A selection from Stockholm University publication database

• Patients' with Multimorbidity and Psychosocial Difficulties and Their Views on Important Professional Competence for Rehabilitation Coordinators in the Return-to-Work Process

  2021. Azade Azad, Veronica Svärd. International Journal of Environmental Research and Public Health 18 (19)

  Article

  Coordinators may play a key role during the return-to-work (RTW) process for people on sickness absence. There are still few studies on the newly implemented rehabilitation coordinators (RECO) within Swedish healthcare, and none focus on their competence. The aim of this study was to explore how persons with multimorbidity and psychosocial difficulties describe the professional competence of the RECO they encountered during their RTW process. The study takes a relational and practical approach in defining professional competence, including both what professionals do and what they possess. Interviews with 12 people with multimorbidity and psychosocial difficulties who had encountered a RECO during their RTW process were analysed using thematic analysis. Six different themes were found: communicative and coordinating skills; advisory and guidance skills; engagement and advocacy skills; being persistent and flexible; being empathic and therapeutic; being professional and trustworthy. Most of these are found in research on RTW coordinators, but being persistent, and having advisory, guidance, advocacy and therapeutic skills have not been recognised as important competences previously. This study adds patients' views on important professional competence that support the RTW process, which should be regarded in further developments of RECOs' functions and their competence descriptions.

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• How People with Multimorbidity and Psychosocial Difficulties Experience Support by Rehabilitation Coordinators During Sickness Absence

  2021. Veronica Svärd, Emilie Friberg, Azadé Azad. Journal of Multidisciplinary Healthcare 14, 1245-1257

  Article

  Purpose: People with multimorbidity face a range of barriers in healthcare, and there is little knowledge about their challenges with regard to return-to-work (RTW). Rehabilitation coordinators, a new function in Swedish healthcare, support people in the RTW process. The present study had two aims: to explore what problems and barriers people with multimorbidity experience during their rehabilitation and RTW process and to explore in which domains the coordinators' support is perceived to be of importance.

  Methods: Interviews were conducted with 12 persons with multimorbidity who had contact with a rehabilitation coordinator during their sickness absence. Thematic analysis was guided by the case-management ecological model; this analysis was revised and adapted to the Swedish context.

  Results: The participants experienced problems in all domains of the model, namely: the healthcare system, the labor market and the workplace system, the sickness insurance system, and the personal system. Rehabilitation programs that did not accommodate combinations of diseases, social complexities and needs were felt to lead to worse symptoms, thus hindering rather than promoting RTW. An overall finding regarding support by coordinators is that interventions, regardless of domain, were felt to be valuable for people with multimorbidity. The coordinator was perceived to give most support by providing advice about and coordination with healthcare and employers. Sometimes the coordinator gave advice and coordination regarding the Social Insurance Agency, very occasionally the Public Employment Services. The coordinator gave least advice and coordination about social difficulties that hindered rehabilitation and RTW processes.

  Conclusion: People with multimorbidity perceive rehabilitation coordinator interventions as important in all domains investigated. Lack of advice and coordination, or rehabilitation programs that were not modified to the complexities of individual's circumstances, were associated with prolonged sickness absence, worse health, or social risk factors not being recognized.

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• Adolescent Females with Limited Delinquency

  2020. Azade Azad, Hanna Ginner Hau. Child and Youth Care Forum 49 (2), 325-342

  Article

  Background

  Research has established a strong relationship between education and later life outcomes, where the connection between different school problems and delinquency have been widely acknowledged. These studies have often sampled male juvenile offenders exhibiting extensive and/or persistent delinquency. Less is known about the educational attainment of female juvenile offenders, especially those who display limited delinquency. In a previous study (Azad and Ginner Hau in Child Youth Serv Rev 95:384–396, 2018), the characteristics of this particular group of offenders were explored where the results showed limited self-reported delinquency but elevated school problems.

  Objective

  The present aim was to conduct a follow-up study of the same sample of female adolescents, in order to study their educational attainment during adolescence and the rate of recidivism within 24 months after being sentenced through registry data.

