, moral work, and discrimination. On a more practical level, this study emphasizes the difficulties imbued in the process of institutional categorization. There are multiple reasons for these difficulties. Human complexity is one of them: the interviewed professionals often work with situations that require responses to human dimensions, which are oftentimes too complicated to reduce to standard formats. Another reason for these difficulties has to do with the ambiguity and/or complexity of institutional category schemes. Moreover, the process of institutional categorization takes place in a context of conflicting demands and professional logics, both within a single organization and across the organizations that work together with respect to the same patient/client.Future research concerned with institutional categorization should address how persons with mental ill-health are matched with the institutional categories in other areas of welfare, such as social services and employment services. A deeper knowledge about how the various organizations of the welfare state match individuals with institutional categories, could bring us closer to an understanding of the problems of multi-organizational collaboration.
  • Isaksson, Joakim, 1976- (författare)
  • Spänningen mellan normalitet och avvikelse : om skolans insatser för elever i behov av särskilt stöd
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • In Sweden, an increasing number of pupils are defined as having some form of difficulties in school. In order to receive special support measures in school, these difficulties must have been subject to a pedagogical examination that state that the pupil is in need of special support measures. This work of identifying and defining difficulties implies that questions about normality and deviance inevitably come into play in school. There has been an increasing demand in school politics to identify these difficulties as early as possible, and this demand has placed further pressure on school personnel in this issue. Furthermore, the personnel’s perspective on the difficulties is also important, i.e., in terms of their origin, because this has importance for the design and content of the special support measures. The overall aim of this thesis is to analyse the tension between normality and deviance that is manifested in the school’s work procedures for pupils with special educational needs. Related to the overall aim, four overarching research questions are addressed. How have pupils with special educational needs and special education been articulated in national policy documents during recent decades? What perspective on school difficulties are being portrayed in schools’ individual educational plans for pupils with special educational needs? How do school personnel identify and differentiate pupils with special educational needs from “normal” pupils? How do pupils with special educational needs and their parents experience the special support measures that they receive in school and what seems to be the main concern of such support measures? The thesis consists of four studies that are based on different empirical materials such as policy documents, individual educational plans (IEPs) and qualitative interviews with school personnel, pupils and parents. The methods that are used for analysing the material are policy analysis, content analysis and grounded theory. The results show that the target group for special support measures has been ascribed with different meanings (over time) in policy documents, something that has affected the recommendations of the support measures and the choice of actors who are assigned to provide such support. Furthermore, the IEPs, as well as the interviews, reveal that an individual perspective on school difficulties seems to be deeply rooted in school.  The identification process of special educational needs followed three models: a pedagogical model, a social model, and a medical/health model.  However, the process of sorting out and defining these pupils invoked ambivalent feelings in the school personnel and the school class usually became the frame of reference for normal or deviant behaviour. Finally, the pupils’ and parent’ main concern of special support measures in school were described as a struggle for recognition and inclusion. The results are discussed with theoretical perspectives on school difficulties and special education. In the concluding discussion, it is argued that pupils with special educational needs have to balance between normality and deviance in school, but also between a pedagogical and a medical discourse by means of having a medical diagnosis in school.
  • Lassinantti, Kitty, 1968- (författare)
  • Diagnosens dilemman : Identitet, anpassning och motstånd hos kvinnor med ADHD
  • 2014
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • This thesis explores the increasing medicalization of society, the process whereby social phenomenon are transformed into medical problems. Alike the general tendency of neu- ropsychiatric diagnoses, the number of people with ADHD (Attention Deficit Hyperactiv- ity Disorder) has increased and expanded from a boys’ diagnosis to include both adult men and women. Studies on the latter category is however scarce. The objective of the thesis is to contribute with a micro sociological and critical perspective on the effects of the biomedicalization process, by focusing women's experience of getting and living with ADHD. The empirical material consists of narrative interviews with sixteen women, diagnosed with ADHD in adulthood. The participants, age 20 to 50, were enrolled via Swedish NGO:s in 2010 and 2013.The thesis resides on four analytical themes: biomedicalization, pharmaceuticalizaton, functionality and gender. It shows how diagnostics evokes processes that involve learning and using a biomedical terminology to describe and understand oneself. ADHD is, in general, depicted as diffuse, expansionary, masculine and deviant sociability and cognitiv- ity. Unlike depression and anxiety, described as temporary and unwanted illnesses, the ADHD-diagnosis embraces the whole personality. Hence, the women find it difficult to identifying and separating ADHD from the self. Furthermore, categorizations of oneself as a ‘woman with ADHD’ imply constructions of individual and collective identity that has ideological implications, i.e. the individual narratives are related to grand narratives. These contradictory grand narratives bring about ideological dilemmas that are handled rhetorically in the women's everyday life. The masculine connotation of ADHD, for ex- ample, render the women experiencing themselves as transgressing not only femininity but also ADHD-personhood. Additionally, as social actions are attributed to the ‘ADHD brain’, the brain is portrayed as a pathological deviant and dysfunctional object for phar- maceutical intervention. Nevertheless, this discourse is also contested by the women by pointing to 1) positive aspects of the ‘ADHD-brain’ in everyday life, or 2) gender inequal- ities and demands of the late-modern society. Concluding, the women in this study are not only victims of their bodies or societal norms, but also agents negotiating– adapting and opposing to – expectations of how to be an ideal citizen or woman.
