1.
Åberg, Linnéa
(författare)
Standardiseringsarbetets kollektiva praktik. En studie om att kvalitetssäkra integrationssatsningen Samhällsorientering för nyanlända.
2020
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Societal efforts to support the integration of newly arrived immigrants have been repeatedly highlighted in the political debate in Sweden and they are described as inadequate and ineffective. Demands have been made for improvements and one of the designated efforts is Civic Orientation (CO). The Civic Orientation programme is a course about Swedish society, targeting newly arrived refugees and their relatives who have received a residence permit. It provides basic information about Swedish society to aid and expedite integration (SFS 2010:1138). The criticism has led to the production of written, national instructions containing correct information that should be provided by the civil servants in CO. The aim is that quality should be high and equal across the country. The overall aim of the dissertation is to deepen the understanding and knowledge of the work-process to develop standard guidelines, that will be used in a welfare sector, where it is difficult to establish definitive knowledge. The dissertation's purpose is also to deepen the understanding and knowledge of instruction work as a collaborative activity. The term ‘instruction work’ covers both work that experts and managers undertake when they develop written guidelines, and work done when implementing these guidelines in local practice. The thesis is rooted in activity theory where work is viewed as a collaborative activity aimed at taking on a task, event or object, such as interpreting, paying attention, participating, thinking, and performing. The study involves five different categories of actors: a representative from the county administrative board, experts from various authorities and universities, coordinators and the head of a unit from a management group in a municipality, and integration workers, who are the local civil servants. The study is based on a field study where video recorded observations of meetings, lectures and workshops have been conducted. Semi structured interviews and written communication have also been used. The result shows that there are different perceptions of what work needs to be done to ensure that the instructions are correct. A variety of, sometimes contradictory, tasks developed: to make the information scientifically correct with multiple perspectives on social phenomena, to make educational simplification, to provide an ideal image of Sweden according to policy, or to describe Swedish society as irrational with hinders and obstacles (papers 1- 3). Another major task was to make the instructions politically neutral which meant producing information that was not offensive for external readers such as politicians and the general public (paper 1). When guideline models have been used for other welfare activities, the work is usually based on analysis of the needs of the target groups. That task took on an obscured role and was first noticed as important by the civil servants in the latter part when the material was used during implementation (papers 1, 3). A further result concerns the work of developing standard guidelines. The study shows that there is formal instruction work (paper 1) which is the planned work, most often done by experts and/or researchers, and informal instruction work (paper 2) often hidden and performed by civil servants in the implementation phase. This informal work is about transforming the instructions to be useful for the individual in the local situation. But the study also shows a third type of work - semi-formal instruction work (paper 3) that is also carried out by the local civil servants, where they, with their biographical and informal instruction work experience, try hard to influence formal instruction work. One conclusion is that it is more fruitful and accurate to perceive standardized instructions as dynamic and integrated in the practical work, than to see them as fixed by an externally controlled process. Developing standards to be used to improve practice is an ongoing fluid process that never ends, and that involves tensions and conflicts that need to be addressed.
2.
Mossberg, Linda, 1982-
(författare)
Mellan norm och praktik : Strategisk samverkan och brukarmedverkan inom verksamhetsområdet psykisk ohälsa
2018
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
There is a steady critique towards the mental health field stating that people with mental health problems do not get the assistance they need. Often, this critique states that collaboration between different organisations is lacking or non-functional. As an increasingly common part in collaboration, service user participation has also been included in this critique as not being adequately performed. Within the mental health field,many studies has focus on collaboration and service user participation on operational level, with and between professionals in direct interaction with service users. Not as many has studied the strategic level of collaboration, between leaders and managers, planning and structuring the organisation of mental health services. This level has also within the operational level studies often been pointed out as paramount to collaboration on operational level.The present thesis aims to describe and analyse collaboration and service user participation on strategic level. The following research questions are included: how are the strategic collaboration councils composed, and how do the participants handle the work within them? What experiences and opinions on collaboration do the participants have? How do the participants handle possibly contradicting expectations and interests from the surroundings and from their own organisations? How are service users and service user participation socially constructed, and what do such constructions entail? How do the participants handle collaboration as a practically unavoidable way of working?Eight strategic collaboration councils from the north, middle, and south of Sweden were included in the study. The participants in these represented mostly social and mental health services, and in some cases Arbetsförmedlingen (the Swedish Public Employment Service), Försäkringskassan (Sweden's social insurance agency), and service user organisations. 80 participants in all were included in the study, mostly managers. The councils were observed during one year, and the participants were asked to participate inan interview and a questionnaire. The material was analysed with the assistance of NVivo9 and SPSS, and by the theoretical aid of new institutionalism, discourse analytic perspective, and negotiationThe results showed a collaboration between the participants that revolved around norm and practice of collaboration. While all participants had very homogenous opinions and experiences of collaboration, showing of a strong norm supported by laws and regulations, there were also a discussion that showed of the possibility to negotiate that norm. Through negotiation and normative arguments, the participants could adhere to the norm that brings legitimacy to the organisation and the collaboration council, while further own interests and interpretations. Negotiation about collaboration meant that the participants could discuss collaboration in itself. Through choosing normative arguments, they could put forward certain aspects of the collaboration norm which gave latitude within the norm. Here, the norm came forward as collaboration should be done by being or becoming to be united, while having good relationships and an open discussion. The dilemma that showed through the negotiation and normative arguments was that while collaboration must be built on good relationships that can withstand disagreements and criticism, one cannot jeopardize the relationships by bringing up contentious topics. But, if pressing matters because of this are not allowed to be discussed, collaboration is at risk to be perceived as pointless. Collaboration through negotiation showed negotiation as a mean to get things done and to handle interests and interpretations in the collaboration councils. These negotiations were both implicit and explicit and were based in the collaboration norm. Normative arguments also served a purpose in building and strengthening the relationships between the participants, putting relationships as a central part of collaboration. Through normative arguments based in the collaboration norm, participants could preserve consensus and discuss disagreements, interpretations, and interests without risking the relationships. Service user representatives tended to be apart in negotiation about collaboration, but not in collaboration through negotiation. Even so, the service user representatives made a mark within the collaboration councils indiscussions and agendas, showing a plausible increasingly stronger position within in strategic collaboration.