  Method

  The sample consisted of adolescent females (N = 144) who were convicted of a crime and sentenced to youth service between 2007 and 2012 in Stockholm, Sweden.

  Results

  The results showed that the majority of the females did not reoffend within 2 years after being sentenced. They did, however, display high educational deficits. Their grade point average at the end of both compulsory education and upper secondary school was much lower than that of young females in general, and the majority had either dropped out, never begun or received zero in all subjects at the end of upper secondary school.

  Conclusions

  The low school results indicate a need to support young delinquent females’ educational attainment in order to improve their overall life chances.

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• Characteristics of adolescent females with limited delinquency

  2019. Azadé Azad (et al.).

  Thesis (Doc)

  Adolescence is a developmental period marked with several changes in a young person’s life. Most adolescents who commit crimes desist over time. Despite this, research has mainly focused on those with extensive and long-term delinquency, including mostly males. Young females with limited delinquency are thus an under-researched group. The overall aim of the thesis was to explore the characteristics of young females with limited delinquency, and relate these features to developmental aspects of adolescence. Further, the objective was to study potential challenges they experience, in connection to family, peers and school. All four studies were based on data from young females sentenced to youth service. Studies 1 and 2 include all (N=144) females convicted in a major city in Sweden during 2007–2012. The data collected through self-reports based on ADAD interviews at the beginning of youth service in Study 1 was further complemented and followed up in Study 2 with registry data on education and recidivism 24 months after starting their sentence. Studies 3 and 4 were based on in-depth interviews with nine adolescent females who started their sentence between 2012–2013 in one of two major cities in Sweden. The results confirmed the assumption that this group of offenders displayed limited delinquency. Their self-reports in Study 1 showed low involvement in crimes during twelve months prior to youth service, which was similar to the reporting of a reference group of females in general. Displaying limited delinquency was supported by registry data in Study 2, showing that the majority of the females did not reoffend within two years after being sentenced, as measured by suspicion and conviction rates. However, they did show high educational deficits. This was evident both by high levels of self-reported school problems in Study 1 and final grade point in compulsory and upper secondary school in Study 2. Their educational attainment was lower than adolescent females in general, irrespective of whether they reoffended or not. These findings suggest that although the females were limited in their delinquency, their low levels of education could still put them at risk for suboptimal development. In the interviews, participants ascribed particular importance to peers and family when describing their delinquency. The narratives illustrated how the process of delinquency as it concerned interpersonal relations involved mutually influential exchanges, both contributing to as well as being affected by the delinquency. As such, delinquency was, in Study 3, portrayed as a way to socialize, where delinquent peers were considered important for committing crimes, and pro-social peers for desisting. Likewise, family relations in Study 4 were given a prominent role in the entire process. Accordingly, delinquency was described as a consequence of the relations to the family, where these were negatively as well as positively affected by the crimes. The collective results indicate that committing crimes for the females may be viewed as part of normative development, in which the quest for independence and establishing ones’ identity can contribute to these behaviors. Practical implications for work with young female offenders are also discussed.

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• Adolescent female offenders’ subjective experiences of their families’ roles in relation to their delinquency

  Hanna Ginner Hau, Azade Azad.

  Family factors have been regarded as central for both general development and delinquency in adolescence. For female delinquency, family factors appear to be particularly important. The aim of the study was to explore young female offenders’ perspectives on their family contexts in relation to their delinquency. Nine female offenders aged 15-21 were interviewed. Data were analysed using consensual qualitative research. Nine core themes concerning the family were identified that included general descriptions of the family and family roles in relation to delinquency. Descriptions of the families were heterogeneous, but in the delinquency-specific themes, common patterns concerning the process of delinquency and relational aspects were identified. Families were described as being involved in the entire process of delinquency. Relational aspects expressed in the delinquency narratives demonstrated attempts for proximity as well as distance. Another relational aspect was delinquency-related transactions between the participants and their families. Participants’ perspectives of the role of their family contexts in relation to delinquency conveyed aspects typical of adolescence, which might be a possible way to understand the role that the family context plays in delinquency.

