| 1. |
- 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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| 2. |
- Heap, Josephine, 1980-
(författare)
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Living conditions in old age: Coexisting disadvantages across life domains
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to analyse coexisting disadvantages in the older Swedish population. Coexisting disadvantages are those that occur simultaneously in various life domains. A person who simultaneously experiences several disadvantages may be particularly vulnerable and less well-equipped to manage daily life and may also need support from several different welfare service providers. Concerted actions may be needed for older people who experience not only physical health problems and functional limitations, but also other problems. Research that encompasses a wide range of living conditions provides a basis for setting political priorities and making political decisions.The studies in this thesis used data from two Swedish nationally representative surveys: the Level of Living Survey, which includes people aged 18 through 75, and the Swedish Panel Study of Living Conditions of the Oldest Old, which includes people aged 77 and older.Study I showed that the probability of experiencing coexisting disadvantages was higher in people 77 and older than in those aged 18 through 76. These age differences were partly driven by a high prevalence of physical health problems in older people. In all age groups, coexisting disadvantages were more common in women than men.The longitudinal analyses in Study II indicated that coexisting disadvantages in old age persist in some people but are temporary in others. Moreover, the results suggested a pattern of accumulating disadvantages: reporting one disadvantage in young old age (in particular, psychological health problems) increased the probability of reporting coexisting disadvantages in late old age. Study III showed that physical health problems were a central component of coexisting disadvantages. The results also showed that being older; female; previously employed as a manual labourer; and divorced/separated, widowed or never married were associated with an increased probability of experiencing coexisting disadvantages. However, the experience of coexisting disadvantages differed: the groups associated with coexisting disadvantages tended to report different combinations of disadvantage.Study IV showed that the prevalence of coexisting disadvantages in those 77 and older increased slightly between 1992 and 2011. Physical health problems became more common over time, whereas limited ability to manage daily activities (ADL limitations), limited financial resources and limited political resources became less common. Associations between different disadvantages were found in all survey years, but certain associations changed over time. The results suggest that in general, the composition of coexisting disadvantages in the older population may have altered over time.In sum, results showed that coexisting disadvantages were associated with specific demographic and socio-economic groups. Physical health problems and psychological health problems were of particular importance to the accumulation and coexistence of disadvantages in old age.
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| 3. |
- Linell, Hanna, 1975-
(författare)
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Child protection through an abuse-focused lens : Adolescent victimization and Swedish social services responses
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Knowledge concerning the social services’ use of the Care of Young Persons (Special Provisions) Act 1990:52 (CYPA) is relatively scarce, especially when it comes to the protection of adolescents victimized by abuse. The overall aim of this thesis is to investigate and discuss different conceptualisations of abuse, adolescents’ agency regarding abuse, victimization and social intervention, and how abuse and adolescent victimization are responded to, primarily by the social services. This is done from a stance influenced by critical realism as well as victim- and child-centred responses. The dissertation consists of four papers and examines these themes in two samples of judgments and related documents concerning applications for care of adolescents aged 13-17 under the CYPA. The findings from the total study of all judgments in the selected year clearly confirm § 2 CYPA as a rare intervention to protect adolescents. In only 85 of Sweden's 290 municipalities was a CYPA application made, but a main finding is that such care to a large extent was used to protect adolescents from various forms of abuse. In the total study, the applications of § 2 CYPA concerned 196 adolescents, for 70 per cent of whom abuse was described, and where more girls (96) than boys (41) were being considered for care based on abuse. Of all the girls, 79 per cent were described as subjected to abuse and of the boys 55 per cent. Also in the smaller sample consisting of judgments for 37 girls in care under § 2 CYPA and §§ 2 and 3 CYPA, abuse was described for many. For several adolescents in both samples abuse was described as having been exerted to maintain standards of honour, shame and virginity, and/ or to enable a forced marriage. The initiative and agency of the adolescents themselves in both the disclosure of abuse as well as the decision on alternative care is one of the most striking findings in the thesis. The majority of the adolescents, 71 per cent, were categorized as having intentionally disclosed the abuse. The aftermath of the disclosure was for many of the adolescents described as intensely challenging. For the majority the abuse was denied during the investigation, not only by the alleged abusers but also by non-abusing parents and other relatives. The findings relating to the social services responses suggest that the initial response to a high degree could be understood as parent-oriented. For 33 per cent, the judgment also revealed that the abuse had been disclosed to authorities one or several times prior to the investigation leading to the application for care under the CYPA. That the abuse in these cases had been known to the social services for on average 5 years can from a child-centred position be seen as a major failure regarding the system’s ability to reach children and stop abuse. A central conclusion is that the various forms of abuse described seem more connected to domination, fear, power and control than to conflict; to some extent mirroring the kind of systematic oppression described for victimized adults seeking the protection of NGOs and public authorities. The findings imply that interventions under the CYPA may enable more child-centred, safe and stable protection of children subjected to this kind of abuse. Given the findings in the present thesis it is argued that it may be important to differentiate the concept of abuse as well as to acknowledge the agency of children in both research and in practice.
