Exploring stakeholder perspectives to facilitate the implementation of shared decision-making in coordinated individual care planning: [Utforskande av stakeholderperspektiv för att stödja implementeringen av delat beslutsfattande i samordnad individuell vårdplanering]

2023. Peter Andersson (et al.). European Journal of Social Work, 1-13

Article

This article explores conditions for implementing shared decision-making(SDM) in coordinated individual care planning (CIP) with individuals withcomplex mental health needs. SDM in CIP are described as central,although such user centred collaboration still remains to be realised.Research underlines the need for a changed way of working, whereuser expertise is valued and a balance of power is promoted. The aimof the present study is to investigate the conditions for implementingSDM in connection with CIP for and with people with mental illness. Tobetter understand the context and conditions that can promote such animplementation, altogether 15 participants were interviewed in threeregions in Sweden within the scope of a stakeholder analysis. Bothhindering and supporting factors were identified with respect to animplementation process, such as staffturnover, differences in workculture and committed leadership. Further focus should be directedspecifically towards professionals working more closely with CIP andtowards in-depth analysis of the construct of culture in terms ofimplementation processes.

Treatment in the context of confinement: understanding the barriers and possibilities for facilitating change in at-risk youth

2023. Ann-Karina Henriksen (et al.). Nordisk Tidsskrift for Kriminalvidenskab 110 (3), 312-331

Article

In this article the authors present a meta-synthesis of their studies on secure institutions in Sweden and Denmark. The aim of the metasynthesis is to explore how the context of confinement shapes the possibilities for providing treatment and positive change for at-risk youth. Drawing on meta-synthesis methodology the authors extract content from nine studies published in 20 articles. We highlight three dimensions, which are a) treatment practices and behavioural regulation, b) the carceral materialities and sociomaterial practices, and c) relations. We argue that while treatment is curtailed by confinement, improvements can be made to support more successful change among at-risk youth and smooth their transition into adulthood.

Bokrecension: Revitalizing residential care for children and youth. Cross-national trends and challenges. Whittaker K.J., Holmes, L., Del Valle J.F., & James, S. (red.) Oxford University Press: Oxford. (2023)

2023. Peter Andersson, David Pålsson. Socialvetenskaplig tidskrift 30 (2), 672-674

Article

Institutionsvård för barn och ungdomar (kollektiv vård och behandling dygnet runt) är en ofta ifrågasatt insats. Att föra samman barn med stora behov är förenat med risker och det finns ont om forskningsstudier som tydligt kan visa institutionsvårdens nytta för barns utveckling. Vårdformen präglas återkommande av skandaler och i Sverige rapporterades nyligen om våld och övergrepp vid Statens Institutionsstyrelses (SiS) särskilda ungdomshem. EU (Europeiska unionen) förordar “avinstitutionalisering” som överordnat mål och många länder, inklusive Sverige, prioriterar vård i familjehem framför institutioner. Samtidigt har institutionsvård en befäst position inom samhällsvård världen över. I Sverige är omkring vart fjärde barn i samhällsvård placerad vid ett HVB- eller SiS-hem. Svensk institutionsvård (SiS-hemmen undantagna) utförs på en löst sammanhållen marknad där vårdutbudet till stor del bestäms av privata aktörer.

I antologin Revitalizing residential care for children and youth. Cross-national trends and challenges (Oxford University Press, 2023) diskuteras institutionsvård i sexton västländer (inklusive Argentina). Boken gör nedslag i så skilda länder som USA, Spanien, Israel, Finland och Tyskland (dessvärre ingår inte Sverige i antologin). Syftet med boken är att ge en bild av hur institutionsvård används i olika länder, men även att identifiera framgångsrika praktiker.

