| 1. |
- Fjellfeldt, Maria, 1976-
(författare)
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Choice as governance in community mental health services
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In 2009, the Act on Freedom of Choice Systems (SFS 2008:962) wasestablished in Sweden, and this enabled municipalities to organise services aschoice models. This thesis describes and analyses the implementation of afreedom of choice system within community mental health services. Daycentre services were in focus, and a case study was conducted of a majormunicipality that sought to be a “world-class city” in regard to citizens’ choice.The experiences of policy makers, managers, professionals, and participantswere explored in interviews, and documents on a national, municipal, and citydistrict level, as well as homepages of providers of community mental healthservices, were all part of the study and were analysed using content-analysismethods.The results showed that the freedom of choice system aimed for two objectives– improvements at the individual level and financial efficiency. In practice,financial efficiency was experienced as the main objective. Increased varietyof services was aimed for by the competitive model, but such variety was notobserved. Instead, services tended to be more similar than specialised.Concerning new providers, they were characterised as committedprofessionals running companies with strained economies. Participantsaffected by the reform expressed anxiety and worries due to theunpredictability and uncertainty embedded in the competitive choice model.Choice within the system concerned where to go, whereas participantsemphasised a wish to be able to influence the choice aspects of who carriedout the service and how much time to attend the services.The conclusion was that the freedom of choice system was implemented as atechnology of governance to increase financial efficiency of services.Individual choice was not experienced as increased in any aspect except forthe choice of where to go. Instead, freedom of choice actually appeared todecrease due to standardisation and hierarchical structures. Aspects that werefound to be relevant when designing freedom of choice systems aiming toincrease individual freedom of choice were to address predictability andcontinuity, to address sustainable financial premises, to analyse the predictedimpact of administrative systems that are to be used, and to avoid the use of“hidden goals” in the policy-making process.
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| 2. |
- Andersson, Peter, 1980-
(författare)
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Hot, våld och emotionellt arbete på de särskilda ungdomshemmen : Personalens berättelser
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this dissertation is to describe how staff working at secure units define violence, the ways in which they say violence affects them emotionally, and the ways they emotionally handle violence. The secure units (särskilda ungdomshem) are managed by the Swedish National Board of Institutional care (Statens Institutionsstyrlese, SiS). The daily work of staff members is often described in terms of various dilemmas, challenges and tensions. Staff work in a context where they are at the intersection between care and punishment. How they respond to these dilemmas, challenges and tensions can affect how they handle violence. The organization (i.e. the institution) requires staff to induce or suppress emotions in order to sustain outward attitudes that produce a proper state of mind. Therefore, secure units are defined as an emotional place for both youth and staff.The dissertation consists of four articles that explore different forms and directions of violence in the daily work of staff, and the ways that staff describe the impact of violence on their professional and private lives. The empirical data consist of 53 individual staff interviews (articles 1–3) and five focus groups with 27 staff members (article 4). Three overarching theoretical concepts are deployed: emotional work, narrative and violence.The main findings from these papers can be summarized as follows: Staff talked about the extent and forms of violence that characterize their everyday work (articles 1 and 4), mostly in the form of stories where they described being exposed to both psychological and material violence. The frequency of this violence ranged from occasional to daily. Staff also talked about how they emotionally handled both perceived and acted-out violence, and how such violence can affect their professional role (articles 2 and 3). A common strategy seems to be role-taking. That is, staff members think they are exposed to violence in their role as “staff”, not as private individuals. This paves the way for the normalization of violence as a strategy for dealing with everyday professional life. Furthermore, staff attribute violence to youth in an explicit way. This means that staff members find it difficult to reflect on their own responsibility and the fact that they are, in fact, co-creators of most incidents of violence.The overall results of the four papers are additionally organized around three themes: (1) the position of the young person: perpetrator, (2) working with violence in a caring context and (3) prohibited workplace emotions. Traces of these themes can be found in all four articles and they are clearly linked to the dissertation’s theoretical concepts. In conclusion, it is possible to describe these three themes as an expression of organizational shortcomings in which the staff are trapped.