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| 4. |
- Månsson, Josefin, 1982-
(författare)
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Cannabis discourses in contemporary Sweden : Continuity and change
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to study how cannabis is constructed in contemporary Sweden, which policy responses are promoted as rational, and how international cannabis trends are received in this context. The four papers are the result of analyzing empirical material from three different sub-studies: 1) a qualitative study of online discussions about cannabis and drug policy, 2) a qualitative and comparative study of print media articles from 2002 and 2012, and 3) a qualitative study of oral presentations from cannabis information symposia. All papers are based on a social constructionist approach.A point of departure is that attitudes and regulations on cannabis have changed in large parts of the Western world. In Sweden, however, strict prohibition of cannabis is still central in the national drug laws. Some of the main findings can thus be gathered in discussions on continuity and change. In Swedish online discussions, there seems to be a strong desire to change the national cannabis policy in line with international developments. This discussion propagates alternative views on cannabis, in which comparisons to alcohol become vital and more liberal cannabis policies become logical. These discussions are also characterized by continuity, as many arguments for liberal cannabis policies seem to be based on traditional social democratic values and prohibitionist “scaremongering” arguments. Continuity is also what seems to characterize traditional print media, where cannabis is generally portrayed as a potent and illegal drug producing social problems. However, this arena also shows signs of change, as the material from 2012 includes stories on cannabis as an economic asset as well as a recreational substance. Both traditional print media and cannabis information symposia focus on youth consumers, who are seen as particularly vulnerable to cannabis effects. Such constructions seem important for protecting prohibition from international influences and for a continuous discourse centered on the dangers of cannabis.It is concluded that cannabis appears to be able to represent almost anything. As such it can be “used” for any purpose to promote a whole set of ideas related to policy often based on what is considered as scientific evidence. Depending on the context, it thus seems possible that cannabis is medicinal, recreational, harmful, and addictive. If so, and if all of these constructions are in some way “real,” then it is suggested that cannabis necessitates a much more tailored and nuanced response than that which prohibition can offer.
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| 5. |
- 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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| 6. |
- von Braun, Therese, 1982-
(författare)
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Theorizing the therapeutic process in substance use-related dependency treatment
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the thesis was to increase knowledge on how to understand the therapeutic process highlighting the importance of the therapeutic relationship as described by therapists and clients in substance use-related dependency treatment. The research questions were related to how the therapeutic process can contribute to a positive outcome considering the therapists’, the clients’ and close co-dependent relatives’ perspectives. The thesis followed a qualitative and narrative research design and consists of six studies (I-VI). Study I contributed a description of a multidimensional interactional model for the analysis of substance use-related dependency. The study revealed how a multidimensional interactional model can provide holistic and detailed knowledge about the complex processes involved in the use or misuse of alcohol and drugs. The interactional model was illustrated by a narrative analysis of qualitative empirical data. This model seemed to support a person-by-situation interactional analysis of substance use-related dependency. Study II revealed the possibilities and limitations of using a self-theoretical perspective in the analysis of the use or misuse of alcohol and drugs. The self-theoretical perspective was related to empirical case illustrations based on qualitative or narrative data. The implications of studies I and II were that a self-theoretical perspective can be integrated within a multidimensional model and can be a fruitful theoretical framework for the analysis of treatment processes of dependency. Study III presented conceptual contributions for understanding treatment of substance use-related dependency, focusing on the importance of the therapeutic process and the therapeutic relationship and the use of narrative methods. Study IV presented a structural perspective on clients’ narrative descriptions of different phases of the use or misuse of alcohol and drugs including phases of treatment. Study V contributed an in-depth analysis of three therapists’ narratives of therapeutic relationships in the treatment of drug-dependent clients. The analysis pointed out the multidimensional aspects of the treatment and focused on three phases of therapy; starting the therapeutic process and building a therapeutic relationship, the ongoing therapeutic process, and the closing phase of therapy. The study also presented an in-depth analysis of two narrative case histories on dependency treatment. Study VI focused on a qualitative in-depth analysis based on narrative data from a group of 10 clients that had undergone treatment for alcohol and drug use or misuse. The study also included qualitative and narrative data from four co-dependent clients and six therapists about their views on the treatment process and the therapeutic relationship. The results of the study described how to understand the experiential world of the clients and their cognitive, emotional and behavioral changes associated with the treatment process. The thesis’ contributions relate to an outline of a self-theoretical perspective integrated within a multidimensional interactional model for the analysis of the therapeutic process and the therapeutic relationship in substance use-related dependency treatment. The theoretical analysis sheds new light on the complexity of the treatment process and the clients’ struggle with their personal identity and sense of self, especially their drug self.
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