Björn Blom

Analysis of short reflective narratives : a method for the study of knowledge in social workers' actions

This article describes and discusses a method for analysing and working with short reflective narratives. The method is inspired by the interpretation theory of Paul Ricoeur, and applied to short written stories where social work students reflect on situations from their field studies - situations they experienced as critical or problematic. The article starts with a discussion about the need to develop complementary methods in narrative research. This is followed by an argument for written narratives as an alternative research approach. A pilot study of 14 narratives from social work students containing critical or problematic events is then presented with a focus on the analysing process. The analysis is evaluated as focused and manageable, easy to combine with quantitative analyses and it appears to generate findings in a form that is easy to publish. It provides a shortcut to a deeper understanding of both the narrative and the narrator. On the negative side, the method using written narratives has potential risks of ‘over-interpretation’, and the loss of the ‘midwife’ effect that can appear in an oral interview.

Explaining social work practice : the CAIMeR theory

• Summary: This article presents the CAIMeR theory, consisting of a conceptual framework and a theoretical model, which can help explain how results in social work practice arise from interventions and its contextual contingencies. The theory has been developed over several years in connection with empirical studies, and together with social workers. • Findings: The article starts from the meta-theoretical perspective critical realism and its notion of explanative knowledge as a stepping stone to open up the so-called black box. A fundamental concept in critical realism, generative mechanisms, is discussed and elaborated. • Applications : The CAIMeR theory can be used in several contexts: social work practice, and for evaluation of social work, and, moreover, for organization development in social work. We argue that social workers, evaluators and decision-makers need accurate theory about the core activity (work with clients) within its contextual conditions. The CAIMeR theory pays attention to generative mechanisms at different levels, which is necessary if one wants to understand what is going on in a certain agency, and explain the results in a more qualified way. The theory can also be useful for researchers and university students that need a comprehensive explanative framework when studying phenomena in social work practice.

Analysis of generative mechanisms

Abstract The focus of this article is the analysis of generative mechanisms, a basic concept and phenomenon within the metatheoretical perspective of critical realism. It is emphasized that research questions and methods, as well as the knowledge it is possible to attain, depend on the basic view - ontologically and epistemologically - regarding the phenomenon under scrutiny. A generative mechanism is described as a trans-empirical but real existing entity, explaining why observable events occur. Mechanisms are mostly possible to grasp only indirectly by analytical work (theory-building), based however on empirical observations. In order to achieve such an explanatory analysis, five methodological steps are suggested and discussed, among them abduction and retroduction. These steps are illustrated throughout by examples drawn from empirical research regarding social work practice. The article is concluded with a discussion of the need for knowledge of generative mechanisms.

Getting a sense of the client: Working methods in the personal social services in Sweden

• Summary: This article presents a study of working methods used by social workers within the personal social services (PSS), in their work with clients. The study is part of a larger research project with the aim of describing and analysing how specialized respectively integrated forms of organizations in the PSS condition social workers’ interventions and client effects (outcomes). The study was carried out in three Swedish municipalities with different organizational models. Two of those represent ‘extremes’ as they have pure specialized (divided in different types of units) respectively integrated (generic) organizations. The third municipality has chosen a middle way with an organization that combines aspects of the two other models. All social workers within the PSS in those three municipalities were included in the study. • Findings: Our findings among other things show 1) that the use of unspecific methods dominates, 2) that several methods that are reported as specific are definitely not specific, 3) that specific methods often are used in free and unspecific ways, 4) that there seems to be a compensating movement (regarding use of methods) with the aim of evening out limitations in the formal PSS organizations, 5) that there are two relatively large groups of method users: ‘improvisers’ and ‘eclecticists’. • Applications: One can neither understand the use of working methods in social work with clients by studying the methods as such nor by studying the evidence base of different methods. Social workers consider their relationships to clients and the clients’ trust as much more important (in order to achieve results) than any particular method. The use of methods is mirroring the social workers’ readiness before, and planned adaptation to, different types of situations.

‘Sometimes it’s really complicated!’: clients with complex needs on their encounters with specialised personal social service organisations in Sweden

Abstract Research in the field of human services has paid limited attention to the consequences of the international development toward organisational specialisation; the consequences for clients have been overlooked in particular. The aim of the article is to describe and analyse the consequences of organizationally specialised personal social services (PSS) in Sweden for clients with complex needs. Findings from a survey and an interview study addressing PSS clients show that clients primarily perceived their encounters with the specialised PSS negatively, and that they experienced several elements of service fragmentation. Implications of the findings are discussed in light of previous research and theory in the area.

Register data in the evaluation and program planning of addiction treatment programs: using Sweden as an example.

Data from large-scale registers is often underutilized when evaluating addiction treatment programs. Since many programs collect register data regarding clients and interventions, there is a potential to make greater use of such records for program evaluation. The purpose of this article is to discuss the value of using large-scale registers in the evaluation and program planning of addiction treatment systems and programs. Sweden is used as an example of a country where register data is both available and is starting to be used in national evaluation and program planning efforts. The article focuses on possibilities, limitations and practicalities when using large-scale register data to conduct evaluations and program planning of addiction treatment programs. Main conclusions are that using register data for evaluation provides large amounts of data at low cost, limitations associated to the use of register data may be handled statistically, register data can answer important questions in planning of addiction treatment programs, and more accurate measures are needed to account for the diversity of client populations.

Qualitative Inquiry and Evaluation in the Beginning of a Third Decade A Response to Michael Quinn Patton

In this appreciative comment on Michael Quinn Patton’s article ‘Two Decades of Developments in Qualitative Inquiry’, two main issues are addressed. The first is whether the quantitative-qualitative conflict in social research really is over. There are signs that quantitative methods still are more accepted, especially in the intersection area between academic research and practice-based evaluations. The other issue is the risk, possibly attached to Patton’s suggestions, of being too pragmatic in evaluation research. For the evaluator it is important to be able to account for the kind of knowledge that has been produced and on which grounds.

Using register data to examine patterns of compulsory addiction treatment care in Sweden: program planning and methodological implications.

Using register data to examine patterns of compulsory addiction treatment care in Sweden : program planning and methodological implications

Mortality among a national population sentenced to compulsory care for substance use disorders in Sweden : Descriptive study

Swedens compulsory addiction system treats individuals with severe alcohol and narcotics use disorders. Merging data from three national level register databases of those sentenced to compulsory care from 2001 to 2009 (n=4515), the aims of this study were to: (1) compute mortality rates to compare to the general Swedish population; (2) identify leading cause of mortality by alcohol or narcotics use; and (3) identify individual level characteristics associated with mortality among alcohol and narcotics users. In this population, 24% were deceased by 2011. The most common cause of death for alcohol users was physical ailments linked to alcohol use, while narcotics users commonly died of drug poisoning or suicide. Average age of death differed significantly between alcohol users (55.0) and narcotics users (32.5). Multivariable logistic regression analysis identified the same three factors predicting mortality: older age (alcohol users OR=1.28, narcotic users OR=1.16), gender [males were nearly 3 times more likely to die among narcotics users (p<.000) and 1.6 times more likely to die among alcohol users (p<.01)] and reporting serious health problems (for alcohol users p<.000, for narcotics users p<.05). Enhanced program and government efforts are needed to implement overdose-prevention efforts and different treatment modalities for both narcotic and alcohol users.