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Tommy LundströmProfessor i socialt arbete

Om mig

Jag forskar och undervisar om bland annat social barnavård, evidensbaserat socialt arbete, institutionsvård för barn och unga, ADHD och socialt arbete samt det sociala arbetets organisering. Jag har även skrivit om det sociala arbetets historia, senast i antologin "Tvångsvård av barn och unga". 

Forskningsprojekt

Barnets färd genom den sociala barnavården

I en sexårig studie ska 2 000 barn och ungdomar i nordvästra Stockholm följas genom barnavårdssystemet. Studien bedrivs av en tvärvetenskaplig forskargrupp med sin bas i socialt arbete, kriminologi, sociologi och juridik, och i samarbete med FoU-Nordväst.

Familjehem som samhällsåtgärd

Studien syftar till att utifrån offentlig statistik och en nationell kommunenkät kartlägga det utbud, dvs subkategorier av hem som betecknas som familjehemsvård, samt vilka faktorer som styr hur utbudet formeras.

Publikationer

I urval från Stockholms universitets publikationsdatabas

  • Social workers in private sector employment: The case of Sweden

    2023. Emelie Shanks, Tommy Lundström. Nordic Journal of Social Research 14 (1)

    Artikel

    This article explores the expansion of the private sector labour market for social workers in Sweden and analyses social workers’ motives for choosing work as temporary agency social workers. The study draws on quantitative data from official registers and qualitative interviews with social workers who have left the social services for careers as temporary agency social workers.

    The findings indicate that the vast majority of Swedish social workers continue to work in the public sector, but due to significant changes in welfare production, more social workers are finding employment in the private sector labour market. Both pull factors associated with the conditions of private sector employment and push factors linked to working conditions in the social services appear to be at play when Swedish social workers choose private alternatives.

    Previous studies have revealed adverse working conditions, high turnover rates and recruitment problems in the social services. The results of this article explore the most significant push factors for opting out of social services in Sweden. Several of these factors are associated with the organisational climate and management, suggesting that they could be addressed by ensuring adequate social support and supervision. Other push factors relate to stress and overload, which are known issues in social services. All of these factors require further attention if the social services are to be competitive in the broadened labour market of social work.

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  • Nya villkor för ett gammalt problem: familjehemsrekrytering i en tid av privatisering och professionalisering

    2022. Pålsson Pålsson, Tommy Lundström, Marie Sallnäs. Socialvetenskaplig tidskrift 29 (2), 173-190

    Artikel

    Foster care is the most common intervention for children who are placed in out-of-home care. At the same time, there are recurrent discussions about difficulties in recruiting foster homes. The preconditions for recruitment have changed and today, there is an increased competition for foster homes between municipalities and private businesses, stricter requirements placed on foster parents and changes in the needs of children placed in care. The aim of the article is to analyse the recruitment of foster homes in light of these changed preconditions. Empirically, the article is based on a survey targeting Swedish municipalities. The findings show, that although a majority of the municipalities have employees particularly responsible for recruitment, small municipalities often lack such resources. Further on, almost three quarters of the municipalities state that it is difficult or very difficult to recruit foster homes. For example, answers to the survey’s open questions demonstrate that competition from other municipalities and private companies affects recruitment. Further on, the municipality’s reputation is considered an important factor for attracting new foster homes. Finally, it appears to be difficult for municipalities to recruit a varied supply of foster homes and, in particular, homes that can care for children with special needs. The findings are discussed in relation to previous international and Swedish research. Finally, suggestions regarding how recruitment may be improved are presented. 

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  • Privatisation of residential care for children and youth in Denmark, Finland, Norway, and Sweden

    2021. Emelie Shanks (et al.). Nordisk välfärdsforskning | Nordic Welfare Research 6 (3), 128-141

    Artikel

    Few studies have investigated the privatisation of residential care for children and youth, and no studies have compared, mapped, and discussed the care markets that have developed in the Nordic countries. Here, we map and discuss the role of providers of residential care for children and youth in Denmark, Finland, Norway, and Sweden. In addition, we explore the driving forces behind the current situation in these countries. Although these countries have significant level of privatisation, they have several differences in terms of the participation of the public sector and how market shares are divided between, for example, for-profit companies and non-profit organisations. These differences are discussed as a result of the historical positions, for example, of non-profit organisations as well as differences in the way the countries adapted New Public Management and procurement regulations.