  • Svanevie, Kajsa, 1976- (författare)
  • Evidensbaserat socialt arbete : Från idé till praktik
  • 2011
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • As an innovation Evidence-Based Practice (EBP) is designed as a tool for clinical problem solving. According to its theory of use EBP will bring a difference for policy makers, for professionals, for researchers and for service users. One question to be asked is whether EBP actually leads to the radical social change it is designed to accomplish. The aim of the study is to describe and analyse the outcome of the effort to establish EBP, with a focus on the case of social work in Sweden. The research questions are: What is EBP? Why are efforts made to establish EBP? What is the outcome of the EBP project? How can the outcome of the EBP project be explained?The case study was conducted on a critical realistic meta-theoretical ground with a focus on explanation of social change with an explicit actor-structure perspective. Methodologically, a narrative synthesis of studies was made. As a complement primary data were collected to fill empirical gaps. The state of things was described before and after the EBP-initiatives. Several helping theories – Kuhn’s theory of paradigm, program theory, neo-institutional theory and theory of diffusion – were used to analyse the empirically mapped outcome of the EBP project.The results show that the import of the original model of Evidence-Based Medicine (EBM) to social work is a part of a wider social movement in the helping and educational professions. The new model has influenced social work as a discipline, as a field of practice and as a field of policy. There are examples of full-scale implementations of EBP, although EBP has not reached a general status as daily practice. Some obstacles remain.The gradual adaption of EBP corresponds to criteria hold by Kuhn for a paradigm shift. Acceptance of the model has contributed to change the structure and function of social systems. At an organizational level, this change means on-going institutionalization. The innovation is influencing the way institutional actors conduct their work. Although the structural conditions have been optimal, the EBP-model has been debated with heat. The EBP-debate and policy-driven infrastructural efforts have brought a more in-depth examination of the model. So-called coercive, normative, and regulative isomorphisms were used to change organizations. The degree of institutionalization depended on the individuals and the organizations willingness and preparedness to change, to understand, and to put the model into practice. When actors used a less strict version of the original EBP model, the pace of cultural and institutional change slowed down.
  • Dag, Munir, 1968- (författare)
  • Unga människor med rörelsehinder : förankring, marginalisering och social exkludering
  • 2006
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • The aim of the thesis was to describe the specific barriers young people with disabilities experience in their ambition to get a job. The aim was also to investigate how these young people’s social and economic situation has been affected by their disability.The results are based on two reports: one qualitative, consisting of interviews with 12 individuals with physical disabilities, and one quantitative in the form of a questionnaire answered by 706 persons. In the case of the questionnaire, the response rate was 48 per cent. Both reports are based on the same criteria, namely, that the respondents should have a physical disability, be 20–35 years of age and be participating in some form of employment policy program.The results from both studies show that individuals with physical disabilities encounter different types of barriers on the labour market, which can be categorised as being either at the individual level or at the social level. The barriers at the individual level are low education, long-term unemployment, grave physical disability and lack of work experience. The barriers identified at the social level are primarily poorly adapted workplaces, a too high working pace, employers’ negative attitudes, insufficient knowledge of the competence of disabled persons and an overly generous social welfare system. All these factors constitute a direct obstacle to employing persons with a physical disability.The results from the interview study show that the respondents have few social relations. The majority of the respondents have social intercourse solely with family members or parents. Most of the respondents in the questionnaire study state that they have frequent social relations with friends and acquaintances. Both the interview study and the questionnaire study reveal that the respondents’ financial position has worsened as a result if their physical disability.Conclusions that can be drawn from this thesis are that young people with physical disabilities encounter different barriers in their attempts to get a job and to maintain social relations. Based on the results, some of the respondents can be regarded as being socio-economically marginalised.
