1.
Svanevie, Kajsa, 1976-
(författare)
Evidensbaserat socialt arbete : Från idé till praktik
2011
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) 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.
2.
Bergström, Magdalena, 1973-
(författare)
Att åldras med långvariga alkoholproblem : hur medelålders och äldre kvinnor och män begripliggör sitt drickande, sig själva och sina liv
2018
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The aim of this thesis is to describe and analyze how late middle-aged and elderly women and men make sense of what it means to age with long-term drinking problems.I have conducted life story-inspired interviews with six women and 13 men who have alcohol problems which have been ongoing for at least 20 years. The analysis of the data has been inspired by thematic narrative analysis. For doing the analysis, I have used theories about meaning making and life stories, as well as theories about how people give meaning to their alcohol use. The interview person’s experiences of their present everyday life are connected to their pasts as well as to their expectations for the future. The interview persons make sense of themselves and their lives in relation to metanarratives that provides them with predefined ways to understand their social reality.The interview persons everyday lives can be seen in the light of their past, there the long-term drinking problems have resulted in severe consequences for their social networks, their physical and mental health as well as their financial situations. The alcohol use was often seen as both a solution to, and a cause of, their problems. Considering that most of the interview persons were suffering from severe health problems, several of them did not expect to live much longer. This, together with the fact that they were becoming older, evoked existential questions about how they wanted to spend their remaining time. In order to avoid an alcohol related death, several interview persons had started to question their alcohol use and a few had made actual attempts to overcome their drinking problems. Others had no hope of changing their life situations or cutting down their alcohol use.The interview persons are living in a time characterized by metanarratives about active and successful ageing. Research show, however, that drinking problems among late middle-aged and elderly people are increasing. People aging with long-term drinking problems are often overlooked when it comes to getting access to treatment programs for problematic alcohol use, and they seldom fit into organized activities for elderly people. Social interventions are, however, important for making the everyday lives less difficult for people ageing with long-term drinking problems and to provide added support to those who wish to change their drinking habits.
3.
Blom, Björn
(författare)
Marknadsorientering av socialtjänstens individ- och familjeomsorg : om villkor, processer och konsekvenser
1998
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Since the end of the 1980s, the introduction of market mechanisms in the public sector has been a dominant feature in Sweden. The same is true for the social services in several municipalities, where business style behaviour and organisation, and competition have become salient features of market-oriented social services.The aim of the study is to describe and analyse: the structural conditions for market oriented personal social services; how social workers pursue client centred work in market oriented personal social services; the consequences of this market orientation on the personal social services.The empirical study is a case study of the personal social services in the municipality of Linköping. The purchaser-provider model in Linköping is one of the most advanced and discussed in Sweden. The research comprises a quantitative pilot study and a qualitative main study. The main study is based on twenty semi-structured interviews with experienced social workers and their immediate superiors.The analysis of the interviews reveals that the personal social services are only achieving to a lesser extent the ends that a quasi-market, theoretically, should achieve. The conditions that have to be satisfied to achieve the ends of the quasi-market are only partly met. Bureaucratic control is one important reason why the personal social services are imperfect as a quasi- market.The re-organisation has resulted in a number of, to some extent, positive consequences. The re-organisation has, however, also resulted in some negative consequences. In the thesis these are categorised in terms of fragmentation, antagonism and obscurity. A linguistic change, in market oriented personal social services, appears to have influenced social workers to think and act differently in relation to their work.The most important conclusion drawn from the study is that the market oriented personal social services partly function as a responsive quasi-market for strong, rational and well- informed clients. However, in relation to the most vulnerable, it is failing in many respects.
4.