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  • ADHD and social work with children and adolescents

    2021. Patrik Karlsson, Tommy Lundström. European Journal of Social Work 24 (1), 151-161

    Artikel

    This article aims to alert social work researchers and practitioners to the importance of engaging in research and debate about how to approach and understand ADHD among children in general and locked-after children in care in particular. Social work researchers have largely been absent from academic discussions about the ‘ADHD epidemic’ despite the fact that the prevalence of ADHD diagnosis and medication is very high in child welfare populations. The social work profession can make important contributions to understanding a phenomenon that is common among children and adolescent clients, that is often co-morbid with other conditions such as conduct disorder and that is linked to social adversity. We argue that research on ADHD in the child welfare systems should be a top priority in social work, and outline some important questions that need to be addressed by both researchers and social workers.

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  • Socialtjänstens respons på "flyktingkrisen"

    2021. Åsa Backlund, Katarina Thorén, Tommy Lundström. Socialvetenskaplig tidskrift 28 (1), 75-94

    Artikel

    Syftet med artikeln är att analysera organisering av och synen på mottagandet av ensamkommande barn inom socialtjänsten våren 2016 – en tidpunkt då antalet asylsökande ensamkommande barn nyligen nått en extrem omfattning under kort tid. Artikeln baseras på en totalundersökning (enkät) av socialtjänstens resurser, organisering och insatser i arbetet med ensamkommande barn och ungdomar. Resultatet visar att trots en statlig ambition om normalisering och integrering av mottagandet i den sociala barnavården, har en tydlig respons från socialtjänsten varit att specialisera verksamheten utifrån den ökande klientgruppen. Den här studien ger inget belägg för att specialiseringen lett till bättre kvalitet, tvärtom indikeras ett positivt samband mellan kvalitet och en integrerad organisation. Främst tyder studien på att resurser, övergripande samverkan och engagerade politiker har varit viktigt för hur man inom socialtjänsten uppfattar möjligheten att anpassa stödinsatser efter behov och att följa upp insatser. Noterbart med tanke på tidpunkten för studien är att  en majoritet av respondenterna (företrädesvis chefer inom socialtjänstens verksamhet för ensamkommande barn) var förhållandevis nöjda med det stöd som erbjöds till ensamkommande barn/ungdomar, dock påtalades brister i möjlighet att följa upp och tillgång till insatser som matchar målgruppens behov.

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  • A Crisis in Swedish Child Welfare? On Risk, Control and Trust

    2021. Tommy Lundström (et al.). Social Work & Society 19 (1)

    Artikel

    In recent decades, Swedish out-of-home care has been criticised for a number of reasons. In this article, based on research and public debate, we discuss this criticism as well as the institutional responses that have been evoked. We use the concepts of risk, control and trust to structure the analysis, which outlines three core issues portrayed as problematic: a) certain principles of the Swedish child welfare system with relevance for the placement of children and adolescence, b) the quality of out-of-home care and c) the privatisation of out-of-home care and the possibility of generating profits on such services. The institutional response to the criticism has mainly been increased control measures, but the development is not uniform - trust and control-oriented responses are often combined. We conclude the article by relating Swedish out-of-home care to international child welfare trends, discussing the institutional responses and the implications for social work practice.

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  • Hur bristfällig är samhällsvården egentligen? Några mätproblem i observationsstudier av placerade barn

    2020. Patrik Karlsson, Tommy Lundström, Stefan Wiklund. Socialvetenskaplig tidskrift 27 (2), 137-155

    Artikel

    How deficient is out-of-home care? Some measurement problems in observationalstudies of children in care

    For decades, out-of-home care for children has been criticized based on discouraging results fromempirical studies. Registry studies consistently show that children in out-of-home care fare worse than their counterparts from the normal population, and these studies have played an important role in highlighting the adverse situation of this group. This article thoroughly discusses the question of whether the negative outcomes among children in care can be attributed to the placement as such. Research on out-of-home care is based on observational studies and it is widely known that it is difficult to make causal inferences from such a design. This particularly holds true regarding out-of-home care where the placed children constitute a highly selected group. In the absence of randomized controlled trials, we can basically never know whether the poorer outcomes among placed children are due to the placement or to other factors that we lack data on. A central argument is that not even the most advanced statistical techniques can solve the challenge of identifying the causal effect of the placement in observational studies. However, some of the challenges may be overcome through design, where a stronger methodological approach is to include comparison groups that are more similar to the children being placed in out-of-homecare. A few methodologically stronger studies adopting such an approach give appreciably fewer indications that the placement has a negative impact on children.

