To enhance user participation in the complex setting of coordinating support, more knowledge is needed about strategies designed to improve user involvement. This study aimed to explore staff perceptions of barriers and facilitators during the implementation process of the innovation shared decision-making (SDM) in coordinated individual planning (CIP) within the comorbidity field of practice. A mixed methods approach was used, involving the collection and analysis of questionnaire data at two time points, followed by individual and focus group interviews. Data were collected from staff working in social services and healthcare. The data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR), focusing on the domains of innovation, inner setting, and individuals involved. Barriers to implementation included among others, perceptions of high workloads, a lack of relational connections between staff from different units, and staff ambiguity regarding user participation. Facilitators included circumstances such as experience with the innovation, a focus on user participation, and the presence of functional collaboration between staff from different organizations prior to implementation. Overall, the findings highlight the importance of relational connections both between users and staff and among staff from different units during the implementation process of SDM in a collaborative setting like CIP.

Navigating healthcare with a contested diagnosis, such as Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS), is fraught with challenges for both patients and their families. PANS is a newly recognized condition marked by a sudden onset of neuropsychiatric symptoms, yet its etiology and treatment remain contentious. This chapter explores how children with PANS and their primary caregivers (parents, in this study) in Sweden seek, acquire, and share knowledge about the condition amidst skepticism and systemic barriers. Using qualitative interviews, this chapter examines the epistemic injustice children and parents face; this includes testimonial injustice, where one’s credibility as a knower is undermined, and hermeneutical injustice, which stems from gaps in medical understanding. The emotional and practical consequences of these injustices are analyzed alongside structural contributors like medical hierarchies and knowledge constraints. The findings emphasize a need for person-centered care that values patients and caregivers as essential knowledge holders. The chapter ends by discussing social workers’ critical roles in fostering epistemic justice in health care.

This study examines staff perceptions of implementing Shared Decision Making (SDM) in Coordinated Individual Care Planning (CIP) in community mental health services. SDM promotes active service user involvement in planning support and treatment. The intervention was applied across three Swedish regions, each with a test site. Focus group interviews with trained psychiatric staff were analyzed using thematic analysis. Four themes emerged: learning-oriented responses, ongoing development, implementation challenges, and potential solutions. Findings raise questions about service user involvement in CIP and emphasize the importance of reconsidering professional power dynamics to enhance collaborative practice.

This study examines outreach practices within a regional project in Sweden, aimed at supporting young people not in education, employment, or training (NEET). Drawing on Lipsky's theory of street-level bureaucracy, the study examines how frontline staff conceptualize and enact outreach, and how structural conditions shape its implementation. Data was collected through five focus group interviews with 46 practitioners and a document analysis. The findings reveal four interrelated dynamics: (1) outreach as a discretionary practice shaped by fragmented welfare systems, (2) systemic absorption of outreach into ordinary service provision, leading to role drift, (3) absence of relational infrastructure for sustainable transitions, and (4) conceptual vagueness undermining strategic coherence. Although outreach was regarded as essential for engaging socially isolated youth, it remained structurally unsupported and dependent on improvisation and moral commitment. The study extends Lipsky's framework by introducing the concept of relational infrastructure and highlighting the performative dimension of outreach under outcome-driven evaluation regimes. Policy implications include the need for a shared definition of outreach, integrated pathways, and metrics that capture relational outcomes. Outreach, when adequately resourced and strategically embedded, holds transformative potential for promoting social inclusion among marginalized youth.

Background: This study critically examines the central policy documents that regulate care and support for people with disabilities in South Africa and Sweden.

Methods: The study critically analyses South Africa's White Paper on the Rights of Persons with Disabilities and the Swedish Disability Act. Utilizing the “What's the Problem Represented to be? (WPR)” framework developed by Bacchi, the problematization of disability in these policy documents is discussed.

Results: Both countries have shifted from a medical model of disability toward a more inclusive, rights-based approach. While South Africa focuses on addressing historical inequalities and promoting mainstreaming, Sweden prioritizes individual autonomy, personal assistance, and structural support for independent living.

Conclusions: The analysis reveals that South Africa relies more heavily on family and community support for individuals with disabilities. By contrast, Sweden promotes greater self-determination for individuals, reducing the burden on families by offering state-supported personal assistance.

Background: Experiencing a stroke disrupts the expected life course and can negatively impact cognitive, emotional, and physical functioning, making it a major source of disability globally. To support recovery, individuals can seek help by sharing their experiences in peer-to-peer support communities.

Objective: The objective of this study was to use discourse analysis to examine how members of a peer-to-peer online support community for stroke survivors construct their understanding of the condition and use narratives to reconstruct their identity into different subject positions.

Methods: The study context was a private Swedish peer-to-peer online support community created and administered by middle-aged people with lived experience of stroke. Data was collected through structured protocols that captured the content of posts and comments (n = 397). The analysis has followed the principles of Laclau and Mouffes discursive framework.