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| 3. |
- Enell, Sofia
(författare)
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Transit i samhällsvården : När unga utreds på särskilda ungdomshem
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is about assessments of young people in secure accommodations. Institutional assessments relate to the paradox in child welfare of combining control and care. The procedure raises questions about their implications for young people, their caseworkers and evolving care trajectories. Although institutional assessments of young people have a historical heritage, research about their implications is lacking. The aim of the thesis is to explore young people’s and their caseworkers’ experiences of assessments in secure accommodations and their implications for young people’s care trajectories. Methods used are primarily repeated interviews with 16 young people during a period of two years and one interview with their caseworkers. Surveys about 85 youths, participatory observations and written assessments are also included. This thesis takes an interactionist approach and the material has been analysed with the main concept of care trajectory along with the concepts of self-presentation, total institution, institutional identity and texts as coordinators.The results are presented in four papers. The concluding analysis shows that assessments in secure accommodations can be divided into three elements: the practice, the text and the placement. These three elements have different implications for the young people and the caseworkers. For the young people the practice and the placement converge into an assessment universe that, with the text, intensifies their shaping of self-identity. The young people’s experiences are characterised by lack of control over their self-presentations, the present and the future. For the caseworkers, the practice has implications for their understanding of the young people’s individual troubles, the text for negotiating with other actors and the placement in their efforts to achieve change in the young people’s troublesome situations. The assessments’ implications for stability and foreseeability in the young people’s further care trajectories are limited. Moreover, the procedure of assessing young people in itself contains instability through involving several professionals in different parts of the assessment and decision-making process. Despite lack of stability, the thesis reveals that some young people experience the assessment as a place for self-development and where the course of the care trajectory changes to the better.
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| 4. |
- Forsman, Hilma, 1985-
(författare)
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Addressing poor educational outcomes among children with out-of-home care experience : Studies on impact, pathways, and interventions
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Children with out-of-home care (OHC; foster family/residential care) experience is a high-risk group for future adverse outcomes. With an ambition of supporting the design of effective preventive child welfare measures targeting children in OHC, the overall aim of this thesis is to examine education as a possible intervention path for improving their development and overall life chances.The thesis consists of four interrelated empirical studies that address different aspects of poor educational outcomes among children with OHC experience by means of analyses of longitudinal survey and register data, and evaluations of two interventions aimed at improving their basic academic skills.Study I examined the hypothesized causal effect of poor school performance on adverse outcomes in young adulthood among children with OHC experience. The results showed that poor school performance has an impact on later psychosocial problems net of observed and unobserved factors, suggesting that the estimated effects allow for causal interpretations.Study II explored educational outcomes at different stages in the educational career, and pathways to varied educational outcomes for children with OHC experience and their peers. The results showed that the OHC group had lower educational outcomes across the life course. Yet, by large, their educational pathways did not differ significantly from their peers – cognitive ability and previous school performance had the largest associations with the outcomes in both groups. However, the influence of these factors were weaker in the OHC group whilst the influence of the birth family’s attitude towards higher education was stronger.Study III aimed at furthering our understanding of the book-gifting program the Letterbox Club’s potential impact on foster family children’s reading skills. The results showed that participation in the program was associated with small improvements. In general, the program was well received by children and carers, and could result in increased reading. The study furthermore suggested that promotion of carer involvement may improve its potential impact.Study IV explored the process of conducting a structured paired reading intervention involving foster family children and their carers. Findings showed that it is possible to engage carers in interventions targeting the education of children in OHC, but that this is no automatic process – carers need a rationale for getting involved, and support in delivering the intervention.In sum, this thesis shows that improving the educational outcomes of children in OHC may be a viable intervention path in supporting their life course development, a path that historically has been overlooked. The thesis furthermore shows examples of promising interventions which may improve the basic academic skills of children in OHC. The results also point out that the child welfare system should provide early and continuous educational support, and highlight the importance of addressing adults’ attitudes, expectations, and involvement in these children’s education.
