In the centre or caught in the middle? - Social workers' and healthcare professionals' views on user involvement in Coordinated Individual Plans in Sweden.

Fragmentation of social service and healthcare services has been given attention in many countries and a variety of strategies and models are used in attempts to remedy the problem. In a parallel development, demands have been made that users/patients should have more influence over their own care, and research has shown that user involvement can support the recovery process. This article focuses on how professionals view user involvement in collaborative efforts in care planning, using the Coordinated Individual Plan (CIP) in Sweden as an example. Since 2009, social service and healthcare agencies are required to draw up CIPs when they are judged to be needed, with the purpose of improving the care process. An additional purpose is to increase users' involvement in their own care. Semi-structured interviews were conducted in 2019 with 20 professionals working within social service and healthcare agencies for people with mental health and/or substance abuse problems in the Stockholm region. Analysis was by qualitative content analysis. Findings show that professionals study experience ambivalence concerning user involvement in care planning. On the one hand, they support the user´s own demands of services and, on the other hand, they correct the user´s demands to fit the range of services and organisation of care. The user/patient's position is expressed as vulnerable, caught between caregivers who often safeguard their organisational duties and economical restrictions. These findings reflect the conflict predicted by Lipsky's theory of street-level bureaucracy. Professionals are expected to act as advocates for the user/patient, while at the same time exercising a controlling and gatekeeping function. The question is raised whether a model such as CIP provides sufficiently for factors which can counterbalance the power of the professionals relative to the user/patient in care planning.

Just Like Any Other Family? Everyday Life Experiences of Mothers of Adults with Severe Mental Illness in Sweden.

This study explores experiences of mothers in Sweden who care for their adult children suffering from severe mental illness. Using 15 interviews with mothers from 40 to 80 years old, the article examines how predominant professional knowledge and sanism constructs the mothers and their children as deviant and what counterstrategies the mothers develop as a response to these experiences of discrimination. The findings show that the mothers' experiences are characterized by endless confrontations with negative attitudes and comments that have forced them to go through painful and prolonged processes of self-accusations for not having given enough love, care, support and help in different stages of their children's life. But the mothers' experiences also reveal important aspects of changes over the life span. As the mothers are ageing, the relationship between them and their children becomes more reciprocal and the ill child may even take the role as family carer.

Trusted and doubted: Discourses of parenting training in two Swedish official inquiries, 1947 and 2008.

AIM: The aim of this study was to analyse discourses of parenting training in official inquires in Sweden that explicitly deal with the bringing up of children and parental education and how the representations of the problems and their solutions affect parental subject positions in the early welfare state and at the onset of the 21st century. METHOD: We carried out a discourse analysis of two public inquiries of 1947 and 2008, drawing on theories about governmentality and power regimes. Tools from political discourse analysis were used to investigate the objectives of political discourse practices. RESULTS: Both inquiries referred to a context of change and new life demands as a problem. Concerning suggestions for solutions, there were discrepancies in parents' estimated need of expert knowledge and in descriptions of parental capacity. In a discourse of trust and doubt, the parents in 1947 were positioned as trusted welfare partners and secure raisers of future generations, and in 2008, as doubted adults, feared to be faltering in their child-rearing tasks. CONCLUSIONS: The analysis revealed how governmental problem descriptions, reasoning about causes and suggestions of solutions influenced parents' subject positions in a discourse of trust and doubt, and made way for governmental interventions with universal parenting training in the 21st century.

Do views on psychosocial needs of children and adolescents differ among professionals depending on their organisational affiliation? A qualitative study.

Unit managers and employees in schools, social services, and child and adolescent mental health services (CAMHS) were asked to describe their views on children's and adolescents' psychosocial needs when collaboration was required. A descriptive case study design was employed and data were gathered from 23 professionals in six focus groups. The data were analysed by the use of an inductive content approach. Disparities were identified that were interpreted as different approaches to children's needs, which we designated individual (CAMHS), contextual (social services), and educational (schools) approaches. These were perceived as emerging from the professional representations of children's needs that were created within each working group. The organisational affiliation seemed however to have a stronger influence than professional education, regarding the view of children's needs. We suggest that it would be an advantage for professionals to be able to participate in dialogue groups to discuss the meaning of their organisational and professional affiliations, and how this affects their views. Rather than formal knowledge, such dialogues should contain more essential knowledge related to the professionals' approaches to children's needs and to the diversities in the way they think and work in a "give-and-take" process. This might influence their way of thinking and working with children and adolescents, and strengthen their understanding of each other's work.