A professional field? Educational attainments, gender and age among staff in Swedish residential care

2023. David Pålsson (et al.). Residential Treatment for Children & Youth

Article

In this article, we discuss residential staff in Sweden. Here, residential care is part of the municipal child welfare system, which covers services targeting juvenile delinquency as well as other residential care services. Children and young people placed in Swedish residential care have diverse needs, from mainly supportive needs to advanced behavioral problems, and the field consists of open and secure residential care units. There is limited knowledge about the staff working in residential care. This article helps to fill this knowledge gap by giving an overall picture of staff educational attainments, age and gender in Swedish residential care between the years of 2008–2020. To reason about staff qualifications, we use theoretical concepts from sociological theory on professions. Findings show that residential care in Sweden can be analyzed as a pre- professional field, dominated by staff with low levels of educa-tion. In addition, we show that the field is dominated by women – even if the proportion of men is higher than in other areas of social work – and that the majority of staff are between 30 and 64 years old. Some differences between open and secure residential care were found, the most notable concerning edu-cational levels and gender.

Yrkeserfarenheter av våld och emotionella strategier. Röster från personalen på de särskilda ungdomshemmen

2022. Peter Andersson. Socialvetenskaplig tidskrift 29 (2), 151-171

Article

During the 2000s, the National Board of Institutional Care (SiS) has reported an increase in violent incidents between staff and young people. This article focuses the staffs´ professional everyday life, especially descriptions of how they handle violence in their professional everyday life and what directions the violence takes. The staffs´ everyday work is often depicted on the basis of various dilemmas and tensions, which can affect how they maneuver in terms of how they deal with, and are affected by, violence during their professional working day. The purpose of this article is to illustrate how staff describe the violence they encounter in terms of form, direction and extent, including their own handling of the violence. The theoretical starting point regarding violence is taken from a relational perspective where context, situation, form and intention are important for how violence is understood. The staff’s work is understood with the help of both Hochschild’s and Bolton’s descriptions of emotional work, where emphasis is placed on the development that Bolton pointed out regarding the importance of colleagues regarding feeling-rules. Fifty-three semi-structured interviews were conducted with staff at three different secure units for adolescents in Sweden. The material was organized through a thematic analysis, yielding four themes placed under two headings; ‘A violent scene? A matter of definition’ and ‘Handling violence: strategies employed’. The results show how staff describe youth as the violent party and how they suppress their own emotions. Additionally, staff articulated their own use of violence toward youth and their emotional stance, describing an interpersonal shield that protected them from violence. The results underline the importance of raising questions about the nature of violence in secure units for adolescents and how staff handle such violence in their everyday work.

Secure Units as Emotional Sites: Staff Perceptions of Fear and Violence at Secure Units for Young People in Sweden

2022. Peter Andersson. Residential Treatment for Children & Youth, 1-29

Article

Secure units for adolescents are emotion-filled places for various reasons, yet previous studies have shown that fear seems to be an emotion which is difficult to deal with in these workplaces. This paper examines how secure unit staff describe their workday, focusing on fear. The analysis applies theories about emotional work as well as the concept of fear. The article builds on 53 semi-structured interviews with staff at three secure units for detained boys and girls run by the Swedish National Board of Institutional Care. The findings illustrate different ways in which staff handle emotions, such as fear, at these institutions. Results are discussed with respect to five themes: (a) the importance of control; (b) safety: not a regular workplace; (c) not my anxiety, but the young person’s; (d) security: standing safe with co-workers; and (e) the ambiguous fear. The results show the importance of taking emotions seriously in daily work, as this renders visible how staff emotionally socialize into their organization. Due to a lack of education and professional identity among staff, the socialization process is highly relevant, as it is primarily perceptions of youth and co-workers that control and develop professionalization for staff.

Countertransference and therapeutic holding: Working with a perpetrator of domestic violence

2022. Peter Andersson. Psychodynamic Practice, 1-21

Article

In the context of the treatment of perpetrators of violence, psychodynamic discourse has often focused on individual aggression and other related emotions and mental phenomena, such as anger, rage, cruelty, sadism and brutality. Psychodynamic theory has been less explicit, however, about how to address an individual’s actual violent acts within the psychotherapeutic setting. This article aims to address this gap. It illustrates how psychoanalytic theory – most notably through Winnicott, Fonagy and Glasser – can be used to inform thinking about, and interventions with, men who use violence against their children and partners, using a clinical case that describes psychotherapeutic work with a perpetrator of domestic violence. The article concludes that the psychotherapist’s countertransference is an important tool in working with men who use violence, and highlights the importance of the therapist’s capacity for impulse regulation, emotional understanding, and handling of his or her own aggression.

