A selection from Stockholm University publication database

• Discretion and Strategies for Investigating Child Abuse: Social Workers' Conceptions of Child Abuse Investigations and Police Reporting

  2024. Sara Quarles van Ufford (et al.). British Journal of Social Work 54 (4), 1554-1573

  Article

  Understanding the capacity of child welfare (CW) organisations to deal with child abuse is complex, and dependent on the specific CW context. Sweden occupies a unique position in trying to balance high demands for CW and protection with a strong family support focus, which carries a risk of overlooking children who need protection. Drawing on an understanding of social service organisations as street-level bureaucracies, this article explores discretion in child abuse cases by examining conditions affecting discretion and strategies for investigating child abuse, including police reporting. Thematic analysis of interviews with Swedish supervising social workers showed that staff's conceptions of the CW system influenced the exercise of discretion, leading to different strategies for dealing with child abuse. This resulted in different practices and potentially unequal access to child protection and support, highlighting the wide margin of discretion. This article concludes that the interplay between knowledge and governance is central to equal child protection. This article contributes to the discussion of discretion in CW organisations by underlining the importance of being particularly vigilant about discretion when both children and parents are considered clients, as the child risks being lost as a subject with individual needs and rights. Understanding the capacity of child welfare (CW) organisations to deal with child abuse is complex. Sweden occupies a unique position in trying to balance high demands for CW and protection with a strong family support focus, which carries a risk of overlooking children in need of protection. This article explores the handling of child abuse cases by examining conditions affecting discretion and strategies for investigating child abuse, including police reporting. Analysis of interviews with Swedish supervising social workers showed that staff's conceptions of the CW system influenced the handling, leading to different strategies for dealing with child abuse. This resulted in different practices and potentially unequal access to child protection and support, underscoring the importance of being particularly vigilant about discretion when both children and parents are considered clients: the child risks being lost as a subject with individual needs and rights. This article concludes that the interplay between knowledge and governance is central to equal child protection.

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• 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]

  2024. Peter Andersson (et al.). European Journal of Social Work 27 (5), 1073-1085

  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.

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• Managing a fragile motivation within an unfit organisation: young adults' experiences of support to achieve employment [Att hantera en skör motivation i en illa lämpad organisation: Unga vuxnas erfarenheter av stöd för att uppnå sysselsättning]

  2024. Ulla-Karin Schön, J. Tranquist, W. Astvik. European Journal of Social Work 27 (3), 638-649

  Article

  This article explores subjective realities of being not in employment, education or training (NEET), with a specific focus on support needs and how labour market support fits these needs. A total of 23 semi-structured interviews were conducted with participants aged 18–29 who had just been recruited to a work support program aimed at increasing the availability, coordination, and individualisation of support in order to enhance the possibility of finding work. The results illustrate a clear yet fragile motivation to work among the respondents. The participants expressed optimism that they would find a job, but were also clear about the need for adaptations in the workplace to succeed. Through the lens of crip time, the participants expressed a need for flexibility and extra time to perform tasks such as finding a job and feeling comfortable in the workplace, compared to the needs of abled people. Rules and time limits at the Public Employment Service and the Social Insurance Agency reinforced the image of this normative time, making the participants express their needs as a deviation from what is considered normal. 

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• Editorial: Addressing epistemic injustice in mental health

  2024. Karen Newbigging (et al.). Frontiers in Psychiatry 15

  Article

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• Gaining Knowledge of a New and Contested Diagnosis – A Qualitative Examination of Swedish Parents of Children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