3.
Björquist, Elisabet, 1959-
(författare)
Mind the gap : transition to adulthood – youths' with disabilities and their caregivers' perspectives
2016
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Transition to adulthood, referring to the process of moving from childhood to adulthood, can be a complex period for youths with disabilities who might need special support transitioning into an independent life as adults. Caregivers are significant persons for the youths, which is why their own health and wellbeing is important. Therefore the overall aim of this thesis was to gain a deeper understanding of health and wellbeing, challenges, preferences and needs during the transition from childhood to adulthood in youths with disabilities and their caregivers. The thesis is comprised of two studies, study A focusing on the perspectives of youths with CP (Paper I) and of their caregivers (Paper II) and Study B focusing on the perspectives of immigrant youths with disabilities and caregivers from Middle Eastern countries residing in Sweden (Paper III and IV). Study A had a qualitative approach and involved focus groups and individual interviews with 12 male and female youths, 17-18 years of age, with CP and various physical and cognitive levels of disabilities (Paper I), as well as 15 mothers and fathers (Paper II). The interviews were analysed using qualitative content analysis. In Study B, a combination of qualitative and quantitative methods was used. Based on structured and semi-structured questionnaires in combination with open ended questions interviews were conducted in Swedish or Arabic with 17 male and female youths, 13-24 years of age with various disabilities and 10 mothers, five fathers and one sibling. The families were all immigrants with Middle Eastern origin and most of them had lived in Sweden for more than five years. The questionnaires Family Need Survey (FNS), Rotterdam Transition Profile (RTP) and Canadian Occupational Performance Measure (COPM) were all translated and adapted to Swedish except for COPM where there already was a Swedish version. The results were analysed using mainly descriptive statistics and based on the framework of International Classification of Functioning, Disability and Health – Children & Youth Version (ICF-CY). The findings from study A showed that the experiences of youths and caregivers mostly concerned mental health and wellbeing described as both positive and negative experiences. Their family life was experienced as important, secure and convenient, which made the youths feel safe and gave parents a sense of meaningfulness. Youths described participation, socialising and love as being important, but also challenging and worrying. Caregivers experienced sorrow and anger and together with demanding logistics, planning and worrying, their health was affected negatively during their children's transition to adulthood. The findings from study B showed that youths were dependent on their caregivers for transportations, participating in leisure activities and socialising with friends. They were also dependent on their caregivers for the demanding of support and health care. The youths had few or no experiences of intimate relationships but felt that they were expected to get married in the future which worried them and their caregivers. Caregivers were uncomfortable with using the term intellectual disability. Caregivers needed help to understand their child's condition and to explain the child's condition to their wives/husbands. A significant difference was found in what problems youths identified with and what their caregivers identified as their youth's problems. The youths experienced problems with handling finances, transportations and seeking employment or daily activities whilst their caregiver thought their youth's primary problems involved self-care. The overall finding showed that to strengthen health and wellbeing in youths with disabilities and their caregivers and to meet challenges, preferences and needs during transition from childhood to adulthood both youths and caregivers need information and support. Both youths and caregivers expressed a desire for individualised support given by one person who could facilitate the transition period by coordinating information and give support based on individual preferences and needs. During the recruiting process in both studies, great challenges were experienced in finding participants. Collaboration with professionals in schools and leisure activities was found to be the most effective way to get in contact with immigrant youths and thereby also their caregivers. The findings from this thesis may enable professionals to develop and improve best practice guidelines for support, habilitation and health care in youths' transition. To facilitate for the youth to transfer from services with a family-centred approach to person-centred adult services, their autonomy must be strengthened by involving them in their own transition planning early on. Immigrant youths need special information and support about love and the freedom of choice to get married. The COPM and RTP are suggested to be used as tools in person-centred transition planning given they are used customized and applied with cultural sensibility. To enable those with communication limitations to give their independent voice the use of communication tools is necessary. Furthermore, the transition to person-centred adult support and health care should be flexible and not determined by biological age. However, youths need support by their caregivers who in turn might both need, and want, support for themselves and occasionally hands-on support. Guidance by a specially designated navigator aimed to support the whole family would be an option to meet individual needs. The information and support should be culturally sensitive with respect to various linguistic and cultural experiences. To close the gaps between systems of care collaboration was discussed to be necessary to facilitate the transition between support and health care for children and youths as well as services for adults. The use of ICF-CY as a framework for understanding needs and the standardised terminology in ICF-CY in documentation can facilitate this collaboration.