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| 5. |
- Lagerlöf, Hélène, 1973-
(författare)
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Samhällsvård och välfärdsresurser : En studie av skolgång, fritid och kamratrelationer bland unga i familjehem och institutioner
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The dissertation analyses access to welfare resources within the areas of schooling, leisure and peer relations for youth in out of home care. The study was conducted in three counties in mid Sweden and is a replication of the recurrent Swedish surveys of living condition of children in general populations. By using the same design, children aged 13–18 (n=272) in foster care and residential care were approached. Throughout the analysis results are compared with conditions for peers living at home, based on data from the 2004/2005 survey on living conditions for children (Child-ULF). Furthermore the results are linked to the young people’s experience of psychosomatic complaints and emotional wellbeing and discussed within the theoretical framework of childhood sociology. Questions regarding society’s ability to convey resources to youth while in care as well as young persons’ potential to exercise determination while in care are also discussed. The study shows that youth in care in general have access to fewer resources than those in general populations in the studied areas. For youth in residential care the differences compared to peers living at home are substantial, while conditions for youth in foster care are more alike those of young people in general. Youth in residential care have fewer school related resources and fewer contacts with friends than peers living at home. Youth in foster and residential care are more subjected to bullying than the general population. The overall conclusions are that society, in the form of foster parents and residential staff fails in certain areas to convey resources to youth in care. The young people’s lack of resources poses limitations to their potential to exercise self-determination while in care. The study points out areas where targeted efforts might be needed to improve the living conditions for youth in out of home care and perhaps broaden their potential to exercise self-determination while in care as well as after.
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| 6. |
- Pålsson, David, 1986-
(författare)
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The Prerequisites and Practices of Auditing Residential Care : On the Licensing and Inspection of Residential Homes for Children in Sweden
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this dissertation is to describe and analyse the prerequisites and practices of auditing Swedish residential care for children. Residential care is a complex intervention provided to children in vulnerable life situations. The care is extensively delivered by private providers and shows difficulties in demonstrating clearly positive treatment effects. Licensing and inspections are policy instruments to address alleged quality problems in decentralised and marketised welfare services. However, in research there are mixed opinions on the ability of audits to generate improved service quality.The dissertation consists of four papers exploring central facets of the audit system. The empirical material is based on interviews (n=50) with inspectors and residential staff, documentation (n=286) in terms of guidelines and license/inspection decisions and observations (n=12) at inspection-related events. Each paper includes a unique set of data.Paper I analyses the controls that private residential homes undergo prior to their entry into the market. The results show that a majority of applicants are granted a license and that the controls do not reduce the need for ex post control. There is limited guidance on care content and research evidence is weakly incorporated in the controls. Overall, the state exerts limited influence over the composition and professional development of the care market.Paper II explores the operationalisation process of care quality in inspections. The results show that the standards display a marked variation and there is no differentiation between different residential homes. In general, the standards focus on reducing malpractice and not maximising care quality. In practice, the inspections are often discussion-based and standards relating to work with children are often indistinct.Paper III analyses how inspections are perceived by representatives from residential homes. The results show that inspections induce reflection and to some extent shape the administrative parts of care, but also that it is difficult to discern the actual impact of the inspections on the work. The inspections appear to bring a degree of stability and legitimacy to the work, but there are sometimes tensions between standards and professional judgment.Paper IV studies the influence the inspection process grants children in care. The results suggest that different inspectorial rationales (regulative, supportive and protective) may influence the agency children exert and that it is difficult to allow children’s views to have a substantial impact on the process. Overall, there tends to be a gap between what the children find important and what the audits can address in concrete terms.The theoretical ideas used to analyse the results are derived from institutional organisational theory and the thesis on the audit society. The overall analysis shows that 1) making certain core care aspects auditable and ensuring their impact is difficult (e.g., children-staff relationships, children’s views and use of research knowledge), 2) the system has a restrained character and is in many senses associated with inconclusive formative effects, 3) the use of uniform goals does not necessarily equal a more suitable care provision and 4) the audits signify strong symbolic values. Despite the limitations, the audits may help to discipline care providers, secure a minimum level relative to the audited care aspects and induce reflection among auditees.
