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Katarina PiuvaUniversitetslektor

Forskning

Socialt arbete inom det psykiatriska fältet, vilket omfattar sociala villkor för målgruppen, anhörigas ställning samt socialpolitiska perspektiv på den professionella utvecklingen.

Ett annat område är utvärdering av sociala insatser och kunskapsbaserat socialt arbete som bla a berör vetenskapsteoretiska aspekter på arbetsmetoder samt evidensparadigmet och dess intlytande över utvecklingen av socialt arbete

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Även gärna textanalyser, narrativ analys, historiska perspektiv, litteraturöversikter, kvantitativa och kombinerade kvant/kval-studier i utvärderingssyfte.

Publikationer

I urval från Stockholms universitets publikationsdatabas

  • In the centre or caught in the middle? – Social workers’ and healthcare professionals’ views on user involvement in Coordinated Individual Plans in Sweden

    2021. David Matscheck, Katarina Piuva. Health & Social Care in the Community

    Artikel

    Fragmentation of social service and heath care 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 health care agencies are required to draw up CIPs when they are judged to be needed, with the purpose of improveing the care process. An additional purpose is to increase users' involvement in their own care. Semi-structured interviews were conduced in 2019 with 20 professionals working within social service and health care 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 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, caugh between caregivers who often safeguard their own organisational duties and economical restrictions. These findings reflect the conflict predicted by Lipsky's theory of street-level cureaucracy. 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.

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  • Integrated care for individuals with mental illness and substance abuse – the example of the coordinated individual plan in Sweden

    2020. David Matscheck, Katarina Piuva. European Journal of Social Work

    Artikel

    Specialisation in care and welfare services often leads to inflexible boundaries between organisations and professions, resulting in fragmented and ineffective care, not least in the areas of severe mental illness and substance abuse. Collaborative models such as case management, multidisciplinary teams and coordinated care plans are used in many countries to address this problem. In a parallel development, demands have been made that individual users/patients should have more influence over their own care. In Sweden, legislation requires the social service and health care to draw up Coordinated Individual Plans (CIP) to clarify responsibility, improve the care process and increase users’ involvement in their own care. This article explores the impact of coordinated care plans, using the Swedish CIP as an example. What can we learn about conditions for integrated care according to the degree of collaboration, involvement for the individual user and supporting structures? The authors have studied 25 case files in a local authority. Findings indicate a low to moderate degree of collaboration and few indications of meaningful user involvement. Further studies are needed concerning factors hindering CIP from achieving a higher degree of collaboration and fully including the intentions and wishes of the individual.

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

    2020. Katarina Piuva, Helene Brodin. Community mental health journal

    Artikel

    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.

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

  • Trusted and doubted

    2018. Hetty Rooth (et al.). Scandinavian Journal of Public Health 46 (Suppl. 20), 59-65

    Artikel

    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.

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  • Competent parents with natural children

    2018. Hetty Rooth (et al.). Childhood 25 (3), 369-384

    Artikel

    This article analyses identity constructions in two manual-based universal parenting training programmes in Sweden, Connect (U) and All Children in Focus (ABC). The analysis was performed with discourse analysis of oral messages during parent training courses. The findings revealed that the parents' subject positions altered between troubled and good while the children's subject positions altered between ambiguous and natural in a confessional discourse of uncertainty and competence. Conclusively, pastoral power operated to support parental self-reflexivity and adult control in a process to improve parenting skills.

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  • An Assessment of Two Parenting Training Manuals Used in Swedish Parenting Interventions

    2017. Hetty Rooth (et al.). Children & society 31 (6), 510-522

    Artikel

    In Sweden, all parents of children aged 0-18years are entitled to attend free parenting courses as part of a national strategy presented by the Government in 2009. This broad parental support welfare strategy is expected to fulfil the intentions of the UN Convention on the Rights of the Child. In this study, two parenting training manuals were analysed: the Canadian Connect program, based on attachment theory, and the Swedish ABC program, based on social learning theory. The results indicate that the manuals use strategies that can both hinder and support children's rights, regardless of rhetoric of children's best interests.

