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- Khoo, Evelyn Grace, 1964-
(författare)
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Protecting Our Children : A comparative study of the dynamics of structure, intervention and their interplay in Swedish child welfare and Canadian child protection
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation is a case study of how two agencies in Umeå, Sweden and Barrie, Canada protect children found in need of child welfare services. The project's purposes are to describe how children are protected from harm in these two contexts, to illuminate the similarities and differences in the child welfare systems reflected at the local level, and explicate the significance of uncovered similarities and differences. The research project is grounded in three complementary theoretical approaches: i) social constructionism, ii) critical program evaluation theory, and iii) institutional ethnography. Using a model I developed to guide cross-national comaprisons, the research project explores three dimensions in the organization and delivery of services: i)Structure (service contexts and features), ii) Intervention (intervention process, and documentation and gatekeeping as two central aspects of intervention), and iii) the interplay between structure and intervention. The project combines methods including focus groups, qualitative application of the vignette technique, and analyses of assessment summaries extracted from case files at each agency. Finding from this investgation are reported in four papers. We identified differences in gatekeeping, use of social work skills, identification of clients, decision-making, and use of compulsory measures and the availability of other measures for clients. The documentation study showed that in Canada documentation is increasingly structured whereas in Sweden documentation is systematically varied but with narrative forms dominating. The different documentation trajectories in these nations are coupled to the paths they have taken with regard to the care and protection of children. We then focus on the "best interests of the child" principle. In Canada, the best interests principle is paramount but intimately connected to "need of protection" and risk assessment. In Sweden, the best interests principle is contibutory to the Social Service Act's emphasis on a solidaristic response to need. When data from this study are taken in context with other research in the field, it appears to give meaning to description of two models of state service for children in need because of abuse or neglect. Umeå is representative of some of the key elements in Swedish child welfare whereas Barrie is representative of some of the key elements in Canadian child protection.
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- Nygren, Gudrun, 1957
(författare)
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Screening and Diagnosis of Autism Spectrum Disorders
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Develop and examine a new screening and diagnostic framework for autism spectrum disorders (ASD), and study the prevalence of ASD in 2-year-old children in Gothenburg. Methods: Psychometric properties of the Swedish version of the Diagnostic Interview for Social and COmmunication disorders (DISCO) were examined in 91 patients aged 2-40 years referred for assessment of ASD. Twenty-one children screening positive for language delay at the Child Health Centres (CHCs) at 2.5 years were followed up with comprehensive neuropsychiatric assessments at 7.5 years. Another CHC general population sample of several thousand 2.5-year-olds was screened for ASD using the Modified Checklist for Autism in Toddlers (M-CHAT) and a new joint attention observation measure, the JA-OBS. Children screening positive for ASD were given very comprehensive ASD diagnostic assessments (including the DISCO) in a specialised centre. Prevalence rates for ASD in one age cohort were estimated. Some psychometric properties of the CHC screening instruments were examined. Results: The psychometric properties of the DISCO were found to be good to excellent. In the “language cohort” 13/21children had a neuropsychiatric disorder at the age of 7 years (of whom several had ASD). The prevalence of ASD in 2-year-olds in 2010 was 0.80%. Corresponding rates for 2-year-olds referred to the specialised centre in 2000 and 2005 (when no population screening had occurred) were 0.18% and 0.04%. The Positive Predictive Value (PPV) for the combination of M-CHAT (+ M-CHAT interview) and the JA-OBS was 90%, and the sensitivity 96%. Discussion: ASD is a relatively common neurodevelopmental disorder that can be detected at high rates already at child age 2 years (prevalence 0.80%). The DISCO appears to be a good instrument in diagnostic assessment both for clinical use and in research. A positive language screen at age 2.5 years should be regarded as an indicator of other possible neurodevelopmental problems, Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE), including ASD. The combination of instruments, M-CHAT and JA-OBS, has excellent PPV and sensitivity and the new screening programme shows promise for early detection of ASD as a routine in the developmental program at CHCs. Trained medical staff is a basic requirement and enables earlier detection and the use of screening tools also beyond routine population screening regardless of the age at which a suspicion of autism is raised. Crucial for screening are effective routines for further diagnostic assessments and interventions without delay. Keywords: autism spectrum disorder (ASD), prevalence, early symptoms, screening, diagnostic
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