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Securing the Floor but Not Raising the Ceiling?: Operationalizing Care Quality in the Inspection of Residential Care for Children in Sweden
Stockholm University, Faculty of Social Sciences, Department of Social Work.
2018 (English)In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664Article in journal (Other academic) Published
Abstract [en]

In many countries, inspections are employed as a central instrument to the promotion of good social work practice, but how inspections operationally should achieve this is not evident. By utilizing data from guidelines, inter-views and observations, the aim of the article is to analyze how the Swedish Inspectorate operationalizes care quality within the service residential care for children. Analytically, the Inspectorate is regarded as an open system that is receptive to different ideas of how to operationalize care quality. The results show that: a) the standards display a marked variation, change annually and are similar across all homes, b) there is a limited link to good quality care as it is defined in empirical research, c) there are several driving forces for care aspects to inspect and, in general, the distinct standards pertain to formal re-quirements, while how the care is provided is associated with more indistinct standards and d) if there is no obvious malpractice in care provided, the in-spections appear to have rather unclear formative effects. The results are inter alia discussed regarding whether inspections foster the idea that the ‘floor’ of the care is raised (i.e. securing a basic level of care) but not the ‘ceiling’ (i.e. maximizing care).

Place, publisher, year, edition, pages
2018.
Keywords [en]
Residential care for children and youth, Audit, Inspection, Quality standards
National Category
Social Work
Research subject
Social Work
Identifiers
URN: urn:nbn:se:su:diva-152141DOI: 10.1080/13691457.2018.1476331OAI: oai:DiVA.org:su-152141DiVA, id: diva2:1177722
Available from: 2018-01-25 Created: 2018-01-25 Last updated: 2018-08-20
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: 2018-02-22Bibliographically approved

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