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  • Impression management in the market for residential care for children and youth in Sweden. 

    2020. Emelie Shanks (et al.). Social Policy & Administration

    Artikel

    In what has become quite a turbulent quasi‐market for residential care for children and youth, providers now compete for public contracts. To create visibility and attract customers, many providers use marketing activities to project the desired impression of themselves to maintain or strengthen their market position. In this article, we analyse how companies that provide residential care for children manage the impressions they project on their websites and in advertisements. The results reveal that residential care providers use a range of impression management strategies to enhance their organizational image and to respond to potentially damaging or threatening images. The information providers choose to disclose leaves customers—in this case, the social workers responsible for choosing and purchasing care on behalf of clients—with rather limited opportunities to evaluate the quality of care. This is a significant problem considering other, more reliable, sources of information are difficult to access.

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  • HVB för barn och unga - en evig vinstmaskin?

    2019. Tommy Lundström, Marie Sallnäs. Socialpolitik (2), 22-23

    Artikel

    Hvb, hem för vård eller boende, är kanske det fält inom välfärdsområdet där privatiseringarna gått som längst. Avkastningen är mycket hög, 20 procent. En siffra som sticker ut.

    Under rubriken ”Ungdomshem en guldgruva”, kunde Dagens Industri för fem år sedan konstatera: ”Boende för barn och ungdomar är en lönsam nisch för vårdbolag. Miljonvinsterna fortsätter att rulla in även om ett stundande vinstförbud hänger som ett mörkt moln över branschen”. Idag kan vi konstatera att något mörkt moln inte längre hänger som ett hot, vinstbegränsningar har i det stora hela försvunnit från den politiska dagordningen. Men hur är det då med själva vinsterna? Den frågan och hur det gått till när hvb-vård blivit ett fält för privata företag diskuteras i den här artikeln.

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  • ADHD and social work with children and adolescents

    2019. Patrik Karlsson, Tommy Lundström. European Journal of Social Work

    Artikel

    This article aims to alert social work researchers and practitioners to theimportance of engaging in research and debate about how to approachand understand ADHD among children in general and locked-afterchildren in care in particular. Social work researchers have largely beenabsent from academic discussions about the ‘ADHD epidemic’ despite thefact that the prevalence of ADHD diagnosis and medication is very highin child welfare populations. The social work profession can makeimportant contributions to understanding a phenomenon that is commonamong children and adolescent clients, that is often co-morbid with otherconditions such as conduct disorder and that is linked to social adversity.We argue that research on ADHD in the child welfare systems should bea top priority in social work, and outline some important questions thatneed to be addressed by both researchers and social workers.

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  • Stability and change in the field of residential care for children.

    2018. Tommy Lundström, Marie Sallnäs, Emelie Shanks. Nordic Social Work Research

    Artikel

    The field of residential care for children and youth in Sweden is often termed unstable and turbulent. During recent decades the field has been subject to many changes. In this study, the development and changes in the field of residential care for children and youth in terms of ownership structure and treatment ideas will be analysed. The study is particularly focused on the changes in ownership structure that have taken place during the 2010s. It also analyses changes in treatment ideas, and discusses how these may relate to transformations of ownership structures as well as to dimensions of institutional logics, such as legislation and other types of normative pressure from the environment. The result reveals that of the approximately 450 treatment oriented residential care units (excluding homes for refugee children), close to 80 % are today run by private companies and to a growing extent by large for-profit corporations. Parallel – and possibly related – to the changes in ownership structure, the dominant treatment ideas have changed over time. The changes in the field can be summarised as a transformation from small-scale establishments with a family logic, to large-scale establishments with a professional logic, or more specifically from a domination of small family run units with milieu therapy to big business and a focus on evidence based interventions.

