Research project Social work with comorbidity: a case study of clients with complex needs, competing treatment goals
Research problem and specific questions
A key-question, nationally and internationally, is whether treatment for people with substance use problems should primarily aim at abstinence or at alleviating harm related to continuous use. The question is particularly urgent regarding people with comorbidity, i.e., multiple parallel problems such as addiction or mental illness, who have particular difficulties with achieving the requirement of abstinence common in Sweden. Despite consensus on the need for effective and easily available interventions, there is a lack of knowledge about social services’ work with comorbidity. These marginalized individuals lack long-term solutions as the services typically address one problem at a time and require total abstinence. The allocation of responsibility between professions is presently unclear, and recent governmental investigations have proposed substantial organizational reforms and an extended use of harm reduction interventions. We carry out a case study of social work with comorbidity that does not demand abstention from substances. It includes an in-depth ethnographic study of a social service unit that have adopted harm-reduction principles as well as a mapping of the broader treatment system that the unit and its clients interact with when striving for sustainable solutions to acute problems. The project is forward-looking and sets out to make visible the potential consequences that organizational and treatment ideological changes have for clients and staff. Important questions are: what characterizes adequate and sustainable social work with comorbidity according to clients and social work staff, and how can professional boundaries and treatment philosophies be coordinated to develop the effectiveness of the treatment system? Answers to these questions provide important knowledge about a field in transition.
Data and methods
The research is carried out at a social service unit in Stockholm that has developed a harm reduction-oriented work model. Using ethnographic methods and qualitative interviews we explore how social work with comorbidity can be carried out in practice. Data is collected through so called “go-alongs” with clients and staff when they navigate the treatment system and by interviewing actors with vested interests (ca 75 interviews with clients, staff, and external stakeholder) about how the help for people with comorbidity should be designed in times of organizational reform.
Societal relevance and utilization
To improve practice with comorbidity we need knowledge on clients’ needs and trajectories through the treatment system, the form and content of the interventions, and collaboration between different actors (social services, healthcare, compulsory treatment, civil society etc.). The support to people with comorbidity in Stockholm constitutes an important case to map and track over time. It highlights and reinforces challenges facing smaller municipalities in helping people with severe, complex, and dynamic needs. The project covers central issues, including user influence, coordinated interventions, clients with complex needs, availability, low threshold services, evidence and proven experiences, as well as treatment ambitions in harm-reduction oriented social work. Through continuous coproduction it contributes to practical and theoretical developments in this field in terms of professional boundaries, evidence-making interventions, and appropriate care in a complex reality.
Plan for project realization
The project has been planned in close collaboration between the researchers and the social services with the aim of yielding relevant and useful knowledge. The project is carried out through empirical investigations and through workshops with representatives from social work practice and user groups, where the research design is developed and findings are disseminated.