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Oplæg ved Jenny Nybom

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Oplæg til FORSA/NOUSA-konferencen, Institut for Socialt Arbejde, Metropol, nov. 2016

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Oplæg ved Jenny Nybom

  1. 1. The logic of assessments and decisions in social work with social assistant claimants in Sweden 2016-12-22 Jenny Nybom, PhD The National Board of Health and Welfare Sweden
  2. 2. Or: What can local (systematic) knowledge about social work with social assistant claimants provide - and how can the building of this knowledge be supported? 2016-12-22 Jenny Nybom, PhD Head of unit at the National Board of Health an d Welfare Sweden
  3. 3. Presentation in three parts 1. The Swedish SA study on assessment, activation and outcome in social work with SA claimants 2. FIA- preconditions to work. A structured assessment method for long term SA claimants 3. SUE – computer-based tool for systematic monitoring (SM) of work with SA claimants I welcome quick questions at the end of each part! 3
  4. 4. Social work with SA claimants in Sweden The work with SA includes two tasks: • Assess whether applicant is entitled to the income support (eligibility) • Social work supporting claimants to become self-sufficient 4
  5. 5. That’s why IMS conducted the SA study Definitions: Activation = interventions to increase job chances Resource activation (HRD) = education, vocational training and work practice in regular work places Job activation (LMA) = Job search, job training in non- regular work place Sanction = rejection of SA due to behavior (claimant formally entitled) 5
  6. 6. The SA study – short description • 351 long-term SA claimants in 4 municipalities (original sample of 568) • Random sample (men, women, different ages and ethnic background) • Detailed measures of assessments and activation in every case during one year (not explained further in the presentation) • Income were followed up in national registers after two years • Data from 2002-2005 The SA study is basically a large scale example of systematic monitoring or follow-up (of work with individual clients) 6
  7. 7. Results from the SA study – simplified version 7
  8. 8. Stereotype patterns in social workers assessments of claimants barriers/needs 2016-12-22 8 • Immigrants rarely had ”soft” barriers like lack of self esteem, mental health issues • Only Swedish men had addiction problems • Only women had barriers related to family and relations
  9. 9. Stereotype patterns of activation and sanctions 2016-12-22 9 • Men received more activation than women, particularly than single mothers • Exemptions from sanctions often targeted women • Swedish men had the highest risks of receiving sanctions • Sanctions most common for claimants with many barriers
  10. 10. Did activation and sanctions have any correlation to income? 2016-12-22 10 Outcome measures: < 80 000 Swedish krona income from work or SA in 2 year in a row • Positive correlation to work Resource activation in combination with sanctions • Positive correlation to SA Job activation in combination with sanctions
  11. 11. Over all results in the SA study 2016-12-22 11 • The impact of sanctions seem to depends on how they are combined with different kind of • Weak match between claimants barriers and activation programs since: Lack of education and work experience were the most common work barriers but claimants rarely received resource activation (education, vocational training or work practice in regular work place). Questions?
  12. 12. How can stereotype patterns be confronted and discovered in local social work practice? 2016-12-22 12 2. Structured assessment methods (as a part of collecting information in a case) 3. Promoting systematic monitoring (of client work)
  13. 13. EVIDENCE BASED PRACTICE (Haynes et al, 2002) Best available knowledge Clients preferences and actions Clinical state and circumstances Clinical expertice Systematic monitoring (follw-up) to generate proven knowledge Structured assessment methods Structured assessment methods
  14. 14. Structured assessment methods - a part of evidence based practice as they: • Are based on research • Bring transparency into assessment • Bring knowledge about the target groups • Promotes a non stereotype examination of clients situation • Involve the client in the assessment • Facilitate “systematic monitoring” (SM for quality in client work) 14
  15. 15. FIA- preconditions to work A structured assessment method for social work with SA claimants 15 In the context of supporting EBP, IMS developed…
  16. 16. FIA… • Aim to assess the preconditions for change (not the entitlement to SA) • Is voluntary for the client • Have two blocks of questions; work and education and a ranges of areas in the social situation • Aim to adapt activation measures to the individual claimant • Target claimants that have been applying for SA about 6 months
  17. 17. Design in FIA… • Structured interview with closed and open questions • Include an over all assessment on barriers/needs in both, either or none of social situation and work/education respectively • Client ranks most urgent barriers to deal with • Goals, measures and follow-up is decided in communication with the client