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| 7. |
- Sallnäs, Marie, 1952-
(författare)
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Barnavårdens institutioner : framväxt, ideologi och struktur
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The study presents an overview of the historical growth and deve-lopment of residential care for children and youth in Sweden as well as an analysis of the present-day structure and organisation. The empirical material consists of official statistics, government reports and data from a questionnaire addressed to all registered residential homes in the child welfare sector at the end of 1995. The history of residential care for children and youth is marked by a period of establishment and expansion in the first decades of the last century, followed by a process of major de-institutionalisa-tion in the period after the Second World War. A third phase was introduced with the Social Service Act of 1980, which laid down new premises for child welfare. Traditional concepts of children’s homes were replaced in the legislation by the “HVB-home” and the dividing line between institutions and foster homes became blurred. The study shows that contrary to what was intended, a growing part of out-of-home placements during the 1980:s and 1990:s where into residential care. In fact, residential care has taken over “market shares” from foster care in Sweden. Analysis of the range of alternatives shows that residential care today is relatively small-scale and that nearly all of the smaller units are privately run. Approximately half of the homes have teenagers as their target group and most homes work with longer-term pro-grammes of treatment and care. Educational background among staff varies considerably, but in general the level of educational is low. So far, no professional forces have proved strong enough to organise the field on a mutually knowledgeable, normative ground. A problem is the lack of unanimous concepts and a common language with a terminology that can be used for a systematic de-scription of the care or treatment given. What is clear, however, is that a new form of residential care can be identified – so-called hy-brid homes that are somewhere in between extended foster homes and small institutions – and that these homes have gained a con-siderable position in the field.
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| 8. |
- Skoog, Viktoria, 1981-
(författare)
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Barn som flyttas i offentlig regi : En studie av förekomst och upplevelser av instabil samhällsvård för barn
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this dissertation is to investigate the incidence of instability in out-of-home care for children and how children experience this instability. The dissertation consists of two studies. The quantitative study is based on an examination of social work case files of 213 children who began 317 placements in 2005 and 2006. Every placement was followed for a maximum of two years. The qualitative study used interpretive phenomenology as method and is based on interviews with 12 purposively selected children who had experienced placement breakdown at some point during 2011 or 2012. The quantitative study shows that the majority of children had experienced problems in their home environments prior to placement. Most commonly reported was parents’ substance abuse or mental health problems. Preschool and schoolchildren were more often placed in care due to neglect whereas adolescents were placed because of their own behavior problems or relational problems. Children in the qualitative study described that the problems they experienced prior to coming into care continued to influence them during their time in care.The quantitative study indicates that different types of instability are associated with children’s ages. That is, breakdown was most common for adolescents whereas preschool children more often experienced planned placements changes. Children in the qualitative study gave similar descriptions of planned placement changes and placement breakdown. The difficulty with which these children experienced the move from a foster family or group home depended on their relationship to caregivers. Therefore, planned placement changes from foster homes or institutional settings in which children reported being happy were described as more difficult than breakdown in placements from which children wanted to move. In children’s views, breakdown was caused by mismatches between them and caregivers, mistreatment in care settings, and their own behavior problems. However, children explained that when social workers did not listen to them, behavior problems in the form of running away, self-harming or behaving badly, were the only way of ending placements in which they were miserable.All children in the qualitative study described a wish for close relationships with consistent adults and an opportunity to feel that they belong somewhere. These fundamental needs were difficult for them to have satisfied due to their parents’ problematic life histories, instability in care which repeatedly placed children in new care situations, and a lack of continuity of social workers.
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| 9. |
- Andersson Vogel, Maria, 1980-
(författare)
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Särskilda ungdomshem och vårdkedjor : Om ungdomar, kön, klass och etnicitet
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis follows a group of youths placed in secure unit care who have participated in a chain-of-care project aiming to better plan their discharge and aftercare. The overall aim of the thesis is to link a detailed description of these young people with an analysis of the project they participated in, and to undertake one- and two-year follow-up studies. Analytic focus is on the significance of gender, class and ethnicity. The study is mainly based on structured interviews performed at the secure units upon entry into care, discharge and at a one-year follow up. Data have also been used from criminal records and interviews with project staff.When entering care, these youths exhibited extensive problems in both family conditions and own behaviour. The major problem in boys was criminality while girls reported poor mental health. Professionals judge youth of foreign background as more criminal than youth of Swedish background despite a lack of difference in self-reported data. Some difference is also noticeable regarding class.Analysis of the project shows that out-of-home care was the most frequent intervention after leaving secure unit care, while other interventions were difficult to uphold over time. Few girls received help with their mental health problems. At the one-year follow up, the youths reported an overall better situation, although extensive problems still remained. Above all, girls’ mental health problems remained as before. At the 2-year follow up the study group was compared with a control group in order to investigate effects of the project regarding criminality and recommitment to secure unit care. The comparison shows that the project had no effect. This is discussed in relation to poor organization and the difficulty of adjusting a project like this to the target group, along with the substantial part played by gender, class and ethnicity in how the youth are construed and treated.
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