Victims, perpetrators, scapegoats and Russian dolls

2021. Peter Andersson. Qualitative Social Work

Article

A rise of violent incidents at secure units for adolescents has been reported by the Swedish National Board of Institutional Care. Meanwhile, research aiming to understand how staff manage violence seems to be lacking. By examining an in-depth narrative by one staff member, “Meral”, this study aims to understand, on the one hand, how staff describe the violence they encounter in light of the context and situation, and on the other, how they describe their handling of violence from outside the immediate environment. Drawing on Georgakopoulou and Bamberg, identities are understood to be produced and performed within personal narratives from different positions in relation to one’s surroundings. The study shows how Meral’s professional identity is shaped and affected by violence. Of essential importance is the way Meral presents herself to herself: as “not afraid.” A narrative interpretation is that fear does not fit within the framework of the professional identity for staff. A key element of placing essential responsibility on staff to manage violence is keeping lines of communication open, which could be made clearer in policy documents, training and supervision. Therefore, studies like this one could result in the development of communication strategies for staff. This is important because emotional rules can generate emotional cultures that in the long run can be destructive for both staff and young people. Only when the emotional rules are identified can staff develop strategies for dealing with the violent incidents that are part of their professional life in a qualified way.

Hot, våld och emotionellt arbete på de särskilda ungdomshemmen

2021. Peter Andersson (et al.).

Thesis (Doc)

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.

Handling fear among staff: violence and emotion in secure units for adolescents

2020. Peter Andersson. Nordic Social Work Research 10 (2), 158-172

Article

The Swedish National Board of Institutional Care (SiS) has reported a rise in violent incidents between staff and youth placed in secure units. This paper explores how secure unit staff narratively position themselves and youth when speaking about violence, and how staff describe the emotional impact violence has on them. The paper takes two theoretical starting points. First is the concept of emotional labour, including feeling rules, emphasizing that staff work with the emotions of others whilst also being expected to control their own. Second is the idea that the interaction among staff shapes various social representations and positionings. Five focus groups were conducted with staff (n = 27) who worked with both boys and girls at three different secure units in Sweden. The empirical data was first processed through narrative analysis and then by an interaction analysis. The results, presented as four excerpts within four themes, reveal collegial processes of narrative helping that steer group members to find emotional positions when talking about experienced violence, i.e., to find appropriate feeling rules. Furthermore, despite counter-narratives expressed by participants in the focus group, a representation of youth as violent persists. Finally, emotional labour seems to involve working with one’s own feelings and controlling the emotions of youth, not the opposite. The results suggest how important it is for staff to recognize youth from different templates and that violence can take various forms, and furthermore, that it is essential to make the emotion of fear visible in this context.

Violence, role reversals, and turning points: work identity at stake at a therapeutic residential institution for adolescents

2020. Peter Andersson, Carolina Överlien. Journal of Social Work Practice

Article

This article focuses on how one staff member at a therapeutic residential institution negotiates his work identity, exploring how he narrates a violent incident, the formation of work identity, and how the adolescent figures within these processes. Mishler argues that when speaking, we perform identity. As social actors, we select and organize language, telling stories that fit the audience, our intentions, and the occasion. The article is framed both theoretically and methodologically through the assumption that narrative is a fundamental human way of giving meaning to our experiences. Identities are understood as being produced and performed within personal narratives. Thus, in an interview situation, narratives provide an interactive space for personal subjectivities to be expressed and enacted. Drawing on Mishler, we find three essential "turning points" that shape Alex’s work identity: (1) the violent incident, (2) the adolescent’s return to the ward, and (3) Alex’s subsequent change of wards. We interpret Alex’s narrative as a "narrative of resistance" that may have practical day-to-day implications for the field of institutional care and help expand the staff’s clinical toolbox. Further, Alex’s narrative is a vital example of stories of violence, which can be incorporated into policy documents on violence management.