What do we think about them and what do they think about us? Social representations of interprofessional and interorganizational collaboration in the welfare sector.

Professionals in healthcare, social services, and schools often collaborate when addressing children and adolescents with complex psychosocial needs. Based on theory of social representations, we investigated how professionals in the mentioned organizations perceived each other through their experiences of collaboration. Twenty-nine unit managers and 35 staff members were interviewed in 12 focus groups, and the data collected were subjected to content analysis. Most social representations indicated complex and problematic interprofessional collaboration, although some were positive in nature. We also found social representations regarding ignorance of each other's organizations, distrust, unavailability, and uncommunicativeness. Conceptions of the other party's way of thinking appeared to include adverse attitudes and low expectations from the other side. Concurrently, there was mutual understanding of the limited room to maneuver and heavy workloads. The professionals' perceptions reflected frustration and ambivalence, and also indicated that dialogue was prevented by established boundaries and low expectations. We conclude that arenas are needed for productive dialogue and exchange of relevant knowledge in such collaborative systems, and that management should enable staff to collaborate based on the existing boundaries.

Parents' experiences of collaboration between welfare professionals regarding children with anxiety or depression - an explorative study.

INTRODUCTION: Well-functioning collaboration between professionals in the welfare sector has a strong influence on the contacts with parents of children and adolescents suffering from mental illness, and it is a precondition for the availability of support for these parents. This paper describes how such parents perceive collaboration between professionals in mental health care, social services, and schools. METHODS: This was a small-scale qualitative study. Data were collected by in-depth interviews with seven parents of children and adolescents diagnosed with anxiety and depression. The families were selected from the Child and Adolescent Mental Health patient records kept by the Stockholm County Council (Sweden), and they all lived in a catchment area for Child and Adolescent Mental Health outpatient services in Stockholm. RESULTS AND DISCUSSION: Our results suggest that when the encounter between parents and professionals is characterised by structure and trust, it is supportive and serves as a holding environment. Parents think that communication links and coordination between professionals from different organisations are needed in the collaboration, along with appropriately scheduled and well-performed joint meetings to create structure in the parent-professional encounter. Parents also think that establishment of trust in this interaction is promoted by individual professionals who are available, provide the parents with adequate information, are skilled, and show empathy and commitment.

Revisiting mental hygiene: Josef Lundahl's interpretation of modern psychiatry in Sweden at the beginning of the twentieth century.

The concept of mental hygiene is historically intertwined with eugenics and what it meant both ideologically and for the care of the mentally ill. A closer investigation of the concept and of the historical context shows that different interpretations existed simultaneously. The aim of this essay is to highlight the literary and scientific works of a Swedish psychiatrist, Josef Lundahl, an advocate of the mental hygiene concept. A close reading of his texts is used to provide an example of how the concept of mental hygiene was understood by a psychiatrist and practitioner of mental hygiene. The practice of child-care and out-patient care that Lundahl founded in Visby is far from what we now associate with mental hygiene in the past.

Barriers to collaboration between health care, social services and schools.

BACKGROUND: It is essential for professionals from different organizations to collaborate when handling matters concerning children, adolescents, and their families in order to enable society to provide health care and social services from a comprehensive approach. OBJECTIVE: This paper reports perceptions of obstacles to collaboration among professionals in health care (county council), social services (municipality), and schools in an administrative district of the city of Stockholm, Sweden. METHODS: Data were collected in focus group interviews with unit managers and personnel. RESULTS AND DISCUSSION: Our results show that allocation of responsibilities, confidence and the professional encounter were areas where barriers to collaboration occurred, mainly depending on a lack of clarity. The responsibility for collaboration fell largely on the professionals and we found that shared responsibility of managers from different organizations is a crucial factor affecting successful collaboration. We conclude that a holding environment, as a social context that facilitates sense making, and a committed management would support these professionals in their efforts to collaborate.