  2024. Noam Ringer, Ulla-Karin Schön. Journal of Child and Family Studies 33 (8), 2646-2654

  Article

  Background: Pediatric acute-onset neuropsychiatric syndrome (PANS) is a symptom-based and clinically heterogeneous condition characterized by an abrupt and dramatic onset of symptoms such as loss of motoric and cognitive abilities, anxiety, compulsion, tics, and eating disorders. PANS is a new diagnosis and the condition has gathered controversy in research and clinical practice. Aim: We aimed to investigate the process by which parents of children with PANS acquire knowledge about the condition; the causes that lead parents to search for knowledge; the ways in which they search for knowledge; and the manner in which this knowledge is received by medical care professionals. Method: The study employed in-depth semi-structured, individual interviews with 13 parents of children diagnosed with PANS. An inductive qualitative thematic analysis was used as a guide for analyzing the data. Results: Challenges to understand their child’s illness and receive effective care led the parents to search for knowledge about PANS and provide an explanation for their child’s symptoms. They used personal and social resources to search for knowledge. They felt trusted and encouraged when clinicians endorsed their knowledge. On the other hand, when they were dismissed as a source of knowledge, they experienced a lack of trust towards professionals. Conclusions: A driving force for parents’ search for knowledge is a perceived incapacity to give meaning to their experiences. Another reason is mistrust of healthcare staff’s existing knowledge.

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• Practitioners exploring intertwined challenges and possible solutions for user participation in social services

  2024. Kristina Bromark (et al.). Nordic Social Work Research, 283-295

  Article

  Despite a strong emphasis on user participation in social services, scientific knowledge on how to achieve these goals is limited. The aim of this study is to explore what social work practitioners identify as challenging in implementing user participation and what solutions they propose to be necessary to meet these challenges. Future workshops were applied, combining data from brainstorming processes and from the participants’ analytical work, identifying current obstacles and co-creating solutions. The workshops took place at the Personal Social Services section in a suburban area outside a large city in Sweden with 95 participants. The findings are discussed in relation to a model of participation, where creating openings, opportunities, and obligations are essential. The participants highlighted the need to strengthen commitment to user participation, increased access to knowledge and methods that enhance user participation, and support from management, with increased resources to ensure continuous development and maintenance. Practitioners must be able to engage in user participation, and actions need to be taken at all organizational levels. To overcome a complex and intertwined set of challenges, an intertwined set of solutions is required. 

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• Prioritised research questions in serious mental illness: A priority setting based on evidence gaps

  2024. Mussie Msghina (et al.). BMJ Mental Health 27 (1)

  Article

  In 2021, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) published an inventory, which identified over 2000 evidence gaps in mental health1 from the two known international database of evidence gaps: the SBU Evidence Gap database, which is continuously updated, and the former UK Database of Uncertainties about the Effects of Treatments. Within the framework of a Swedish governmental commission on mental health, we conducted a priority setting partnership to assess which of the identified evidence gaps regarding serious mental illnesses (SMI)2 were most urgent to address. A similar project regarding common mental illness is also envisioned. The aim of the current priority setting was to identify what patients, carers, clinicians and practitioners consider to be the most important outstanding research questions in the care of SMI. The interventions studied include prevention, diagnostics, treatment, support and social care, service delivery and coordination of healthcare and social care. Target groups for the report are researchers, research funders, government agencies and authors of systematic reviews.

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• Developing sustainable service user involvement practices in mental health services in Sweden: the Userinvolve research program protocol

  2023. Urban Markström (et al.). Frontiers in Psychiatry 14

  Article

  Background: The purpose of this paper is to outline the protocol for the research program UserInvolve, with the aim of developing sustainable, service user involvement practices in mental health services in Sweden.Methods: This protocol outlines the knowledge gap and aim of the UserInvolve-program. It further provides an overview of the research infrastructure, with specific focus on the organization and management of the program as well as the design of the six underlying research projects. These six research projects form the core of the UserInvolve-program and will be carried out during a six-year period (2022-2027). The projects are focused on examining articulations of experiential knowledge in user collectives, on four specific user involvement interventions (shared decision-making, peer support, user-focused monitoring, and systemic involvement methods) and on developing theory and method on co-production in mental health research and practice.Results or conclusion: The knowledge gained through the co-production approach will be disseminated throughout the program years, targeting service users, welfare actors and the research community. Based on these research activities, our impact goals relate to strengthening the legitimacy of and methods for co-production in the mental health research and practice field.

