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Adjusting to standards: reflections from 'auditees' at residential homes for children in Sweden
Stockholm University, Faculty of Social Sciences, Department of Social Work.
2016 (English)In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, Vol. 6, no 3, p. 222-233Article in journal (Refereed) Published
Abstract [en]

In recent years, state inspection of Swedish residential care for children has been reinforced. This study explores how inspections are perceived from the point of view of residential staff. The empirical material is based on interviews (n = 23) with residential staff and managers (n = 55) of residential homes subject to requirements from the Swedish Inspectorate. The material has been analysed using concepts shedding light on the different aspects of how audit affects ‘auditees’. The results suggest that inspections have mainly shaped the administrative part of care; that compliance with regulatory standards bring about stability in the work performed; that the standard-setting sometimes creates tensions between professional judgment and formal authority; and that inspections play an accreditation role for the residential homes. The implications of this are discussed, e.g. that the regulatory standards seem to target aspects of care that are alternatives to those of evidence-based practice, that general standards to some extent challenge the possibilities of organising the care according to the individual needs of the children and that the receptiveness of professionals to inspection ideas entails both possibilities and obstacles for the development of a professional field.

Place, publisher, year, edition, pages
2016. Vol. 6, no 3, p. 222-233
Keywords [en]
residential care for children, audit, inspection, out-of-home care
National Category
Social Work
Research subject
Social Work
Identifiers
URN: urn:nbn:se:su:diva-131104DOI: 10.1080/2156857X.2016.1192054OAI: oai:DiVA.org:su-131104DiVA, id: diva2:935934
Available from: 2016-06-13 Created: 2016-06-13 Last updated: 2022-02-23Bibliographically approved
In thesis
1. The Prerequisites and Practices of Auditing Residential Care: On the Licensing and Inspection of Residential Homes for Children in Sweden
Open this publication in new window or tab >>The Prerequisites and Practices of Auditing Residential Care: On the Licensing and Inspection of Residential Homes for Children in Sweden
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this dissertation is to describe and analyse the prerequisites and practices of auditing Swedish residential care for children. Residential care is a complex intervention provided to children in vulnerable life situations. The care is extensively delivered by private providers and shows difficulties in demonstrating clearly positive treatment effects. Licensing and inspections are policy instruments to address alleged quality problems in decentralised and marketised welfare services. However, in research there are mixed opinions on the ability of audits to generate improved service quality.

The dissertation consists of four papers exploring central facets of the audit system. The empirical material is based on interviews (n=50) with inspectors and residential staff, documentation (n=286) in terms of guidelines and license/inspection decisions and observations (n=12) at inspection-related events. Each paper includes a unique set of data.

Paper I analyses the controls that private residential homes undergo prior to their entry into the market. The results show that a majority of applicants are granted a license and that the controls do not reduce the need for ex post control. There is limited guidance on care content and research evidence is weakly incorporated in the controls. Overall, the state exerts limited influence over the composition and professional development of the care market.

Paper II explores the operationalisation process of care quality in inspections. The results show that the standards display a marked variation and there is no differentiation between different residential homes. In general, the standards focus on reducing malpractice and not maximising care quality. In practice, the inspections are often discussion-based and standards relating to work with children are often indistinct.

Paper III analyses how inspections are perceived by representatives from residential homes. The results show that inspections induce reflection and to some extent shape the administrative parts of care, but also that it is difficult to discern the actual impact of the inspections on the work. The inspections appear to bring a degree of stability and legitimacy to the work, but there are sometimes tensions between standards and professional judgment.

Paper IV studies the influence the inspection process grants children in care. The results suggest that different inspectorial rationales (regulative, supportive and protective) may influence the agency children exert and that it is difficult to allow children’s views to have a substantial impact on the process. Overall, there tends to be a gap between what the children find important and what the audits can address in concrete terms.

The theoretical ideas used to analyse the results are derived from institutional organisational theory and the thesis on the audit society. The overall analysis shows that 1) making certain core care aspects auditable and ensuring their impact is difficult (e.g., children-staff relationships, children’s views and use of research knowledge), 2) the system has a restrained character and is in many senses associated with inconclusive formative effects, 3) the use of uniform goals does not necessarily equal a more suitable care provision and 4) the audits signify strong symbolic values. Despite the limitations, the audits may help to discipline care providers, secure a minimum level relative to the audited care aspects and induce reflection among auditees.

Place, publisher, year, edition, pages
Stockholm: Department of Social Work, Stockholm University, 2018. p. 90
Series
Stockholm studies in social work, ISSN 0281-2851 ; 38
Keywords
Child welfare, Out-of-home care, Residential care for children and adolescents, Audit, Licensing, Inspection, Quality Indicators
National Category
Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-151624 (URN)978-91-7797-135-1 (ISBN)978-91-7797-136-8 (ISBN)
Public defence
2018-03-09, Aula Svea, Socialhögskolan, Sveavägen 160, Stockholm, 10:00 (Swedish)
Opponent
Supervisors
Note

At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 2: Manuscript.

Available from: 2018-02-14 Created: 2018-01-25 Last updated: 2022-02-28Bibliographically approved

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