Emotional adjustments to violent situations at secure units for adolescents: A staff perspective

2020. Peter Andersson. Emotion, Space and Society 37

Article

Secure units for adolescents are emotion-filled places. This paper examines how secure unit staff are socialized to match emotions to violent situations in a dynamic social context according to different feeling rules. The analysis applies theories about emotional culture as well as feeling rules. The article builds on 53 semi-structural interviews with staff at three secure units for detained boys and girls run by the Swedish National Board of Institutional Care. The findings illustrate different ways in which staff adjust their feelings in violent situations by both breaking and following rules. Results are discussed with respect to three themes: (1) emotional adjustments tuned to co-workers; (2) emotional adjustments tuned to self; and (3) emotional adjustments tuned to youth behaviour. The results show the importance of taking emotions seriously in daily work, as this makes it possible to visualize how staff emotionally socialize into their organization. Due to a lack of education and professional identity among staff, the socialization process is highly relevant, as it is primarily perceptions of youth and co-workers that control and develop feeling rules for staff.

Behandlande arbete medvåldsutövande fäder

2020. Peter Andersson. Mellanrummet 40 (4), 25-32

Article

I mötet med en annan människa

2019. Peter Andersson. Mellanrummet 38 (1), 81-83

Article

‘If you take it personally you break’ Neglected voices on violence in secure units for adolescentssw

2018. Peter Andersson, Carolina Överlien. Social Work and Social Sciences Review 19 (3), 61-80

Article

To a large degree, the voices of staff running daily operations in secure units for adolescents, particularly on sensitive issues such as violence and abuse, have been missing. The aim of the present paper is to make these voices heard by investigating what forms of violence staff in secure units encounter in their day-to-day work and to deepen our understanding of how they handle it. The study uses two theoretical starting points. First, the secure unit is understood in terms of Berger and Luckmann’s concept of institutionalisation, emphasising how behaviour and practices develop through well-defined roles. Secondly, inspiration is drawn from Goffman’s notion of frontstage and backstage, highlighting how staff within an institution (i.e. secure unit) enter into different roles. Fifty-three semi-structured interviews were conducted with staff at three different secure units for adolescents in Sweden. The material was organised through a thematic analysis, yielding six themes placed under two headings; ‘A violent scene? A matter of definition’ and ‘Handling violence: strategies employed’. The results show how staff describe youth as the violent party and how they suppress their own emotions. Additionally, staff articulated their own use of violence toward youth and their emotional stance, describing an interpersonal shield that protected them from violence. The results underline the importance of raising questions about the nature of violence in secure units for adolescents and how staff handle such violence in their everyday work.

Peter AnderssonSenior lecturer

Research projects

Publications

Exploring stakeholder perspectives to facilitate the implementation of shared decision-making in coordinated individual care planning: [Utforskande av stakeholderperspektiv för att stödja implementeringen av delat beslutsfattande i samordnad individuell vårdplanering]

Treatment in the context of confinement: understanding the barriers and possibilities for facilitating change in at-risk youth

Bokrecension: Revitalizing residential care for children and youth. Cross-national trends and challenges. Whittaker K.J., Holmes, L., Del Valle J.F., & James, S. (red.) Oxford University Press: Oxford. (2023)

A professional field? Educational attainments, gender and age among staff in Swedish residential care

Yrkeserfarenheter av våld och emotionella strategier. Röster från personalen på de särskilda ungdomshemmen

Secure Units as Emotional Sites: Staff Perceptions of Fear and Violence at Secure Units for Young People in Sweden

Countertransference and therapeutic holding: Working with a perpetrator of domestic violence

Victims, perpetrators, scapegoats and Russian dolls

Hot, våld och emotionellt arbete på de särskilda ungdomshemmen

Handling fear among staff: violence and emotion in secure units for adolescents

Violence, role reversals, and turning points: work identity at stake at a therapeutic residential institution for adolescents

Emotional adjustments to violent situations at secure units for adolescents: A staff perspective

Behandlande arbete medvåldsutövande fäder

I mötet med en annan människa

‘If you take it personally you break’ Neglected voices on violence in secure units for adolescentssw