  • Evertsson, Lars, 1964- (författare)
  • Välfärdspolitik och kvinnoyrken : organisation, välfärdsstat och professionaliseringens villkor
  • 2002
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • The relationship between the Swedish state’s welfare political commitments and the emergence and development of three female-dominated welfare state occupational groups - nurses, home relief helpers and occupational therapists - is at the heart of this thesis. The primary aim is to study the professional possibilities and limitations created by the state’s welfare political commitments in health care, family policy and rehabilitation. The thesis emphasises the importance of regarding the state as a historically conditioned actor and as an organisation of organisations. The state is not a unified and static actor and this makes it difficult to speak of the state’s relationship to different welfare occupations in general terms. Nurses, home relief helpers and occupational therapists have encountered the state in different historical contexts and established ties to different parts of the state. Abbott’s (1988) term jurisdiction is used to characterise the area within welfare politics that nurses, home relief helpers and occupational therapists have made claims on or been allotted. The struggle for jurisdiction takes place on three, analytically separate but in reality interconnected arenas. These arenas are the workplace, the media arena and the legal arena. The thesis limits itself to the legal arena, that is, the state’s administrative, planning and legislative structures. At the centre of the analysis of the legal arena are the Swedish Government Commission and the welfare political reform work that to a large degree has been formed by these institutions’ function and work. An important conclusion from these three case studies is that the state’s welfare political commitments have been central for the emergence of nurses, home relief helpers and occupational therapists and their development into welfare state occupational groups. The state’s welfare political ambitions have contributed considerably to the transformation of nurse, home relief helpers and occupational therapists into modern occupational groups. Dependency on the state has not always been easy to handle however. The state’s welfare political interests have often contradicted the wishes of the professions regarding the content, length and organisation of training programmes, as well as regarding continuing education and licensing. The state has been unwilling to provide more training than deemed necessary from a welfare political perspective. An important conclusion from this study is that it is difficult for welfare state occupational groups to steer their professional project in a direction that falls outside of the state’s welfare political commitments.
  • Holmberg, Lars, 1970- (författare)
  • Den frånvarande intellektuelle : En diskursteoretisk analys av en kollektiv representation
  • 2015
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • From an institutionalized conception of contemporary intellectuals as silent or absent, the aim of this thesis is to analyse how the representation of the intellectual changed from a hero of reason to a more or less absent actor. Descriptions of intellectuals that were initially analysed which showed that the representation of the intellectual, besides being linked to modernity, contained a relationship between the individual actor and political power, a relationship which could be traced back to ancient myths. Using discourse theory and concepts primarily from Ernesto Laclau and Chantal Mouffe, the dissertation demonstrates how the discourse of intellectuals changed the representation content in relation to the myth of the postmodern and to the myth of the modern society. In relation to the modern intellectual, the discourse linked the representation with elements as reason, freedom and politics. Texts written after the linguistic turn or the myth of the postmodern describe intellectuals as specific, bourgeois, academic and politicized. This makes the representation impossible in relation to the initial establishment. The main contribution of the thesis to research on the discourse of intellectuals is the myths bearing on how intellectuals can or should act and how the representation can be described. The notion of the intellectuals can only be understood in an already existing discourse based on what an intellectual should do or be.
  • Hultgren, Peter, 1970- (författare)
  • Det dubbla statushandikappet och sjukförsäkringens moraliska praktiker : en aktstudie om sjukpenningärenden som får negativa beslut på Försäkringskassan
  • 2011
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • In recent years an increasing number of sickness allowance cases have been closed with a negative decision despite the fact that a certifying doctor has recommended sick leave. At Social Insurance Offices, a case file is established for each sickness allowance case. The case files for 538 rejected cases form the basis for this study.   The assessment of the entitlement to sickness allowance is a key instrument of control in the health insurance system and the sharpened borderline between the obligation to work and the entitlement to sickness allowance can be interpreted as the result of a political aim to promote work through the health insurance system. This thesis explores these demarcation practices, highlighting the ways in which this policy of work promotion is translated into and made manifest in real world cases.   Three aspects of these practices were highlighted in the study described in the thesis. The first aspect concerns the identification of those who are denied sickness allowance; their diagnoses and work situations. The second aspect relates to the interaction between the certifying doctor, the medical officer and the case officer and their respective roles in the process leading to negative decisions. The third aspect examines how the actors interpret and apply the concepts of sickness and ability to work in cases with negative decisions. In addition to these themes, in the final chapter of the thesis, I draw on theories of institutionalised organisations and moral practices to analyse the outcomes of the decision-making process.   The thesis shows that a negative decision is most likely to be applied to insured persons who are either unemployed or who are manual workers without educational qualifications, and who have received diagnoses of mental illhealth or of diagnoses of pain and ache problems in the locomotive organs. It is argued that this is a moral category formed through the interaction of government policy dictates promoting work with actors, who in their official roles must apply an extremely vague criterion for entitlement to social insurance, namely disablement caused by illness.  In this way, the dual handicap  – undervalued labour (market) position plus undervalued gravity of illness – has become a borderline marker when the right to sickness allowance is being investigated and contested.  