Results: Our findings suggest that identity struggles revolve around looking ahead and negotiating normative expectations with oneself and others. We identified five subject positions: survivor, pathfinder, mentor, struggler, and outsider. These positions highlight the plurality and fluidity of post-stroke identity processes. Members often shifted between these roles based on changes in health, emotional state, or community interactions.

Conclusions: The diversity of subject positions demonstrates that stroke recovery is not a uniform process, emphasizing the importance of recognizing identity work as a core aspect of post-stroke adaptation. The findings highlight the need for more flexible, patient-centered services that accommodate diverse narratives, including those shaped by long-term disability, emotional trauma, and shifting life priorities.

This article explores how mental health professionals narrate successful experiences of implementing shared decision-making (SDM) within coordinated individual care planning (CIP) for adults with severe mental illness in Sweden. Drawing on narrative theory and the concepts of master and counter-narratives, the study analyzes two in-depth interviews with professionals who adopted a new SDM-oriented CIP model. While previous research has highlighted barriers to implementation, this study focuses on stories of localized success. The findings show that professionals engage in narrative identity work to navigate and, at times, resist dominant institutional discourses centered on time scarcity, user passivity, and bureaucratic rigidity. Through reflective practice, relational engagement, and adaptive use of tools such as pre-meetings and informational media, the professionals reframe SDM as both feasible and desirable. These counter-narratives reveal the importance of time, trust, and storytelling as enabling conditions for change. The study highlights the role of narrative as a tool of professional agency, offering insight into how small-scale innovations can challenge organizational inertia and foster more participatory models of care.

Background: Many stroke survivors face disabilities that can have a substantial lifelong impact on both their own and their significant others' life situations. Online groups on social media can serve as forums for peer support among people sharing a common experience. However, there is limited knowledge about online peer-support groups for people living with the consequences of stroke that are initiated and managed by stroke survivors themselves. Objective: The aim of this study was to explore and describe what stroke survivors and their significant others share in posts and comments in a Facebook group for stroke survivors, initiated and run by stroke survivors. Methods: In this participatory, exploratory and qualitative study, three stroke survivors, engaged as co-researchers with no previous research experience, identified Facebook as an important context for sharing experiences and peer support. Data were collected by summarizing posts and comments from a Facebook group over 3 months and analyzed using the principles of inductive qualitative content analysis. Results: In total, 5 categories and 11 subcategories were created. The categories Narrating About Everyday Life with the Consequences of Stroke, Dealing with the Emotional Struggle of Poststroke Life, Making Progress and Enjoying Everyday Life, Navigating Societal Services and Societal Demands and Continuing Everyday Life describe narratives, questions and requests for other members' experiences related to challenges and situations that the group's members faced post-stroke. Conclusion: We conclude that there is considerable breadth in the topics and issues discussed in the online forum, reflecting that a stroke affects many areas of life for both stroke survivors and their significant others. Furthermore, online peer-to-peer support for stroke survivors have the potential to provide a context for sharing experiences and knowledge, and for developing experiential knowledge. Clinical implications are that rehabilitation professionals can inform stroke survivors about the existence of online peer-to-peer groups, include the ability to use social media in assessments of activity performance, and, if relevant, support stroke survivors' use of social media. Patient or Public Contribution: Stroke survivors identified Facebook as a context for the study. They collaborated in data collection, analysis, interpretation and discussion of findings and are co-authors.

Understanding the capacity of child welfare (CW) organisations to deal with child abuse is complex, and dependent on the specific CW context. Sweden occupies a unique position in trying to balance high demands for CW and protection with a strong family support focus, which carries a risk of overlooking children who need protection. Drawing on an understanding of social service organisations as street-level bureaucracies, this article explores discretion in child abuse cases by examining conditions affecting discretion and strategies for investigating child abuse, including police reporting. Thematic analysis of interviews with Swedish supervising social workers showed that staff's conceptions of the CW system influenced the exercise of discretion, leading to different strategies for dealing with child abuse. This resulted in different practices and potentially unequal access to child protection and support, highlighting the wide margin of discretion. This article concludes that the interplay between knowledge and governance is central to equal child protection. This article contributes to the discussion of discretion in CW organisations by underlining the importance of being particularly vigilant about discretion when both children and parents are considered clients, as the child risks being lost as a subject with individual needs and rights. Understanding the capacity of child welfare (CW) organisations to deal with child abuse is complex. Sweden occupies a unique position in trying to balance high demands for CW and protection with a strong family support focus, which carries a risk of overlooking children in need of protection. This article explores the handling of child abuse cases by examining conditions affecting discretion and strategies for investigating child abuse, including police reporting. Analysis of interviews with Swedish supervising social workers showed that staff's conceptions of the CW system influenced the handling, leading to different strategies for dealing with child abuse. This resulted in different practices and potentially unequal access to child protection and support, underscoring the importance of being particularly vigilant about discretion when both children and parents are considered clients: the child risks being lost as a subject with individual needs and rights. This article concludes that the interplay between knowledge and governance is central to equal child protection.