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- Björk, Alexander, 1983-
(författare)
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Evidence-based practice behind the scenes : How evidence in social work is used and produced
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this dissertation is to examine empirically what Evidence-based practice (EBP) and its standardized procedures become when put into practice in social work. EBP builds on the idea that professional practice should be based on systematic and reliable knowledge of the interventions and instruments used in this work. This implies a standardization of both research and practice that has been highly contested. Inspired by works within science and technology studies (STS), this dissertation analyses the actual content of the standardized procedures and their uses in social work practice.The dissertation examines a ‘critical case’, a substance abuse social services agency that has worked extensively for several years at implementing EBP, and consists of four papers focusing on three standardized procedures used by the agency in order to enact EBP: 1) the Addiction severity index (ASI) assessment instrument; 2) the psychosocial intervention Motivational interviewing, and 3) the decision-making model Critical appraisal (CA). Ethnographic methods were employed to study the agency’s concrete uses of the standardized procedures in daily practice. MI was also followed in the research literature as it became established as an ‘evidence-based’ intervention.Fundamentally, the development of the standards of EBP can be a messy and paradoxical process. In the stabilization of MI, its differences and ‘fluidity’ have eventually been made to disappear and left a stable ‘evidence-based’ object.Findings from the ethnographic studies show that EBP, as enacted in the agency’s daily practice, is a bureaucratic project where the agency’s managers have decided on and control the use of a set of standards. Thus, what constitutes relevant evidence is based not on professional discussion within the agency but is ultimately determined by the managers.In practice, the standards introduce new logics that cause tensions within the agency, tensions which the social workers are left to handle. Main conflicts concern how the client work is ordered and contradictory organizational rationales. The three standards are used to varying extent, which can be understood by examining what they seek to standardize and how they are put to work. CA was not used at all, mainly due to its design. Disregarding organizational rationales that are unavoidable within the social services, it could not be adapted to the agency’s work. With ASI and MI the situation was different, mostly because of their organizational adaptability. ASI could be implemented in several phases of the agency’s work flow resulting in adjustments of both the instrument and the work flow. As a ‘fluid intervention’, MI was constrained by, but also adjustable to the organization. It was thus possible for both ASI and MI to transform and be transformed by pre-existing practices, in effect creating new practices.A major conclusion is that EBP and its standardized procedures is a more dynamic and multifaceted process than previously acknowledged in social work. Rather than a deterministic one-way path, there are different kinds, degrees, and mutual transformations of standardization processes, which must be appreciated in research and in practical efforts to implement EBP. Given the importance of the organization in professional social work, there is a need to move away from individualistic conceptions of EBP and to consider what evidence use might mean from an organizational perspective.
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- Demichev, Vadim, et al.
(författare)
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A time-resolved proteomic and prognostic map of COVID-19
- 2021
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Ingår i: Cell Systems. - : Elsevier BV. - 2405-4712 .- 2405-4720. ; 12:8, s. 780-794.e7
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Tidskriftsartikel (refereegranskat)abstract
- COVID-19 is highly variable in its clinical presentation, ranging from asymptomatic infection to severe organ damage and death. We characterized the time-dependent progression of the disease in 139 COVID-19 inpatients by measuring 86 accredited diagnostic parameters, such as blood cell counts and enzyme activities, as well as untargeted plasma proteomes at 687 sampling points. We report an initial spike in a systemic inflammatory response, which is gradually alleviated and followed by a protein signature indicative of tissue repair, metabolic reconstitution, and immunomodulation. We identify prognostic marker signatures for devising risk-adapted treatment strategies and use machine learning to classify therapeutic needs. We show that the machine learning models based on the proteome are transferable to an independent cohort. Our study presents a map linking routinely used clinical diagnostic parameters to plasma proteomes and their dynamics in an infectious disease.