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

    2016. Catharina Widmark (et al.). Journal of Interprofessional Care 30 (5), 643-648

    Artikel

    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.

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

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

    2016. Catharina Widmark (et al.). Journal of Interprofessional Care 30 (1), 50-55

    Artikel

    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.

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

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

    2013. Catharina Widmark (et al.). International Journal of Integrated Care 13

    Artikel

    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.

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

  • Revisiting mental hygene

    2013. Katarina Piuva. History of Psychiatry 24 (1), 34-45

    Artikel

    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.

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  • Tema

    2012. Katarina Piuva (et al.). Genusperspektiv i socilat arbete, 235-237

    Kapitel
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  • Barriers to Collaboration Between Health Care, Social Services and Schools

    2011. Catharina Widmark (et al.). International Journal of Integrated Care 11

    Artikel

    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.

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  • The Meaning of Normality

    2010. Katarina Piuva. Scandinavian Journal of History 35 (2), 198-216

    Artikel

    At the height of the Swedish welfare society, a campaign with the aim of promoting mental health issues within the Swedish labour market was launched. The title and purpose of the campaign, 'Mental health - an action of increased understanding and solidarity at work', was to illuminate mental health issues at work. Surprisingly to the organizers, the mental health campaign stirred up major opposition, especially from the political left. The idea of mental hygiene in an industrial and workplace setting, a cross-breed between the values of the Human Relations School and psychiatric science, was received with deep mistrust. The campaign caused an agitated debate in the media about power relations between employers and employees. The political disagreements were exposed in a number of articles in the daily newspapers and in the evening papers during the summer of that year. This article undertakes an investigation of the campaign literature and the media debate. The interpretation of the debate highlights different opinions about the meaning of normal mental health. Four different views of normality and mental health which demonstrate the complexity of the issue are presented. Mental health could mean adjustment and harmony, it could be a medical weapon to suppress the working class, it could even mean a neutral state of absence of mental problems, or lastly it could be a claim for the right to live a normal life.

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  • Att inte släppa taget. En utvärdering av SAM-teamet - ett Case management projekt i Järfälla och Upplands-Bro 2006-2008

    2009. Katarina Piuva, Martin Åberg.

    Rapport

     

     

     

     

     

     

     

     

     

     

     

    S

     

    AMMANFATTNING

    En utvärdering av SAM-teamet. Ett Case management-projekt i Järfälla och Upplands-

    Bro kommuner

    Bakgrund

    Projektet finansieras främst med medel från regeringens satsning på ”psykiatri och socialt stöd och omsorg för personer med psykisk sjukdom och/eller psykiskt funktionshinder”. För att kunna ansöka om projektmedel förutsattes det att kommuner och landsting sökte gemensamt samt hade en gemensam plan för projektet (Regeringsuppdrag: S2005/441/HS). Järfälla och Upplands-Bro kommuner, Psykiatri Nordväst samt Beroendecentrum Stockholm sökte, med bakgrund av detta, medel för att bygga upp en verksamhet för personer med komplexa vårdbehov. Våren 2007 gavs FoU-Nordväst i uppdrag att utvärdera projektet. Inom ramen för projektet har en integrerad verksamhet, enligt ACT-modellen (Assertive Community Treatment), byggts upp för att förbättra vården och omsorgen om personer med komplexa vårdbehov. Järfälla och Upplands-Bro kommuner har tillsammans med landstingets beroendevård och den psykiatriska vården utvecklat ett integrativt arbetssätt för de individer som har behov av samtidiga insatser från flera huvudmän. Satsningen inbegriper utbildning och anställning av Case managers som ska samordna insatserna och utveckla ett nätverksorienterat arbetssätt. Ett team upprättades med representanter från de olika huvudmännen. Teamet ska inneha samlad medicinsk, social och psykiatrisk kompetens för att på bästa sätt möta behovet hos de hjälpsökande.

