Anna Meeuwisse

Cross-national comparisons of social work - a question of initial assumptions and levels of analysis

The last few decades have seen the publication of articles and textbooks containing surveys and comparisons of social work in different countries. This article discusses various attempts at systematic descriptions and comparisons of social work in different parts of the world. Three main ways of making comparisons are identified: comparisons based on models of social policy, profession-oriented comparisons, and practice-oriented comparisons. Each of the three methods captures essential aspects of similarities and differences in social work, but they all have obvious limitations as well. The article sums up what has been discovered by the different methods of comparison and the criticism that can be levelled at them.

The flight from universalism

Abstract Up to the beginning of the 1990s Sweden had been considered a paragon welfare state in its realisation of universalist principles and an institutional welfare model. This seems to be changing rapidly. Mass unemployment, welfare expenditure cuts and institutional transformation have introduced several selective mechanisms into the Swedish welfare system, adding up to a retreat from universalism. New forms of selectivity can be seen in all layers of the welfare system, both transfer benefits and social security, public personal social services and the relation between state and voluntary organisations. The shifting of burdens from universal social security and insurance-based welfare onto local means tested systems has already meant a restigmatisation of unemployment, as the unemployed lose eligibility for the insurance-based systems, and an increase in the proportion of people who have to rely on poor relief instead of rights-based welfare, and when unemployment has gone up, so have work requireme...

What can we learn from consumer reports on psychiatric adverse drug reactions with antidepressant medication? Experiences from reports to a consumer association

BackgroundAccording to the World Health Organization (WHO) the cost of adverse drug reactions (ADRs) in the general population is high and under-reporting by health professionals is a well-recognized problem. Another way to increase ADR reporting is to let the consumers themselves report directly to the authorities. In Sweden it is mandatory for prescribers to report serious ADRs to the Medical Products Agency (MPA), but there are no such regulations for consumers. The non-profit and independent organization Consumer Association for Medicines and Health, KILEN has launched the possibility for consumers to report their perceptions and experiences from their use of medicines in order to strengthen consumer rights within the health care sector. This study aimed to analyze these consumer reports.MethodsAll reports submitted from January 2002 to April 2009 to an open web site in Sweden where anyone could report their experience with the use of pharmaceuticals were analyzed with focus on common psychiatric side effects related to antidepressant usage. More than one ADR for a specific drug could be reported.ResultsIn total 665 reports were made during the period. 442 reports concerned antidepressant medications and the individual antidepressant reports represented 2392 ADRs and 878 (37%) of these were psychiatric ADRs. 75% of the individual reports concerned serotonin-reuptake inhibitor (SSRI) and the rest serotonin-norepinephrine reuptake inhibitor (SNRI). Women reported more antidepressant psychiatric ADRs (71%) compared to men (24%). More potentially serious psychiatric ADRs were frequently reported to KILEN and withdrawal symptoms during discontinuation were also reported as a common issue.ConclusionsThe present study indicates that consumer reports may contribute with important information regarding more serious psychiatric ADRs following antidepressant treatment. Consumer reporting may be considered a complement to traditional ADR reporting.

Experiences from consumer reports on psychiatric adverse drug reactions with antidepressant medication: a qualitative study of reports to a consumer association

BackgroundThe new European pharmacovigilance legislation has been suggested as marking the beginning of a new chapter in drug safety, making patients an important part of pharmacovigilance. In Sweden since 2008 it has been possible for consumers to report adverse drug reactions (ADRs) to the Medical Products Agency (MPA), and these reports are now understood as an increasingly valuable contribution in the monitoring of safety aspects in medicines. Already in 2002 it was possible to report experiences with medicines to the non-profit and independent organization Consumer Association for Medicines and Health (KILEN) through a web-based report form with an opportunity to describe ADR experiences in free text comments. The aim of this study was to qualitatively analyze the free text comments appended to consumer reports on antidepressant medication.MethodsAll reports of suspected adverse reactions regarding antidepressant medications submitted from January 2002 to April 2009 to KILEN’s Internet-based reporting system in Sweden were analyzed according to reported narrative experience(s). Content analysis was used to interpret the content of 181 reports with free text comments.ResultsThree main categories emerged from the analyzed data material: (1) Experiences of drug treatment with subcategories (a) Severe psychiatric adverse reactions, and (b) Discontinuation symptoms; (2) Lack of communication and (3) Trust and distrust. A majority of the reports to KILEN were from patients experiencing symptoms of mental disturbances (sometimes severe) affecting them in many different ways, especially during discontinuation. Several report included narratives of patients not receiving information of potential ADRs from their doctor, but also that there were no follow-ups of the treatment. Trust was highlighted as especially important and some patients reported losing confidence in their doctor when they were not believed about the suspected ADRs they experienced, making them attempt to discontinue their antidepressant treatment on their own.ConclusionsThe present study indicates that free text comments as often contained in case reports directly submitted by patients can be of value in pharmacovigilance and provide important information on how a drug may affect the person using it and influence his or her personal life.