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  • Effects of psychosocial interventions on behavioural problems in youth

    2017. Patrik Karlsson, Anders Bergmark, Tommy Lundström. International Journal of Social Welfare 26 (2), 177-187

    Artikel

    Research indicates that a number of psychosocial interventions are effective for reducing behavioural problems in youth. These interventions are now often included on best practice lists aiming to facilitate informed treatment choices among practitioners. However, analyses in neighbouring research areas have highlighted serious shortcomings in how primary studies are analysed and how studies are synthesised in research reviews. This study took a closer look at the evidence of efficacy for psychosocial interventions that aim to reduce behavioural problems in youth, as shown in systematic research reviews by the Cochrane and the Campbell Collaborations (n = 8). The findings suggest a bias towards overemphasising the efficacy of the interventions in several reviews, an over-confidence in the validity of the findings in some reviews and, overall, a somewhat uncertain evidence base for the efficacy of the interventions. Systematic reviews are crucial for summarising research but more attention to methodological issues may be needed in this area.

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  • Big Business in a Thin Market

    2016. Gabrielle Meagher (et al.). Social Policy & Administration 50 (7), 805-823

    Artikel

    This article analyzes the transformation of Swedish residential care homes for children from a regionally coordinated, public social service system into a thin, but highly profitable, national spot market in which large corporations have a growing presence. Marketization and privatization are theorized as complex processes, through which the institutional structure and logics of this small, but significant, social policy field changed profoundly. Using official documents, register data, media reports and existing research, three consecutive phases in the development of the children’s home market are identified since the early 1980s. Change was driven on one hand by policies inspired by New Public Management, which shifted public authority horizontally to the private sector, and vertically to local authorities (funding) and to the state (regulation). On the other hand were responses of local authorities and private actors to the changing incentives that policy shifts entailed. During the first two phases, both the proportion and size of for-profit providers increased, and the model of family-like care was replaced by a professional model. Cutting across the trend of privatization in the third phase was establishment of a parallel system of homes for unaccompanied refugee children – mostly in public ownership. Similarities with privatization in the English system of children’s care homes are noted. By showing how the Swedish market for residential care has been created by policy and by actors’ responses to those reforms, the article provides a foundation for thinking through how the predictable, significant and well-documented problems of such care markets might be addressed.

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  • High job strain among social work managers and its relation to perceived work situation

    2016. Stig Elofsson, Tommy Lundström, Emelie Shanks. European Journal of Social Work 19 (5), 664-678

    Artikel

    The purpose of this study was to examine how middle managers within the personal social services in Sweden perceived demands, control and support at work. The study group included 402 frontline, second tier and third tier managers who have answered questions concerning their work situation and perceptions of their psychosocial work environment. Based on Karasek's demand–control model, a ‘high strain’ group was defined and analysed further. The results showed that this group experienced less support from immediate superiors, but no correlation could be found between high strain and other forms of support, such as courses on leadership, managerial supervision or networks. Organisational factors, such as municipality size, managerial level, number of subordinates and field of social work, seemed to be of little importance. Comparisons between the ‘high strain’ group and other managers showed that the high strain group spent more hours working with administration, that they to a lesser degree regarded budget responsibility as a way to exercise power in the organisation and that they had a more negative view on their organisation, especially concerning the possibility to influence decisions. They also had less confidence in the way the organisation was governed.

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  • ADHD på kartan, om geografiska skillnader i medicinering till barn och unga

    2015. Patrik Karlsson, Tommy Lundström. Socialmedicinsk Tidskrift 92 (5), 553-565

    Artikel

    ADHD är den snabbast växande psykiatriska diagnosen bland unga i Sverige. Till många av de diagnostiserade förskrivs också läkemedel. I artikeln analyseras geografiska skillnader i förskrivning. De kommunala skillnaderna är mycket stora men skillnaderna kan bara i viss grad förklaras av variabler på kommunal nivå. Kommunernas tillhörighet till landsting tycks ha stor betydelse för nivån på förskrivning och systemfaktorer som olikartad organisering, mer eller mindre explicit policy och professionell hållning diskuteras som tänkbara förklaringar till skillnader som inte endast kan ha att göra med förekomst av fenomenet.

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  • Från lokal förankring till regional samverkan? FoU-miljöer i socialtjänstens individ- och familjeomsorg

    2015. Åke Bergmark, Tommy Lundström, Hugo Stranz. Socialvetenskaplig tidskrift 22 (2), 133-151

    Artikel

    R&D units in Swedish social services: From local integration to regional collaboration.