  • Jacobsson, Maritha, 1960- (författare)
  • Terapeutens rätt : rättslig och terapeutisk logik i domstolsförhandlingar
  • 2006
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • In this dissertation, I explore a quite unique legal situation, namely administrative court hearings relating to coercive interventions: the Care of Young Persons Act (LVU), Care of Abusers (Special Provisions) Act (LVM), and the Compulsory Psychiatric Care Act (LPT). There are three central participatory roles in the court hearings: The official party is the authority who files the application for coercive intervention – either a chief psychiatrist or a social welfare board (typically represented by a social worker or sometimes a lawyer assisted by a social worker), whereas the citizen party is the person about whom the application is brought. The citizen party is represented by a legal representative. The professionals represent two different logics: therapeutic and judicial.The purpose of this dissertation has been to study the tension between therapeutic and judicial logic in court hearings relating to compulsory care. With theoretical concepts from Scott (1995) and Wetherell & Potter (1998), it is possible to say that the therapeutic and judicial logics are built up by institutional elements that are communicated through interpretative repertoires. Three questions are central:1. How do professional participators handle the different role expectations embedded in therapeutic and judicial logic? In this case, I am particularly interested in role conflicts faced by social workers and psychiatrists.2. How do different institutional elements (regulative, normative/cognitive) play out in the court hearings?3. To what extent can these court hearings be considered a scrutinizing order of discourse, where the arguments of official party are subjected to critical examination?In my analysis I am inspired by both critical discourse analysis and organizational theory, more precisely, new institutionalism. These two perspectives provide useful insights and make it possible to combine the micro- and macro levels in the analysis. Data for the analysis consist of 43 court hearings and 31 interviews, gathered from two different county administrative courts in Sweden. All written documents used and produced by the courts are also part of our data.The dissertation consists of five studies that indicate that the court hearings hardly can be described as a scrutinising order of discourse. In spite of this, the court constantly finds that the legal criteria for coercive intervention are satisfied. Neither the official party nor the legal representative argue according to a judicial logic. Instead, therapeutic logic dominates the order of discourse. When the arguments for compulsory care are therapeutic, they are not explicitly related to the criteria in the law. In my interpretation, the reason why the conflict between therapeutic and judicial logic is not realised can be found in the existence of a logic of normalisation. This ideological logic of normalisation can be found in most of the institutions in the Swedish society and are built on the idea of traditional welfare norms.
  • Järkestig Berggren, Ulrika, 1969- (författare)
  • Personligt ombud och förändringsprocesser på det socialpsykiatriska fältet
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • In a new reform in 2001, Swedish authorities emphasized the need for support for persons with psychiatric disabilities living in the community. This reform included the establishment of a new occupation: the Swedish case manager, personligt ombud (PO). In examining this new occupation, the overall aim of this thesis is to analyze how the Swedish case manager, PO, as an evolving occupation, affects and is affected by the organisational and professional field in which it enters. More specifically, the aim is to describe and analyse, using organisational and professional theories, the changing processes that the PO con-tributes to in the welfare system and the practice of social policy, the field of social psychiatry focusing on the discretion for professionals and in the under-standing of the professional role to help as described by clients. Three studies have been carried out. The first study, for the licentiate´s degree, focused on the PO occupational role and functions for the welfare system as well as for mental health service users. In the second study, the results from the first study were analyzed together with the results of another reform, namely, the Swedish care manager reform, in order to investigate their joint implications for social policy and its practice. The third study focused on what meaning the PO has for the clients and particularly what features of the service the clients find to be helpful. In summary, the results indicate that the PO contributes to the development of a negotiated rights model, by taking on the assignment of advocacy as a client representative, and then defining the social worker as a representative for the organisation with the assignment of needs assessment. In the field of social psychiatry, the PO fills a vacancy by supporting the legitimacy of the professionals as well as their organisations. Furthermore, the PO has a function of providing organised transparency through restricting the discretion of other professionals. The discretion of the PO itself has weak boundaries allowing for great liberty of action. Finally, the PO service has led to a new understanding of the professional role, as built on reciprocity with the client, using knowledge evolving from the interaction between the professional PO and the client. These findings suggest that the PO could be understood as a new occupation evolving from weak professional traits to, as suggested, a new model for professionalism, called user-mandated professionalism. This emphasizes the reciprocative foundation of knowledge between the service user and the professional.
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