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• Editorial - Special Issue

  2023. Peter Beresford (et al.). British Journal of Social Work 53 (3), 1275-1281

  Article

  Over the years, with accelerating impact, a quiet revolution has been taking place in public policy internationally. This has mushroomed, particularly since the development of user-led movements, such as the Disabled people’s movement, the looked-after children’s movement and survivors’ movements. Social work has been in the vanguard of addressing this challenge and was an early profession to require and centrally fund the involvement of people with lived experience in its qualifying education courses in the UK. Such involvement is central to social work’s global philosophy. Now, the UK’s social work flagship journal, the British Journal of Social Work, has produced this special issue with the aim of making a step change forward in people with lived experiences’ involvement in academic and professional analysis and discussion.

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• Exploring the Sharing and Legitimacy of Experience-Based Knowledge of Living with Acquired Brain Injury in Two Practice Communities

  2023. Lill Hultman (et al.). Health & Social Care in the Community 2023

  Article

  Background. Involving people with acquired brain injury in service development has the potential to improve service and give experience-based knowledge legitimacy. The objective of this study was to explore experiences of sharing experience-based knowledge of living with acquired brain injury with others, with a particular focus on the conditions for sharing and learning, and the legitimacy of experience-based knowledge.

  Materials and Methods. Using a single case study design, the processes in two groups that were part of a Swedish supportive network for people with acquired brain injury were explored. One group consisted mainly of people with acquired brain injury who authored a blog and the other group consisted of healthcare staff who produced educational material with the involvement of a person with own experience of acquired brain injury. The data consisted of forty-one collective blogs, fifteen semistructured individual interviews, and ten observations from meetings. The data were analysed by utilizing the community of practice framework and the concepts of legitimate peripheral participation and epistemic injustice.

  Results. The findings showed that both groups developed learning processes with a focus on everyday rehabilitation as a joint enterprise. Mutual engagement developed from doing activities together and legitimacy in the groups came from engagement in these activities. In the education group, the ambition to involve people with own experience of acquired brain injury was never realized in practice. Hence, experience-based knowledge of living with acquired brain injury never got legitimacy in the group.

  Conclusions. We conclude that integrating experience-based knowledge from people with own experience of acquired brain injury demands careful and deliberate planning with specific consideration to existing power asymmetries between healthcare professionals and people with own experience. Mitigating epistemic injustice and gaining legitimacy for such knowledge require that people with experience of living with acquired brain injury are recognized as knowledge producers.

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• Introduction to Academic Papers Section

  2023. Omar Mohamed, Ulla-Karin Schön, Peter Unwin. British Journal of Social Work 53 (3), 1282-1284

  Article

  In keeping with the ethics of this special issue, we sought to attract academic papers of the same quality and integrity as those published regularly in the journal, the key differentiation being that a person with lived experience of social work had to be the lead or solo author.

  The vast majority of academic papers accepted for peer-reviewed social work journals are from practising academics, with very few practitioners, and even less people with lived experience, managing to have their views heard from such platforms. Writing and presenting an academic paper to a peer-reviewed journal can be an arduous task, shrouded in mystery and labyrinthine processes for those attempting a first effort. Academic journals have extremely specific protocols, systems of reviewing, referencing and using language that can be quite off-putting to newcomers. Worse still is the negative tone and content of feedback that most academics have received at some time in their career in respect of their submissions. As an editorial team, we were determined to avoid any such culture of negative criticism and set ourselves the goal of always giving positive, constructive criticism, even when we had made the decision not to accept a paper. Such an approach included advising about where the article might perhaps be better received, or whether perhaps it could be presented in a different format. Rather than always communicating via the formal online journal platform, editors used e-mails and other platforms to communicate issues in ways that encouraged the authors to continue working on a paper. Again, we were at all times aware of boundary issues and checked out such practices at our regular online and WhatsApp meetings.

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• Perceptions of participation: how nursing home staff and managers perceive and strive for participation of older residents: [Brukardelaktighet på äldreboenden – vad vill personal och chefer uppnå?]