    For a period of over thirty years, the emergence of R&D units serving locally based Swedish social services has been considered an important ingredient in the evolvement of more professional and knowledge-based social services. It has also been regarded as a vital component for increasing practice orientation in social work research, both inside and outside the universities. In this article we describe and analyse the development of these units, with respect to their pro-liferation, organizational features and how they are valued by representatives of local social servi-ces. Our data show that almost every municipality in Sweden is, in one way or another, served by an R&D unit. These units, however, display a considerable variation with respect to basic resour-ces, activity and organizational framework. Data enabled the identification of four basic catego-ries that, more or less, represent different phases in the evolvement of R&D activities. At one end, representing the early stages, there are units integrated with and exclusively serving single municipalities. At the other end there are R&D units organized within regional associa-tions, serving multiple municipalities and in general established in recent years. In between, there are two categories of R&D units formed in direct collaboration between a limited number of municipalities – one category formally connected to academia, another with less systematic con-tacts with university-based research. In general, development over time has resulted in a dilution of resources and an increasing distance between practice and R&D activities. Originally, the units were established by the initiatives of the municipalities and expected to respond to research needs emanating from practice. The regional associations have to a considerable extent been initiated and funded by earmarked state grants with the intention to implement evidence-based practice.

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  • Middle managers in social work

    2015. Emelie Shanks, Tommy Lundström, Stefan Wiklund. British Journal of Social Work 45 (6), 1871-1887

    Artikel

    With respect to marketisation and managerialism, the changes in the Swedish social services resemble the changes in many other countries. This article analyses how Swedish middle managers within the personal social services reason about professional identity, everyday work and leadership in the context of these changes. The study draws on four focus group interviews with a total of twenty-two managers. The results suggest a persisting social work identity among the managers, although noticeable changes have taken place within the social services. For example, the managers' budgetary and administrative responsibilities have increased, and relations to private companies in the area of residential care place new demands on their managerial skills. The managersseem to find some of the new conditions easier to integrate with their social work identity than others. The resistance to the reforms appear to be less obvious in Sweden than in, for example, the UK. There are a number of possible explanations for this. For example, it may be connected to the relatively mild implementation of marketisation and managerial strategies, a less apparent downsizing of social work and a relative lack of central state bureaucratic control.

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  • Embedded in practice? Swedish social work managers on sources of managerial knowledge

    2014. Emelie Shanks, Tommy Lundström, Åke Bergmark. Human Service Organizations: Management, Leadership & Governance 38 (5), 435-447

    Artikel

    This study focuses on managers in the personal social services and aims to explore these managers’ qualifications and their views on what sources of knowledge have contributed most to their managerial competence. Findings indicate that most managers have undergone in-service managerial training and that a majority appear to rely on sources of knowledge that could be described as practice oriented for attaining managerial competences. This practice orientation is discussed in relation to the character of the in-service managerial training, the knowledge base of social work, and the lack of postgraduate managerial education offered by the Swedish schools of social work.

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  • Procedures and claims among US evidence-producing organizations

    2014. Patrik Karlsson, Anders Bergmark, Tommy Lundström. Evidence & Policy 10 (1), 61-76

    Artikel

    We explore how four evidence-producing organisations in the US go ahead when they rate the evidence base for psychosocial interventions, using the Incredible Years programme as our case study. The findings demonstrate variation in the procedures and resulting evidence claims across the organisations, with some organisations being strict and some being permissive. The presence of such conflicting practices highlights central challenges for the evidence-based practice framework and its ambition of obtaining uniform evidence statements. We conclude that practitioners and policy makers should be aware of such variation in order to be able to make informed decisions regarding which programmes to use.

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  • Good idea, bad prerequisite, zero result - the meaning of context in implementing aftercare for young people in secure unit care

    2014. Maria Andersson Vogel, Marie Sallnäs, Tommy Lundström. Journal of Children's Services 9 (3), 248-260

    Artikel

    Purpose– The purpose of this paper is twofold: first, to report results from a quasi-experimental study of outcomes of a leaving care project for youth placed in secure unit care and second, based on the (zero) results, to analyse and discuss the interplay between organisational boundaries, social work and the target group when implementing a project such as the one studied.

    Design/methodology/approach– The outcome study had a quasi-experimental design. The young people in the leaving care programme were compared with a matched reference group who did not get the special leaving care services. Data were collected (structured Adolescent Drug Abuse Diagnosis-interviews) when the young people entered secure units and on follow-up (registered crime and re-entry into care).

