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- 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. |
- 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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| 3. |
- 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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| 4. |
- 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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