  2023. Sara Erlandsson, Ola Knutsson, Ulla-Karin Schön. European Journal of Social Work 26 (5), 815-827

  Article

  User participation is increasingly emphasised in policies guiding social services. However, translating policy into practice is fraught with difficulties. The staff’s approaches to user participation are crucial for the users’ opportunities to participate in decision-making, particularly for users with extensive care needs and reduced autonomy. The aim of this article is to explore how nursing home staff and managers perceive the participation of older residents and what the implications are for residents’ involvement in decision-making in everyday life. Interviews and future workshops were carried out with staff and managers in two Swedish nursing homes. The analysis identified differing and partly conflicting perceptions of user participation that have different implications for the residents’ opportunities to be involved in decisions. The staff’s and managers’ approaches to participation ranged from encouraging independent decision-making to excluding the residents from decisions, depending on the situation and the assessment of residents’ abilities. In addition, the analyses showed that perceptions of participation are intertwined with perceptions of good care and with the staff’s and managers’ understandings of their mission and responsibilities. The findings indicate that increasing user participation in nursing homes requires organisational policies that clarify what user participation is and strategies for implementation in daily practice. 

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• Review: Young people’s recovery processes from mental health problems – a scoping review

  2023. Jennie Moberg, Lisa Skogens, Ulla-Karin Schön. Child and Adolescent Mental Health 28 (3), 393-407

  Article

  Background: Recovery from mental illness and mental health problems is relatively well-researched among adults, but evidence that focuses on the recovery experiences of young people and what characterizes it is scarce. With this in mind, this article aims to map out the existing research in order to identify prevailing knowledge about the recovery of young people between the ages of 12 and 25. Method: Drawing on scoping review methodology, this article is based on an analysis of 33 articles conducted in the USA, Australia, and Eur-ope. Results: Our findings reveal that young people express both similar and divergent lines of reasoning about recovery compared with adults. Our findings also indicate that young people often fluctuate in the way they view recovery, and that they thus tend to be ambivalent about what recovery means. Parents usually high-light the importance of professionals facilitating recovery, while care staff problematize the organizational frameworks available as aggravating circumstances for implementing personal recovery. Young people, parents, and care staff consistently describe recovery as a way to, despite lingering problems, enable a satisfying life. Conclusions: Through this review, we outline the need for a more distinct focus on agency and participation in young people’s recovery processes, at the same time as family involvement needs to be further investigated and operationalized.

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• Who cares? A scoping review about the experiences of parental caregivers of autistic adults

  2023. Malin Ljungberg, Ulla-Karin Schön. JARID 36 (5), 929-939

  Article

  Background: The autistic population is growing and ageing and this also applies to the parents. Despite this, research about parental experiences is still relatively scarce. Even though studies show, compared with adults with other disabilities, parents of autistic adolescents and adults report a decrease in well-being and that caregiving is often a lifelong commitment. MethodThis scoping review maps, synthesises and identifies gaps in previous research as regards the experiences of parental caregivers of adult autistic children. The review was based on Arksey and Malley's framework and six databases were searched. Results: The results show how the research has focused on the well-being and consequences of daily caregiving for an American middle-class mother who co-resides with an adult son. Conclusion: To enhance knowledge about formal services and service needs, more research is necessary on different welfare regimes and social contexts.

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• Shared decision making in social services–some remaining questions

  2023. Pia Nykänen, Ulla-Karin Schön, Alexander Björk. Nordic Social Work Research 13 (1), 107-118

  Article

  Recent years have seen increased emphasis on person-centring and user involvement in healthcare delivery and social services. In Sweden, the rights of users to participate in and influence care planning and services are stipulated in the Social Services Act, the Health Care Act and the Patient Law. Shared decision making (SDM) is presented as a supportive collaboration between users and staff, drawing on users’ preferences and values as well as the best available evidence to discuss options and reach a consensus on care decisions. However, studies on the implementation of SDM in somatic care illustrate challenges, such as staff trying to persuade users to agree to a particular option rather than offering opportunities to discuss various alternatives. The Swedish National Board of Health and Welfare recommend that SDM should be offered in social services support in relation to certain groups. However, the imperative that ‘SDM should be offered in the social services’ raises questions; in addition to the question of how SDM should be understood, we need to account for why SDM should be offered, who should offer SDM, when it should be offered, to whom and regarding which decisions. The questions concern justification as well as clarifications. The aim of this article is threefold: to discuss SDM and its components; to deliberate upon what SDM may imply to the social services and finally, to suggest some preconditions that should be present for an implementation of SDM.