  18. 18. The social situation in FIA • Includes 12 life areas e.g. physical and mental health, addictions, family violence, social network • “Objective” and subjective measures (How often X? and To what extent is X a problem/barrier according to you?)
  19. 19. Questions regarding education and work regards clients… • Goals regarding work • Positive and negative experiences of work • Skills in searching for work • Resources in work • Opinion on mandatory activation • Opinion on most helpful content in activation
  20. 20. • Based on research • Developed together with practitioners • 150 social workers had workshops about content and formulations before tested • Tested and revised in 2 phases in 20 municipalities (2011-2014) • 200 FIA-interviews was conducted in the test • Both clients and social workers answered questions after every FIA- interview about the FIA-interview The development and test of FIA
  21. 21. Results in FIA-test • Relevant life areas • FIA identifies groups with different kind of preconditions • New relevant information emerge • Both client and social workers accept and appreciates FIA • The interview takes time, sometimes three hours • Few clients opposes mandatory activation “Never mind – but we want a job”
  22. 22. Challenges with FIA and structured assessment methods • Ethical issues, is it ok to ask about barriers if you don´t have relevant interventions? • Do the social services have the mandate to change content in activation programs? • Social workers immediately ask for documentation support to FIA (although they are all tired of documentation)…. Questions?
  23. 23. A good idea would perhaps be… • To only document the results from FIA or any other interview or assessment • To use systematic monitoring to actually use the information from assessments
  24. 24. Systematic monitoring is… 2016-12-22 24 • Describes, measures and documents needs, interventions and results for individual claimants • Aggregates the information for groups and use it to enhance the work with clients
  25. 25. Systematic monitoring answers questions like.. 2016-12-22 25 • What kind of problems do our clients have? • What interventions do we provide ? • Do clients situation change for better or for worse? • Do we reach the goals we formulate with our clients? • Do clients feels involved in the process? Many social service organizations lack this knowledge..
  26. 26. To assist this type of questions, we made an unusual interpretation of two government assignments 2016-12-22 26 • Assignment: Create models for systematic monitoring of work Decided to go beyond theoretical models • Decided to make tools to support SM • We have developed three tools, generic and work with partner violence and Social assistance
  27. 27. Properties of the tool… 2016-12-22 27 • Individual data – one row one client • Data entered when suitable to the social worker • Interface looks like a web survey • The database is kept in local network • Cases are anonymous and encrypted • Easy function to get aggregations and tables of data • Flexible model – the organization choose which variables to use and can “grow in the system”
  28. 28. Same principle for data in all tools… 2016-12-22 28 • Background data • Before intervention (e.g. description of problem, goals) • Interventions • After intervention (follow-up of problem i similar way as before intervention) • Follow-up clients’ view (on positive and negative change, shared decision-making/influence and more)
  29. 29. Potential with the SM-tools… 2016-12-22 29 • Low cost training environment in entering and analyzing data • Improved meetings and supervision with local knowledge • Stimulate interest for research (if we know that 33 % of our clients get work it is much more interesting to read a RCT on effects of activation) • Brings a ”hands on” understanding of missing data and such (when results seem to be wrong - the question is why)
  30. 30. If SM have such potential – then why so rare? Social workers … 2016-12-22 • Are tired of documentation (without use for client work) • Lack experience in collection and analyzing quantitative data • Are insecure of the legislation on personal record and integrity issues • Have a perception that all computer based applications must be connected - otherwise it is to ”messy” • Have difficulties to describe necessary variables to public purchasers who ”buy” their ordinary system for follow-up
  31. 31. Why keep striving towards SM..well, without SM … 2016-12-22 • Change of interventions and of context cannot be analyzed in terms of client results or satisfaction • A critical view on evidence based methods is hard to achieve • Inadequate inequality in assessments and interventions remain unknown • Todays heavy documentation with limited use for the clients will remain standard
  32. 32. • Systematic monitoring (and EBP) linked to New Public management • Technical aspects, bugs and so on • Huge needs of support in how to analyze and use local knowledge in improvements for quality - new infra structure is needed The tools will be available soon. We aim to follow the use of them in ordinary practice! Challenge with SM and the tools…
  33. 33. Thank you for listening! jenny.nybom@socialstyrelsen.se

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