4.
Bolin, Anette
(författare)
Shifting Subordination : Co-located interprofessional collaboration betweenteachers and social workers
2011
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The purpose of this thesis is to describe and analyse the practice processes involved in colocated interprofessional collaboration. The study took place in a resource school where social workers and teachers collaborate on an everyday basis around children who are both in receiptof special educational support and interventions from social services. The research questioncentres on the division of labour and the explicit notions and implicit assumptions thatunderpin it. Further, the organisational conditions that influence the division of labour, theprocess involved in the selection of pupils, and the processes of maintenance anddevelopment of professional identities in a close collaborative context are all examined.The study is a qualitative case study of interprofessional collaboration. Through interviews with the teachers and social workers, and via participatory observation of their professionalpractice, empirical data has been generated. This has been used to examine processes ofcollaborative collaboration in accordance with a thematic analytical scheme. A theoretical framework based on theories of the sociology of professions (Abbot, 1988; Evetts, 2006b) and drawing also on the work of Hasenfeld (2010a) on human serviceorganisations and Lipsky (1980) on street level bureaucrats, in conjunction with Strauss’ (1978) theory of negotiations, has been used in analysing the empirical data.The results indicate that the intake process functions primarily to legitimise collaborationfrom an organisational and professional perspective. Further, the teachers and social workerscreate what are termed common and separate grounds for practice. The concept of common grounds describes the processes in which common collaborative relationships are created, such as, forexample, the construction of interchangeability and a common practice ideology. Separate grounds, on the other hand, involves situations in which social workers and teachers are engaged in defining and specifying their profession-specific roles in the context of their everyday work. Another means of maintaining and reinforcing a profession-specific professional identity in co-located collaborative contexts is the use of the spatial design. The results also point to three particular characteristics in the construction of co-located interprofessional collaboration. First, professionals are engaged in what can be termed a form of shifting subordination as a means of both legitimising and developing their professional identities. Shifting subordination is a strategy used to reduce and avoid professional conflict around roles and working tasks. Secondly, they are engaged in constructing a shared professional identity as a means to meet the organization’s imperative of ‘getting the job done’. Thirdly, there is the characteristic of interdependence which shapes the negotiation processes involved in the division of labour.
5.
Klamas, Maria
(författare)
Av egen kraft tillsammans med andra : Personer med psykiska funktionshinder, socialt stöd och återhämtning.
2010
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The purpose of this study was to describe and analyse the significance of social support to adults with psychiatric disabilities, based on the individual's experiences. This includes research questions concerning what type of social support was perceived to be beneficial or restrictive, which relational aspects were considered having a beneficial or restrictive effect on the support- and recovery process, as well as what strategies and capacities the individual developed on their own in order to cope with their obstacles and disadvantages.The empirical material was based on qualitative inteviews with ten individuals that defined themselves as having psychiatric disabilities. They were each interviewed on three occasions. The repetetive form of the interviews lead to three separate interview guides being created over the course of the data collection process. The goal of the first interview was to get a general idea of the subject's daily life, activities, arenas, relationships and support. The second interview focused on meaningful relationships. The third and final interview had one general and one individual part. The general part focused on the subject's psychiatric disabilities, their opportunities as well as existing and desired support measures. The subject matters in the individual part were related to the previous interviews with each of the participants and aimed to develop or expand on previous discussion.The material was analysed using theories about social support and recovery and was presented with roots in four different networking entities: close and extended family, friends, coworkers and fellow students, as well as formal support instances. The result showed that it is the support with mobilising qualities that is beneficial to the recovery process. It increases the individual's degree of control over their illness, obstacles and challenges. In addition, it appeals to the individual as a central actor and as a person with difficulties as well as resources. The fact that the social support from the various support agencies have varying focus and direction benefits recovery since it increases the individual's opportunity to maintain as well as develop their social bonds and roles within the community. A relational prerequisite for social support is an equal relationship, which benefits the recovery process as it encompasses acknowledgement and acceptance of both the individual on a personal level and of their situation. The type of social support that hinders recovery is the kind that lacks a connection between the individual's perceived problems, their need for support and their over time fluctuating ability to handle their psychiatric disability. This is due to the fact that it robs the individual of control over the situation, increases the need for support and strengthens their perception of themselves as sick. Recovery comes to a halt when the individual isn't included in the support and recovery process, which is clarified in relational aspects such as lacking attentiveness, subpar acceptance as well as rejection. The individual's will and capacity to actively take on the responsibility to steer their recovery in a positive direction was made visible through four groups of strategies that were crystallised through the course of the research; creation of understanding and legitimisation, cultivation, including strategies and the creation of boundaries.