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• Young adults' experiences of living with paediatric acute-onset neuropsychiatric syndrome: An interview study

  2023. Ulla-Karin Schön. International Journal of Qualitative Studies on Health and Well-being 18 (1)

  Article

  Aim

  This article explores experiential knowledge of living with paediatric acute-onset neuropsychiatric syndrome (PANS), and the factors that are associated with perceived good care.

  Methods

  Ten people with lived experience of PANS participated, five women and five men aged 19-34. Semi-structured interviews were used to explore their experience of living with PANS and their encounters with healthcare. Thematic analysis was carried out to identify central themes in the transcribed interviews.

  Results

  The study revealed a group of young adults living fairly isolated lives, dependent on care from relatives. To them, the illness was a tangible presence. They perceived a lack of knowledge among healthcare staff on PANS in healthcare, and negative consequences linked to this. In addition, their experience-based knowledge of their own illness is devalued in healthcare encounters. A feeling of being pushed around in healthcare, without anyone taking responsibility for the treatment, emerged in the interviews. The participants emphasized the need for increased knowledge among staff to identify PANS and be able to offer effective treatment.

  Conclusion

  There is a need to increase the knowledge about PANS in healthcare and to coordinating care between neurology, immunology and psychiatry. To be able to offer evidence-based care to children with PANS, in-depth knowledge is needed about aetiology, treatment effects, and user experiences and preferences.

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• Coordinated individual care planning and shared decision making: staff perspectives within the comorbidity field of practice: [Personals perspektiv på samordnad individuell planering och delat beslutsfattande inom samsjuklighetsområdet]

  2022. Amanda Jones, Ola Knutsson, Ulla-Karin Schön. European Journal of Social Work 25 (2), 355-367

  Article

  Integrated treatment is recommended for users with a comorbidity of mental illness and substance misuse. However, due to a divided support system, coordinated individual care planning (CIP) and user participation are emphasised to provide users with the necessary support. One way of increasing user participation is through shared decision making. However, the challenges are evident why coordination and user participation are not used in practice as intended. To contribute with knowledge to bridge the gap between the intended CIP process and practice, this study examined the problems and solutions perceived by staff. Future workshops were conducted with 17 staff members from social services and health care. Problems and solutions were identified within three main areas: organisation and staff knowledge, coordination among staff, and staff attitudes and user participation. The problems are in agreement with previous research, but this study contributes with knowledge regarding solutions. Overall, the solutions expressed relate to improving collaboration between providers and users and having more resources to conduct this work. However, the study also assents to the question if CIP is the best way to coordinate support or if integrated treatment should be the future.

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• Legitimizing user knowledge in mental health services: Epistemic (in)justice and barriers to knowledge integration

  2022. Katarina Grim (et al.). Frontiers in Psychiatry 13

  Article

  Including the voices and knowledge of service users is essential for developing recovery-oriented and evidence-based mental health services. Recent studies have however, suggested that challenges remain to the legitimization of user knowledge in practice. To further explore such challenges, a co-production study was conducted by a team of researchers and representatives from user organizations in Sweden. The aim of the study was to explore the barriers and facilitators to the legitimacy of user knowledge, as a central factor in sustainably implementing user influence in mental health practice. A series of workshops, with representatives of mental health services and user organizations were conducted by the research team to explore these issues. The analysis built on the theoretical framework of epistemic injustice, and the underlying aspects, testimonial, hermeneutic and participation-based injustice, were utilized as a framework for a deductive analysis. Results suggest that this is a useful model for exploring the complex dynamics related to the legitimacy of user knowledge in mental health systems. The analysis suggests that the legitimacy of user knowledge is related to the representativeness of the knowledge base, the systematic formulation of this knowledge in applicable methods, access to resources and positions within the mental health system and participation in the process of integrating this knowledge-base in mental health contexts. Legitimizing user knowledge in practice additionally challenges mental health systems to support readiness for change in working environments and to address the power and role issues that these changes involve.

