The increasing specialization and differentiation within welfare organizations in Sweden and internationally have, due to fragmentation and inflexible boundaries, resulted in ineffective care for users. In order to improve care, the Coordinated Individual Plan (CIP) was introduced by the government in Sweden in 2009, with the aim of improving collaboration between social service and health care. Persons with concomitant mental health problems and substance abuse were one of the target groups. Earlier studies by the authors indicate that CIP has had limited impact. Use of CIP has been unsystematic and the user/patient’s role less central than expected. This study investigates what can contribute to these findings, based on professionals’ experience of their participation in CIP. Interviews were conducted with 20 professionals in the social service and health care sectors and analysed by qualitative content analysis, using the theoretical perspectives of institutional isomorphism. Findings indicate that, while the professionals were positive about the idea of CIP to improve the situation for the individual user/patient, coercive isomorphism in the form of CIP also led to a more confrontational view of collaboration which does not necessarily solve problems for the individual. Organizational and professional perspectives were cited, which can be linked to issues of organizational uncertainty. The study confirms earlier findings indicating that a stronger, team-based model is needed, with development based on professional experience, as the coercive aspect tends to take precedence over professional activities connected to mimetic and normative isomorphism.

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.

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.

Specialisering och sektorisering i välfärdsservice orsakar svårigheter i många länder, inte minst för vuxna med komplexa behov i samband med missbruk och psykisk ohälsa. Modeller för samverkan, t.ex. case management, multidisciplinära team och individuella samordnade planer, används i många länder i syfte att uppnå en högre grad av integration mellan organisationer. Samtidigt har kraven ökat för att brukare/patienter ska ha större påverkan över sin egen vård. I Sverige kräver lagstiftning att socialtjänst- och hälso- och sjukvårdvårdssektorerna gör Samordnade Individuella Planer (SIP, eng. CIP) kring enskilda brukare i syfte att klargöra frågor om ansvar och förbättra vårdprocesser samt för att öka brukarnas delaktighet i sin egen vård. Denna explorativa studie undersöker vilken påverkan samordnade planer har haft, med den svenska SIPen som exempel. Vad kan vi lära oss om villkoren för integrerad vård utifrån graden av samverkan, delaktighet för brukaren samt stödjande strukturers roll i genomförandet av SIP? Författarna har studerat 25 akter i en kommun. Resultaten visar en låg till måttlig grad av samverkan med få indikationer på meningsfull brukardelaktighet. Ytterligare forskning behövs för att undersöka vilka faktorer som hindrar CIP från att uppnå en högre grad av samverkan och helt omfatta den enskilde brukarens intentioner och önskemål.

Behovet av samverkan kring personer med psykisk ohälsa och/eller missbruk har en förhistoria som handlar om utanförskap i den framväxande välfärden i Sverige. I detta kapitel, som inleds med en tillbakablick, följer vi förändringarna fram till idag, beskriver vad forskning har att säga om möjligheterna och hiner med olika samverkansmodeller och frågar oss hur en fungerande modell för samverkan kan formas utifrån aktuella förutsättningar.

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.

Persons with mental health problems and substance abuse often have complex needs requiring many kinds of help concurrently. In Sweden, an attempt has been made to counterbalance the effects of fragmentation by means of legislation on collaboration, requiring on the individual level the use of Coordinated Individual Plans (Sw. Samordnad Individuell Plan, SIP). The aim of the study is to explore collaboration as it is indicated in SIP and other case documentation with focus on how SIP is motivated, and what kind and degree of collaboration is indicated by the documentation. 12 individual case files have been studied in six local authorities and the results have been analyzed in relation to a regional collaboration agreement and local collaboration agreements. The results show unclear motivation for SIP and that SIP is primarily used for documentation of short-term planning. Use of SIP and participation in SIP appears also to be uneven. The authors characterize SIP as an unsystematic form of interagency meeting, with documentation indicating a relatively low to moderate level of collaboration. The authors question whether SIP is an optimal form for collaboration and suggest that more distinct models such as case management or multidisciplinary teams could be more effective.

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.

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.

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.