    Utvärderingens syfte

    Utvärderingens syfte och frågeställningar har formulerats utifrån verksamhetens intentioner och syfte. tvärderingen består dels av en uppföljning av de personer som omfattats av projektets insatser samt dels en beskrivande del avseende organisation, samverkan och arbetsmetod.

     

    Utvärderingens metodologiska ansats

    Undersökningsmetoderna som tillämpas i denna utvärdering har både en kvalitativ och kvantitativ ansats. För bedömningen av klienternas/patienternas hälsa, missbruk och livskvalitet användes instrumenten GAF-F, CAN, KASAM, Audit och Dudit. En brukarenkät användes vid datainsamlingen med syftet att undersöka hur klienterna/patienterna värderade insatserna. En fokusgruppintervju med de anställda Case managerna genomfördes för att få en bild av bland annat arbetsmetod och yrkesroll. Intervjuer med styrgruppsrepresentanter gav information om projektets tillkomst, organisation och samverkansmöjligheter. Statistik angående omfattningen av klienternas institutionsvistelser och slutenvårdsdygn inhämtades för att få en jämförande bild av huruvida Case manager-insatsen påverkat projektdeltagarnas vårdkonsumtion.

    Resultatet av utvärderingen

    Som benämningen antyder har det inte varit problemfritt att arbeta med målgruppen personer med komplexa vårdbehov. Den kontaktskapande fasen kan vara lång, men ACT-modellens förespråkande av enträget arbete är något Case managerna har tagit fasta på. Av de 43 individer som deltagit i projektet har endast ett fåtal lämnat verksamheten för att de inte ville ha det erbjudna stödet. Att arbeta uppsökande betonas som en viktig del av arbetet för att upprätthålla den kontinuerliga kontakten. Vidare framgår det av fokusgruppintervjun att en god relation mellan Case manager och klient är avgörande för att positiva förändringar ska kunna äga rum. Utifrån de skattningar som gjorts, med CAN, GAF-F, Audit, Dudit och KASAM, är det svårt att dra några definitiva slutsatser eftersom bortfallet är stort. Medelvärdena indikerar dock förbättringar för de klienter som skattats vid två tillfällen. De största behovsområdena, hos dem som genomfört en CAN-skattning, är

    allvarliga psykiska symtom och emotionella besvär. Inom dessa områden återfinns också de flesta pågående insatserna. Resultatet av brukarenkäten visar att brukarna är nöjda med insatsen i stort. Mest stöd upplever de att de får med sin psykiska hälsa vilket bekräftas av de CAN-skattningar som gjorts. Efter drygt ett års arbete verkar fokus hittills legat på förbättrad psykisk hälsa och mindre missbruk. Sammantaget ges höga omdömen till Case manager-stödet. Det sammanlagda antalet slutenvårdsdygn inom psykiatrin har nästan halverats under den studerade tidsperioden. Trots det har ett flertal individer fått mer psykiatrisk vård efter deltagande i projektet. För kommunernas del har antalet vårddygn ökat. Beroendevården har en viss minskning av antalet vårddygn för projektets deltagare. Vid en uppföljning av de 14 första personerna med Case manager blir tendensen tydligare att vårddygnen inom psykiatrisk vård minskar medan vårddygnen inom HVB- institutioner ökar.

     

     

     

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  • Att förebygga hemlöshet

    2008. Anders Arnsvik, Katarina Piuva.

    Rapport

    Sammanfattning

    Socialstyrelsen har under åren 2005-2006 på regeringens uppdrag fortsatt att stimulera

    kommunernas utvecklingsarbete för att motverka hemlöshet. Utvecklingsarbetet skulle ske i

    nära samarbete med kommuner, frivilligorganisationer, hälso- och sjukvården och

    bostadsföretag. För uppdragets genomförande disponerar Socialstyrelsen cirka 10 000000 ( tio

    milj.) kronor år 2005. Uppdraget skall slutredovisas senast den 1 juli 2008. Individ och