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• Patient Participation and the Environment: A Scoping Review of Instruments

  2022. Maya Kylén (et al.). International Journal of Environmental Research and Public Health 19 (4)

  Article

  Patient participation and the environment are critical factors in achieving qualitative healthcare. We conducted a systematic scoping review using Arksey and O’Malley’s framework to identify instruments intended to measure patient participation. We assessed those instruments’ characteristics, which areas of the healthcare continuum they target, and whether environmental factors are considered. Instruments were considered eligible if they represented the patient perspective and measured patient participation in healthcare. The search was limited to articles written in English and published in the last 10 years. We extracted concepts (i.e., patient empowerment, patient participation, and patient-centeredness) based on the framework developed by Castro et al. and outcomes of significance regarding the review questions and specific objectives. The search was conducted in PsycINFO, CINHAL/EBSCO, and PubMed in September 2019 and July 2020. Of 4802 potential titles, 67 studies reported on a total of 45 instruments that met the inclusion criteria for this review. The concept of patient participation was represented most often in these studies. Although some considered the social environment, no instrument was found to incorporate and address the physical environment. Thirteen instruments were generic and the remaining instruments were intended for specific diagnoses or healthcare contexts. Our work is the first to study instruments from this perspective, and we conclude that there is a lack of instruments that measure aspects of the social and physical environment coherently as part of patient participation.

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• Samskapande processer - om makt, ansvar och epistemisk rättvisa i deltagande forskning

  2022. Kristina Bromark (et al.). Socialvetenskaplig tidskrift 29 (3/4), 325-344

  Article

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• Staff’s experiences of implementing patient-initiated brief admission for adolescents from the perspective of epistemic (in)justice

  2022. Jennie Moberg, Ulla-Karin Schön. Frontiers in Psychiatry 13

  Article

  Background: The implementation of Patient-Initiated Brief Admission (PIBA) in child and adolescent psychiatry (CAP) in Sweden is ongoing. This intervention enables adolescents between the ages of 13–17 and with complex mental health problems to initiate a short care period for relief and support rather than the care apparatus being controlling in this process. Offering it is likely to promote epistemic agency, an exchange of knowledge and recovery from mental health problems.

  Aim: The aim of this study was to explore staff’s perspectives of PIBA for adolescents with complex mental health problems, and what facilitates or hinders its implementation.

  Methods: Twenty seven employees, 21 women and six men, with various professions in CAP were interviewed and the material was analyzed thematically.

  Results: Two overall themes emerged: “Staff’s Experiences of PIBA” and “Managing Clinical PIBA Work.” The results were discussed in relation to the theoretical frameworks of epistemic injustice and Normalization Process Theory (NPT). The main findings indicate that PIBA was generally viewed in a positive way, but that obstacles arose when it was actually put into practice. Findings also point at an overall lack of agency among staff when implementing this new way of working, at the same time as the need to adapt PIBA from an adult psychiatric intervention to one for adolescents in CAP is addressed.

  Conclusion: This article offers insights into the views of psychiatric staff regarding the implementation of PIBA. If staff wish to support epistemic agency and recovery among adolescents, their agency may be an important aspect in the continued implementation. Furthermore, in order for PIBA to become normalized in a sustainable way, we suggest that the continued implementation should be characterized by a youth-friendly framework.

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• The Swedish social services' police reporting and children's access to protection and support in child abuse cases: A quantitative content analysis

  2022. Sara Quarles van Ufford (et al.). International Journal of Child Abuse & Neglect 133

  Article

  Background: The UN Convention on the Rights of the Child prohibits all forms of violence against children. Sweden was early in introducing a ban on disciplinary violence; however, difficulties have been noted in identifying children in need of protection and providing help for children exposed to violence.

  Objectives: The purpose of this study was to explore the social services' police reporting and children's access to protection and support in cases of physical and sexual child abuse.

  Methods: The sample consisted of 291 child welfare reports from three Swedish municipalities. Data were collected from child welfare reports, investigations, and child social records and analyzed using quantitative content analysis.