Grell, Pär, 1966-
(författare)
Komplexa behov eller komplexa organisationer? : konsekvenser av specialiserad individ- och familjeomsorg ur ett klientperspektiv
2016
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Even though recent decades have seen a clear trend towards organizational specialization within Swedish personal social services (PSS), there is a lack of knowledge about the consequences of this, particularly from a client perspective. The aim of this compilation thesis is to describe and analyse the consequences of organizational specialization for clients with complex needs. The empirical material consists of a survey and an interview study, both addressing clients whose needs can be considered complex since they entail several parallel contacts with different specialized PSS units. Article one is a research review aimed at summarizing and discussing the research on organizational structures in the social services, and these structures' impact on work with clients. The review suggests that, to function adequately, social service organizations need to combine and balance aspects of both specialization and integration. Article two aims to describe and analyse how clients with complex needs perceive and value the service conditions of the organizationally specialized PSS. The main findings are that clients primarily perceive and value their encounters with the specialized PSS negatively, and that they experience several elements of service fragmentation. The aim of article three is to describe and analyse how clients with complex needs account for their handling of service conditions within specialized PSS. A key finding is that clients combine different approaches (categorized as consensus, resignation, fight, and escape) in a balancing act intended to promote their own best interests. Article four aims to describe and analyse how clients with complex needs perceive the conditions for helping relations in a PSS setting marked by organizational specialization. A lack of system trust, the people-processing dimensions of work, and an organizational and professional emphasis on formal organizational structures and boundaries were found to constitute unfavourable conditions. Conversely, the occurrence of individual trust, the people-sustaining and people-changing dimensions of client work, and the boundary-spanning efforts of both informal organizations and individual social workers constituted favourable conditions. The thesis concludes that there seems to be a substantial lack of fit between the logics and features of organizational specialization on one hand, and the complex and interwoven nature of clients’ actual needs and everyday lives on the other. It is also argued that organizational specialization means that the complexity involved in encounters between clients and the PSS is overlooked or obscured. Further research on the structural arrangements and service conditions that surround encounters between clients and the social services is suggested, especially research that adopts a client perspective.
5.
Nilsson Blom, Marcus, 1980-
(författare)
Opioidberoende : en studie om beroendevården och det sociala sammanhangets betydelse
2018
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Opioid dependence is highly associated with health problems relating to physical health (infectious diseases) as well as mental health (depression, anxiety, antisocial behavior). In addition, research has found an association between use of opioids and increased risk of premature death as a consequence of overdose or other circumstances, such as suicide. Furthermore, opioid dependent individuals experience a high level of social exclusion and problems with relationships, housing, income and livelihood. Overall, there is a connection between opioid dependence and physical, psychological and social vulnerability as well as premature death.The importance of social cohesion has rarely been the focus in research on opioid dependence. Therefore, there is a need to further explore whether differences in outcomes (medication assisted treatment, mortality and co-morbidity) in addition to individual characteristics, can be derived from social aspects of the opioid dependent individual’s life.The overall aim of the dissertation is to examine individual and social factors among individuals who are dependent on opioids and how they are associated with outcomes relating to: a) medication assisted treatment; and b) mortality and co-morbidity.This dissertation is based on data from four different registers. The first and second sub-studies use ASI data. The third uses DOK data from the National Board of Institutions (SiS) and the Death Registry (National Board of Health and Welfare). The fourth study is based on both DOKdata and data from the national patient registry (National Board of Health and Welfare).Overall, this dissertation confirms the understanding of opioid dependence as associated with a high level of vulnerability. This dissertation shows that opioid dependence is characterized by extensive care efforts, low levels of employment, and a high level of mental health and comorbidity.This dissertation shows that the characteristics related to the social network (parenting, work and education) are of significance for being in treatment, but also remaining in care (medication assisted treatment), which in turn promotes the individual's health and long-term health development. In that, this dissertation shows that for individuals dependent on opioids, there is an association between being part of a social network and favorable health development.
6.