    Findings– The outcome study showed that the leaving care project had no effect on the young people's situation at follow-up regarding re-offending and re-entry into secure unit care. This is understood and discussed in relation to the poor implementation of the leaving care project along with an inbuilt conflict between state and local municipality that overshadowed the good intentions of the project.

    Research limitations/implications– The effect study has a quasi-experimental design, and hence differences between the project group and the comparison group at T1 cannot be fully precluded, although nothing is pointing in such a direction. The unclear content of the intervention makes it difficult to decode how the variation in the support given to the young people eventually impacted the results. The zero-results apply to group level, but that may not be valid for each and every one in the project.

    Practical implications– According to earlier research, a key person following young persons through different phases of the care trajectory may be of importance. Learning from the CoC project, one can conclude that such a key person should preferably take the role of advocate for the young person, and not be an administrator mainly concerned with coordinating other professionals. Further, when planning and financing is split between organisations, that split hinders efforts to actually mobilise support for young people leaving secure unit care.

    Originality/value– Few leaving care services are designed for youth with severe behavioural problems and hence, the research is scarce. This study contributes with important knowledge about leaving care interventions for the target group.

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  • A Comparison of Out-of-home Care for Children and Young People in Australia and Sweden

    2011. Karen Healy, Tommy Lundström, Marie Sallnäs. Australian Social Work 64 (4), 416-431

    Artikel

    In this paper we present a comparative analysis of out-of-home care in Australia and Sweden. We compare the age structure of the out-of-home care population and the types of out-of-home care services provided to children and young people in both countries. Our analysis reveals that in Australia the out-of-home care service system is focused mainly on children who are deemed to be abused or neglected within their families, while in Sweden the majority of the out-of-home care population are teenagers who cannot live with their families for emotional or behavioural reasons. These population differences intersect with variations in the forms of service provision in both countries, with a much greater reliance on home-based care in Australia than in Sweden, while there is more extensive use of residential care in Sweden. We envisage that this paper will demonstrate how the age structure of the out-of-home care population, though rarely considered in international comparative child welfare research, reveals much about the assumptions on which State intervention with children and young people is based. We intend that this analysis will assist social workers to better understand and address the gaps in the quality and comprehensiveness of out-of-home care service provision to children and young people in both countries.

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  • Sibling contact among Swedish children in foster and residential care

    2012. Tommy Lundström, Marie Sallnäs. Children and youth services review 34 (2), 396-402

    Artikel

    This article investigates siblingcontact among Swedish fostered children in foster and residentialcare. The study also examines a potential link between siblingcontact and psychosomatic status. Highly structured interviews were conducted with 240 young people (13–18 years) in out of homecare. Results show unfulfilled desire for siblingcontact among children in Swedishout-of-homecare. Nearly 40% of the children interviewed see their siblings more seldom than monthly and a good half of the children—more girls than boys—want more siblingcontact. The longer the time the children have spent in care, the greater is the risk of being without contact with brothers and sisters; and the more seldom the children see their siblings, the more they crave contact. The Swedishfamilyservicesystem is obviously no guarantee of fostered children keeping their desired contact with brothers and sisters. Thus, an important task for social workers and others involved in the life of separated children is to open opportunities for contact—if the children want it. From achildren's rights perspective, it is fundamental to facilitate siblingcontact among fostered children according to their own wishes.

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  • Guided or independent? Social workers, central bureaucracy and evidence-based practice

    2011. Anders Bergmark, Tommy Lundström,. European Journal of Social Work 14 (3), 323-337

    Artikel

    Since the start of the 1990s, a number of professional fields in the Western world have been confronted with increasingly explicit demands for scientific assurance regarding the effects of the work they do. The debate on the relationship between research and practice in social work has often been carried out under the heading of evidence-based social work or evidence-based practice (EBP). This article is based on a survey distributed to a representative sample of social workers and middle managers within the Swedish municipal social services. The results indicate a generally positive attitude among Swedish social workers towards EBP; at the same time they show a low level of active contact with the research literature of relevance for EBP. The results are contextualized and discussed against the background of some major methodological issues in EBP, such as, for example, the so called Dodo bird verdict in psychotherapy outcome research.

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