  Results: A majority of the cases, including cases with a high indication for police reporting, were not reported to the police by the social services. Although the child in 60.1 % of cases provided information about violence, 70.7 % of all child welfare investigations were completed without support measures, and only 8.2 % led to protection or support linked to violence. Children's participation was limited, suggesting inadequate conditions for children's access to protection and support.

  Conclusions: Children's right to protection against violence requires the recognition of children as active participants with access to safe participation. Failure to report suspected crimes against children risks minimizing acts of violence or making violence invisible. Difficulties in handling conflicts of interest between children and parents risk neither protection nor support being provided for the child.

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• The implementation of a culturally tailored parenting support programme for Somali immigrant parents living in Sweden—A process evaluation

  2022. Fatumo Osman (et al.). PLOS ONE 17 (9)

  Article

  Background

  Parental support programmes aim to strengthen family functioning and the parent–child relationship and to promote the mental health of children and parents. However, there is a lack of knowledge on how parenting support programmes can be implemented for newly arrived immigrant parents. This process evaluation describes the implementation of a successful parenting programme for immigrant parents from Somalia and identifies key components of the implementation process with a focus on Reach, Adaptation, and Fidelity of Ladnaan intervention.

  Method

  This process evaluation considered context, implementation and mechanism of impact, in accordance with the Medical Research Council’s guidance. Data were collected through focus group discussions, a questionnaire, attendance lists, field and reflection notes and observations of the sessions. The data were then analysed using content analysis and descriptive statistics.

  Results

  Of the 60 parents invited to the parenting programme, 58 participated in the sessions. The study showed that involving key individuals in the early stage of the parenting programme’s implementation facilitated reaching Somali-born parents. To retain the programme participants, parents were offered free transportation. The programme was implemented and delivered as intended. A majority of the parents were satisfied with the programme and reported increased knowledge about children’s rights and the support they could seek from social services.

  Conclusions

  This study illustrates how a parenting support programme can be implemented for Somali-born parents and provides guidance on how to attract immigrant parents to and engage them in participating in parenting support programmes.

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• How do users with comorbidity perceive participation in social services? A qualitative interview study

  2021. Amanda Jones, Kari Jess, Ulla-Karin Schön. International Journal of Qualitative Studies on Health and Well-being 16 (1)

  Article

  Purpose: This study aims to construct a theoretical framework that explains how users with comorbidity of substance use and mental illness/neuropsychiatric disorders portray user participation in social work encounters.

  Methods: To construct this framework a constructivist grounded theory approach was used with semi-structured qualitative interviews with 12 users.

  Results: The main concern of the participants was the low trust in the social services and perceiving that this lack of trust is mutual. Establishing mutual trust is a social process that cuts through the whole framework. In the framework, prerequisites for participation are explained. The prerequisites are users being motivated and having the willingness to stop using drugs and receiving support, making use of user and staff knowledge and decision-making abilities and accessing help and support.

  Conclusion: Unlike previous frameworks, the model describes participation as a social process and does not explain participation at different levels of power. The results suggest that staff need to be aware of low trust perceptions and work on establishing mutual trust. In addition, the staff need to see each user as an individual and consider how the user would prefer to be involved in decision-making.

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• Impact of a culturally tailored parenting programme on the mental health of Somali parents and children living in Sweden: a longitudinal cohort study

  2021. Fatumo Osman (et al.). BMJ Open 11 (8)

  Article

  Objectives This study aimed to evaluate the long-term impact (3-year follow-up) of a culturally tailored parenting support programme (Ladnaan) on the mental health of Somali-born parents and their children living in Sweden.

  Methods In this longitudinal cohort study, Somali-born parents with children aged 11-16 were followed up 3 years after they had participated in the Ladnaan intervention. The Ladnaan intervention comprises two main components: societal information and the Connect parenting programme delivered using a culturally sensitive approach. It consists of 12 weekly group-based sessions each lasting 1-2 hours. The primary outcome was improved mental health in children, as measured by the Child Behaviour Checklist (CBCL). The secondary outcome was improved mental health in parents, as measured by the General Health Questionnaire-12. Data were collected from the parent's perspective.