    Familjeomsorgen (IFO) i Upplands Väsby beviljades hösten 2005 utvecklingsmedel inom

    ramen för ovanstående uppdrag. Föreliggande rapport beskriver två modeller i arbete med att

    motverka hemlöshet. De har bägge det gemensamma syftet förebygga hemlöshet. De

    verksamheter som kommer att beskrivas är Boenderådgivningen, en samverkansmodell

    mellan socialtjänsten och Väsbyhem, samt ungdomsboendet Min Framtid. Verksamheterna

    startades under första kvartalet 2006 och FoU-Nordväst har haft uppdraget att följa upp och

    utvärdera verksamheterna.

    Boenderådgivningen är en form för samverkan mellan socialtjänsten i Upplands Väsby

    kommun och det allmännyttiga bostadsföretaget Väsbyhem. Bakgrunden till inrättandet av

    Boenderådgivningen var att man inom IFO ville utveckla det vräkningsförebyggande arbetet.

    Inom Väsbyhem fanns intresse för att hitta ”nya” former för samarbetet.. För ändamålet

    anställdes inom IFO en Boenderådgivare vars huvudsakliga uppdrag var att utveckla metoder

    i samverkan med Väsbyhem. Boenderådgivningens funktion var att fungera som länk till

    socialtjänsten och i synnerhet gentemot Väsbyhem. Syftet var bland annat att nå hyresgäster

    som riskerade vräkning på grund av försenad hyresinbetalning alternativt hyresskuld. Mycket

    arbete nedlades i samverkan med Väsbyhem för att nå berörda hyresgäster. En väsentlig

    erfarenhet är att samverkan har betydelse. Både IFO och Väsbyhem har varit positiva till den

    samverkansmodell som utvecklats. Även de hyresgäster som intervjuats har varit positiva.

    Sammantaget har man genom denna form av samverkan nått en stor grupp hyresgäster som

    inte hade tidigare aktualitet inom socialtjänsten. En iakttagelse är att antalet vräkningar på

    grund av enbart hyresskuld minskade under 2006.

    Min Framtid syftar till att stödja och vägleda unga kvinnor till att själva forma sin framtid.

    Hemmaplanslösningen som fick namnet Min Framtid består av ett kollektivboende i lägenhet

    i centrala Upplands Väsby( med plats för tre kvinnor) och dels stöd. . IFO hade också

    uppmärksammat att unga kvinnor, 18 – 25 år, med psykosociala problem var en riskgrupp för

    framtida hemlöshet. I stället för att erbjuda kvinnorna en extern lösning – oftast någon form

    av placering - skulle de erbjudas en hemmaplanslösning. I så stor utsträckning som möjligt får

    kvinnorna själva ta ansvar för boendet. Väsentligt är att kvinnorna måste ha någon form av

    sysselsättning dagtid vilket kan vara arbetsträning, arbete eller studier. Kollektivboendet utgör

    första länken i en boendekedja där nästa steg är försökslägenhet. Totalt under perioden mars

    2006 – september 2007 har 10 kvinnor varit aktuella för Min Framtid. Tre bor idag i

    försökslägenhet. Utmärkande för Min Framtids arbetssätt är att man utgått från kvinnans

    situation vid aktualiseringstillfället och att man i fokuserar på helheten. Initialt lades mycket

    tid och engagemang ned för att skapa bärande relationer, en arbetsallians, vilket sågs som en

    nödvändig förutsättning för att kunna arbeta med klienten. Stor vikt lades vid att kvinnorna

    själva skulle förmås ta ansvar för sin framtid. Centralt har varit att göra dem delaktiga i detta

    arbete och personalen antog olika roller som exempelvis att vara vägledare och ”bollplank”.

    Andra karaktäristika för Min Framtids personalgrupp är bred kunskap om olika

    förhållningssätt, flexibilitet, tillgänglighet, småskalighet och inte minst humor.

    Läs mer om Att förebygga hemlöshet

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