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- Hübner, Lena
(författare)
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Constructing relations in social work: client, customer and service user? The application and relevance of the term user in social work discourse
- 2014
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Ingår i: Nordic Social Work Research. - 2156-857X .- 2156-8588. ; 4:2, s. 87-98
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the article is to accomplish a critical discussion of the terms service user/user and through this highlight the power of language in social work. Two main issues are dealt with: to study to what extent the terms service user/user are applied when addressing recipients of social services in the UK and in Sweden, and to discuss the relevance and meaningfulness of the term in Swedish social services discourse. The point of departure for the study is the reappearance of the term user in Swedish social work discourse in the context of a campaign for evidence-based social work. Through search in 11 volumes of research journals in the UK and in Sweden, it can be concluded that the application of the term service user are quite common in the UK, simply as a synonym for client. The term’s equivalent in Swedish, user is not extensively applied in Sweden. The application of the term user in Swedish social work discourse can be relevant when considering the supportive side of social work, but is shown to be problematic when it comes to statutory services like compulsory treatment or the removal of children from parents. The term hides questions of power and unequal relations immanent in the delivery of social services and social work.
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- Hübner, Lena, 1958-
(författare)
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Narkotika och alkohol i den allmänna opinionen
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the thesis is to study public opinion on social problems, with focus on the problems of alcohol- and drug abuse. Public opin-ion is studied through a sur-vey, distributed to a cross-sectional, ran-domised and represen-tative sample of the Swedish population, aged 18 to 69 years. The survey was distributed in spring 1995 (N=3 000). Apart from background questions, the survey contains questions on how respondents perceive different aspect of alcohol- and drug prob-lems and what should be done about them.The theoretical perspective treats social problems as the result of collective de-fi-tio-nal processes, through which alcohol- and drug problems have been given diffe-rent cognitive and moral connotations. As a result, the problems have acquired objec-tive facticity. According to this perspective, reality is a social construction and reali-ty and soci-ety have a dual character of objective facticity and subjective mean-ing.The term "public opinion" is discussed in the thesis. The conclu-sion drawn is that there is mainly two ways of understanding public opinion. In the first case, public conversation and debate is seen as a prereq-uisite to public opinion, which is comprehended as a group-based discur-sive phenomenon. In the second case, public opinion is equated with the results of opinion polls.The results show that alcohol- and drug problems are perceived as serious social problems, though drug abuse is seen as more serious. Concerning drugs, the public perceptions are, to a large extent, unanimous. Drugs are dependency-generating, dangerous and should be forbidden. The punishment for drug-re-lated crimes should be more severe than today. Large parts of the respondents agree on all of this. Concerning alcohol, the results show greater differences between different groups of respondents. A majority of the women are less positive to alcohol than the men, and more in favour of alcohol re-strictions. The same goes for older people compared to younger. One central conclu-sion concerns the unamity in the percep-tion of drugs, while the perception of alcohol is much more varied. The low visibil-ity of groups expressing different views on the drug problem in public debate seems to be reflected in the results of the survey. The respon-dents’ perception of drugs is thus very much in line with official dis-course.
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- Hübner, Lena
(författare)
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Reflections on knowledge management and evidence-based practice in the personal social services of Finland and Sweden
- 2016
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Ingår i: Nordic Social Work Research. - 2156-857X .- 2156-8588. ; 6:2, s. 114-125
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Tidskriftsartikel (refereegranskat)abstract
- Evidence-based practice (EBP) is a form of knowledge management and is a trend that has influenced many professional fields during the past 10–15 years, including social work. In Sweden, a campaign for an implementation of EBP has been launched towards social work practice from the Swedish central authority since the late 1990s. Knowledge management in social work can however take other directions which seem to be the case in Finland. Finland and Sweden bear many resemblances concerning political and administrative structures as well as approaches in the social services. Both countries also have highly educated social workers. The main question for the study was how come demands to implement EBP in the personal social services have been so strongly articulated in Sweden but not in Finland. The aim was to reflect on knowledge management in social work in two similar cases, Finland and Sweden, focusing EBP. Results show that the close contacts between representatives of the Swedish authority and proponents of a radical EBP version in the US was a decisive factor for the campaign towards social work in Sweden. Such mediators and proponents seemed to be absent in Finland. The length and the focus on academic skills in the education of social workers in Finland is seen as a contributing factor, giving Finnish social workers a sense of being ‘true professionals’ and thus more independent towards external demands.
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