  Results Of the 60 parents who were originally offered the intervention, 51 were included in this long-term follow-up. The one-way repeated measures (baseline to the 3-year follow-up) analysis of variance for the CBCL confirmed maintenance of all the treatment gains for children: total problem scores (95% CI 11.49 to 18.00, d=1.57), and externalising problems (95% CI 2.48 to 5.83, d=0.86). Similar results were observed for the parents' mental health (95% CI 0.40 to 3.11, d=0.46).

  Conclusion Positive changes in the mental health of Somali-born parents and their children were maintained 3 years after they had participated in a parenting support programme that was culturally tailored and specifically designed to address their needs. Our findings highlight the long-term potential benefits of these programmes in tackling mental health issues in immigrant families.

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• Co-creating a process of user involvement and shared decision-making in coordinated care planning with users and caregivers in social services

  2020. Ola Knutsson, Ulla-Karin Schön. International Journal of Qualitative Studies on Health and Well-being 15 (1)

  Article

  Purpose: Although user participation and shared decision-making in formal statutory coordinated care planning are described as central, they remain to be implemented. The aim of this study is to explore how collaboration and shared decision-making in the social services can be realized in formal care planning activities with people with mental disabilities.

  Methods: We conducted eight workshops with 12 users and 17 caregivers to investigate existing barriers to and possible solutions for participation in coordinated care planning.

  Results: Workshop formats and techniques from participatory design generated rich research materials illustrating challenges currently experienced by users and caregivers in care planning work, as well as a large variety of solutions to these challenges. They also illustrated differences in how participation is understood and the conditions required to realize shared decision-making between users and caregivers.

  Conclusions: An improved coordinated individual plan (CIP) process emerged, based on the active participation of users and caregivers. This process is a familiar and transparent process for users and caregivers, reflecting the needs and preferences of users at all stages. It requires careful preparation and collaboration with the users, as well as caregiver flexibility.

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• Qualitative study showed that a culturally tailored parenting programme improved the confidence and skills of Somali immigrants

  2019. Fatumo Osman (et al.). Acta Paediatrica 108 (8), 1482-1490

  Article

  Aim: Parenting programmes tailored to immigrant parents have been reported to improve the mental health of the children and parents, as well as parents' sense of competence in parenting. However, research on parents' experiences of programmes tailored to their needs is scarce. This qualitative study aimed to describe Somali parents' experiences of how a culturally sensitive programme affected their parenting.

  Methods: The study was conducted in a middle-sized city in Sweden in 2015. Data were collected through semi-structured interviews with 50 participants two months after they took part in a parenting support programme. Inductive and deductive qualitative content analyses were used.

  Results: A light has been shed was a metaphor that emerged from the analysis and that captured the knowledge the parents gained from the parenting system in Sweden. Parents gained confidence in their parenting role and became emotionally aware of their child's social and emotional needs and how to respond to them. Holding the sessions in the participant's native language was important for the parents' participation and acceptance of the programme.

  Conclusion: Parenting programmes should be tailored to the specific needs of the participants and cultural sensitivity should be factored into programmes to attract immigrant parents.

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• How men and women in recovery make meaning to severe mental illness

  2009. Ulla-Karin Schön. Journal of Mental Health 18 (5), 433-440

  Article

  Background: Creating a new meaning of the illness, changing values and expectations due to the illness are seen as important factors in recovery from mental illness.

  Aims: In this study, conducted in Sweden, male and female meaning making of severe mental illness is explored and how these meanings compass the recovery process.

  Method: Through 30 in-depth interviews male and female meaning of mental illness are explored through a grounded theory analysis. Results: In the process of making meaning illness reason emerged as the core category. But the reasons differed both in relation to gender and within the two genders. Four patterns of response were found in the analysis of the material. These four patterns influenced how the recovery process was encompassed. Three of the four groups were restructing the meaning of the illness in a more favorable way contributing to a redirection of life towards authenticity.

  Conclusions: The results underline a demand for further research on recovery achievements connected to meaning making and changes in attitude. One such area is to create a meaning in one’s life where gender is reconsidered in relation to the individual’s capacity and life situation.

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