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• Adolescent females with limited delinquency ‒ A follow-up on educational attainment and recidivism

  Azade Azad, Hanna Ginner Hau.

  Research has established a strong relationship between an individual’s education and later life outcomes, with, for example, the connection between different school problems and delinquency having been widely acknowledged (e.g., Hirschfield, 2017). These studies have often sampled juvenile offenders exhibiting extensive and/or persistent delinquency, involving mostly males (e.g., Foley, 2001). Less is known about the educational attainment of female juvenile offenders, especially those who display limited delinquency sentenced to non-custodial measures. In a previous study (Azad & Ginner Hau, 2018), we explored the characteristics of this particular group of female offenders, i.e., females sentenced to youth service, and found that they self-reported limited delinquency but elevated school problems. The present aim was to conduct a follow-up study of the same sample of female adolescents, in which educational attainment during adolescence and the rate of recidivism within 24 months after being sentenced were explored through registry data. The results showed that the majority of the females did not reoffend within two years after being sentenced. They did, however, display high educational deficits. Their grade point average at the end of both compulsory education and upper secondary school was much lower than that of young females in general, and the majority (66%) had either dropped out, never begun or received zero in all subjects at the end of upper secondary school. These findings indicate a need for interventions targeting young delinquent females’ educational potential in order to improve their overall life chances.

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• Adolescent female offenders’ subjective experiences of how peers influence norm-breaking behavior

  2018. Azade Azad, Hanna Ginner Hau, Markus Karlsson. Child and Adolescent Social Work Journal 35 (3), 257-270

  Article

  Delinquent peers have a strong influence on adolescent delinquent behavior. However, few studies have investigated adolescents’, and in particular young females’, own perspectives of the role of peers on their delinquent behavior. The purpose of the present study was to explore how young female offenders described their delinquent behavior and more specifically the role they assign to peer relations in committing or avoiding delinquent acts. Nine female adolescents, sentenced to youth service, were interviewed, and the data was analyzed using the Consensual Qualitative Research (CQR) method. The results showed that committing crimes and taking drugs with peers were portrayed as a way for the female delinquents to socialize. Delinquent and pro-social activities with peers appear to serve similar developmental functions in the sense that it is described to fulfill the same developmental needs. The young offenders also described collectively created pressures and norms in the peer group as the main contributing factor to their norm-breaking behavior, where they described being both recipients and producers of influence in the group. Another important finding was that the female offenders showed an awareness of the importance of pro-social peers and the need to eliminate delinquent friends from their peer network in order to help them refrain from deviant behavior. Implications for prevention and intervention are discussed.

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• Adolescent females with limited delinquency – At risk of school failure

  2018. Azade Azad, Hanna Ginner Hau. Children and youth services review 95, 384-396

  Article

  During adolescence, risk behaviors (e.g., running away from home, truancy, alcohol/drug use, and delinquency) increase, and most individuals who at some point commit crimes do so during their teenage years. Since the crime rate is so high during adolescence, juvenile delinquency can be regarded as a normal rather than a deviant behavior. Delinquent females have historically been under-researched. However, the little research that is available indicates that low-risk female offenders (females with limited delinquency receiving community-based measures), may be at risk of suboptimal development. The objective of the present study was to provide a basic description of this group of offenders by using their self-reports on delinquency, drug and alcohol use, school, peers, family and mental health. The self-reports of 138 females between 15 and 20 years of age sentenced to youth service in Stockholm, Sweden, were compared to young females in residential care and to a reference group of adolescent females without known adjustment problems. The results showed that the youth service females did not have a higher number of accumulated problems than the reference group with regard to criminal acts, drug and alcohol use, peers, mental health, and in some regards also for family. However, the youth service group reported various school-related problems and failures, more in line with the residential group. This suggests that interventions aimed at helping the young females develop strategies for becoming more academically successful are important.

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