Perlinski, Marek, 1955-
(författare)
Skilda världar : specialisering eller integration i socialtjänstens individ- och familjeomsorg
2010
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The general objective of this dissertation is to describe and analyse how specialised respective integrated forms of organisation in the Swedish Personal Social Services (PSS) condition social workers’ interventions and client effects (outcomes). The three specific questions are: 1) How are structural conditions for social work with clients created in specialised versus integrated (generic) forms of organising PSS? 2) How do social workers carry out their work with clients in specialised versus integrated (generic) PSS-organisations? 3) How do different organisational models of PSS influence the results for clients? The research was conducted in three Swedish municipalities with different organisational models within the personal social services: 1) specialised organisation, 2) integrated organisation, and 3) a “combined” organisation with a mix between integration and specialisation. The research had a complex design. It was carried on as comparative case study. Data was collected in several different ways: 1) by means of survey among social workers, 2) by interviewing politicians, mangers and social workers, 3) focus groups consisting of social workers, 4) by collecting official documents, guidelines etc. 5) by mapping of the organisation of social services in the municipalities by means of analyse of their homepages and additional interviews by telephone. The data were analysed using both qualitative and quantitative methods. The main results in this dissertation are: 1) In the majority of Swedish municipalities the PSS are nowadays specialized. 2) The formal organizational structure of PSS is always challenged by the employees’ spontaneous organising process that goes in an opposite direction. 3) Only the integrated (generic) organisation emphasizes social workers professional competence and knowledge. 4) Social workers, as a professional group, have the collective power to (to a certain degree) influence political decisions on what kind of PSS organisation is chosen in their municipality. 5) Regardless of organisation model, social workers’ method use is more unspecific than specific. 6) Social workers, in general, place significantly more weight on working with clients’ relationships and aspects of trust than on (specific or unspecific) working methods. 7) A holistic (generic) view of a client can only exist in a direct relationship between social worker and the individual and a unique client. It seems difficult to build in holism into primarily specialised organisations. 8) One may question whether a specialised organisation leads to specialisation of its employees in a way that they become experts on specific problems. The three organisational models are not equally good. Neither the specialised organisation nor the combined organisation is able to create economic or organisational conditions for working with clients that are clearly experienced as good. This also holds true for assessment of need, possibilities to make relevant interventions, such as building relationships. Those two organisations show several deficits regarding work with clients.
7.
Rexvid, Devin, 1975-
(författare)
Professionsutövning och kunskapsstyrning : en jämförelse av socialarbetares och allmänläkares klientarbete
2016
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The aim of this thesis is to study whether the Swedish state’s efforts to govern the professional practice of social workers (SWs) by knowledge to achieve an evidence-based practice, address the difficulties that SWs encounter in their practice. The Swedish state’s ambition is to govern the practice of social work by ideas and methods originating from medicine. The thesis therefore compares, through four different studies, the professional practice of SWs with general practitioners (GPs) as the most comparable sub-profession in medicine. The research questions that the thesis seeks to answer are:What situations are perceived as problematic and non-problematic by SWs and GPs?How does the professionals’ relationship with clients affect the performative aspects of these occupations’ enactment of their practice?How do SW and GPs experience the state’s efforts to govern their professional practice by knowledge?What problems can arise when the Swedish state builds its knowledge governance of social work practice on a comparison with medicine, even though these professional fields exhibit a number of important differences?The empirical material in the first and second studies consists of 52 narratives, written by SWs and GPs on problematic and non-problematic situations. The third study is based on vignette-based focus group interviews with 25 SWs and GPs. And the fourth study is based on a literature review, consisting of 54 articles about SWs’ and GPs’ practice.A first finding is that professionals rarely describe lack of knowledge or difficulties with knowledge use as problematic. A second finding is that non-problematic situations are connected to professionals’ control of the intervention process. SWs gained control of the relationship with the client either by use of coercive means or by the client’s active co-operation. GPs gained control of the intervention process by the use of professional knowledge. A third finding is that an understanding of professional practice as a linear process consisting of diagnosis, inference and treatment reflects GPs’ practice but not all aspects of SWs’ practice. A fourth finding is that both professions hold ambivalent positions towards evidence-based risk reductions technologies. The responses towards organisational risk reductions technologies differ in that GPs are sceptical, whilst SWs take a more pragmatic view.A main conclusion is that the Swedish state’s efforts to govern the performative aspects of SWs’ practice by knowledge, runs the risk of becoming a insufficient strategy since they tend to exhibit two main blind spots. The first is that these efforts tend to ignore that the relationship with the client has a crucial affect on and conditions SWs’ and in problematic situations also GPs’ knowledge use. The second is that the efforts also tend to ignore that control of the intervention process is not always maintained through control of knowledge use. For SWs control of the relationship with clients represents another mode of professional control of the intervention process.