Europeanize for Welfare? EU Engagement among Swedish Civil Society Organizations

Abstract This article explores how and why Swedish-based civil society organizations (CSOs) in the welfare area engage with the European Union (EU). Europeanization is understood as a two-sided process in which the EU influences national actors while national actors are engaged in usage of the EU. The data collection was conducted through a systematic study of the websites of organizations that participated in the Swedish Compact, and through subsequent e-mail interviews with representatives from 56 of those same organizations. The assumption was that organizations with a privileged position vis-à-vis the Swedish government would be affected by EU influences. The results show that these Swedish CSOs indeed signalled Europeanization in terms of attention to the EU, cooperation, ‘projectification’, professionalization, and transformation of organizational identities and interests. The EU engagement was analysed in relation to organizational origin and the historical development of the Swedish welfare state, and the conclusion is that the national sociopolitical context influences the scope and strategies of EU engagement.

A Pill for the Ill? Patients’ Reports of Their Experience of the Medical Encounter in the Treatment of Depression

Background Starting in the 1960s, a broad-based patients’ rights movement began to question doctors’ paternalism and to demand disclosure of medical information, informed consent, and active participation by the individual in personal health care. According to scholars, these changes contributed to downplay the biomedical approach in favor of a more patient-oriented perspective. The Swedish non-profit organization Consumer Association for Medicines and Health (KILEN) has offered the possibility for consumers to report their perceptions and experiences from their use of medicines in order to strengthen consumer rights within the health care sector. Methodology In this paper, qualitative content analysis was used to analyze 181 KILEN consumer reports of adverse events from antidepressant medications in order to explore patients’ views of mental ill health symptoms and the doctor-patient interaction. Principal Findings Overall, the KILEN stories contained negative experiences of the patients’ medical encounters. Some reports indicated intense emotional outrage and strong feelings of abuse by the health care system. Many reports suggested that doctors and patients had very different accounts of the nature of the problems for which the patient was seeking help. Although patients sought help for problems like tiredness and sleeplessness (often with a personal crisis of some sort as a described cause), the treating doctor in most cases was exceptionally quick in both diagnosing depression and prescribing antidepressant treatment. When patients felt they were not being listened to, trust in the doctor was compromised. This was evident in the cases when the doctor tried to convince them to take part in medical treatment, sometimes by threatening to withdraw their sick-listing. Conclusions Overall, this study suggests that the dynamics happening in the medical encounter may still be highly affected by a medical dominance, instead of a patient-oriented perspective. This may contribute to a questionable medicalization and/or pharmaceuticalization of depression.

Italian and Nordic social workers’ assessments of families with children at risk

The question of how social workers view child welfare problems and what are seen as appropriate interventions has been subject of debate and research the last decades. The aim of the study is to investigate how different child welfare models influence social workers’ assessment of cases involving children at risk. This is done by identifying differences and similarities between Nordic and Italian social workers’ assessments regarding the levels of intervention, their line of reasoning and the types of intervention proposed. A recent comparative study of social workers’ assessment in four Nordic countries reveals a tendency to apply a common model in social work with children and families. The data for this study, collected through a qualitative vignette study involving 18 Italian social workers, are compared with the results of the Nordic study. The analysis displays certain differences between Italian and Nordic social workers’ assessments, in particular with adolescents, but also indicates similar approaches with babies and children. The similarities in the assessment of Nordic and Italian social workers, especially in the line of reasoning, indicate a common professional base of values and knowledge among social workers working with families. The study also shows that child welfare models, as institutional factors, actually influence social workers’ assessment of cases involving children at risk, when it comes to level of intervention and intervention proposed. Such influence seems to be mediated by meso-level organisational factors related to how social work with children at risk is organised.

The European Citizens' Initiative Stage: A Snapshot of the Cast and Their Acts

The European Citizens’ Initiative (ECI) is one of the newest additions to the EU civil society field and one of the remains of the aspired democratic reforms of the failed Constitutional Treaty. It moves beyond previous institutional arrangements with civil society by inviting citizens to participate directly in EU politics. The ECI has previously been studied through top-down approaches focusing on its constitutional characteristics and democratic promise, but much remains to be learned about the new actors in the EU civil society field (e.g. Auer, 2006; Szeligowska and Mincheva, 2012). This chapter gives an original account of the horizontal relations within the ECI structure. We do this through a field analysis assisted by Goffman’s dramaturgical sociology. This approach allows us to capture a snapshot of the ECI stage: a moment of interaction in a dynamic setting. The aim is twofold: to explore the actors of the ECI and to evaluate the usefulness and potential of a dramaturgical field analysis.

‘State governing of knowledge’ – constraining social work research and practice*

ABSTRACT Evidence-based practice (EBP) has been launched, spread, and established in social work in Sweden in the last decade. Today, impact studies and ‘what works’ are the recommended approaches, and medical ways to understand and examine social problems thus are prioritised over the broad social science perspectives on which social work rests. This development has culminated in an institutionalised system called ‘state governing of knowledge’. We analyse the Swedish EBP movement as an ‘epistemic community’, directing our attention to the ways in which evidence is constructed and proclaimed valid for policy and practice. Empirically, we build on documents from various actors involved in EBP in social work and on results from our on-going research on documentary practices in the social services. We identify four strategies that key actors use within the Swedish EBP community to contest, redefine, and constrain the academic knowledge base of social work: efforts to (1) construct a (state) knowledge bureaucracy, (2) standardise social work research, (3) exclude important aspects of social work expertise, and (4) govern social work practice. All four strategies are supported by ‘improvement rhetoric’ that aims at justifying the project.