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The Balancing Act: Clients with Complex Needs Describe Their Handling of Specialised Personal Social Services in Sweden
Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för socialt arbete och psykologi..
Högskolan i Gävle, Akademin för hälsa och arbetsliv..ORCID iD: 0000-0002-2885-0635
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0002-5867-234X
2016 (English)In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, 1-19 p.Article in journal (Refereed) Epub ahead of print
Abstract [en]

Dealing with specialised social service organisations can be a challenge for clients with complex needs. These organisations may appear confusing and hard to navigate, and there is also a risk of service fragmentation, as such clients often participate simultaneously in an array of interventions. An additional complication to be handled is that these parallel interventions can range from voluntary to more or less involuntary. The aim of the present article is to describe and analyse how clients with complex needs account for their handling of service conditions within specialised personal social services (PSS), using data from a qualitative interview study with PSS clients in Sweden. A conceptual model is presented, covering four ideal typical client approaches to these specialised services: consensus, resignation, fight and escape. One key finding is that the clients combined these approaches in a balancing act intended to promote their own best interests in their parallel contacts with different parts of the specialised PSS organisation. The article concludes that future improvements in social services could be made by paying more attention to the structural arrangements that surround encounters between clients and the social services, as well as clients’ valuable first-hand knowledge of social service organisations.

Place, publisher, year, edition, pages
2016. 1-19 p.
Keyword [en]
Personal social services, organisational structure, specialization, client perspective
National Category
Social Work
Identifiers
URN: urn:nbn:se:umu:diva-120184DOI: 10.1093/bjsw/bcw042OAI: oai:DiVA.org:umu-120184DiVA: diva2:927048
Available from: 2016-05-10 Created: 2016-05-10 Last updated: 2016-09-13
In thesis
1. Komplexa behov eller komplexa organisationer?: konsekvenser av specialiserad individ- och familjeomsorg ur ett klientperspektiv
Open this publication in new window or tab >>Komplexa behov eller komplexa organisationer?: konsekvenser av specialiserad individ- och familjeomsorg ur ett klientperspektiv
2016 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Complex needs or complex organizations? : consequences of specialized personal social services from a client perspective
Abstract [en]

Even though recent decades have seen a clear trend towards organizational specialization within Swedish personal social services (PSS), there is a lack of knowledge about the consequences of this, particularly from a client perspective. The aim of this compilation thesis is to describe and analyse the consequences of organizational specialization for clients with complex needs. The empirical material consists of a survey and an interview study, both addressing clients whose needs can be considered complex since they entail several parallel contacts with different specialized PSS units. Article one is a research review aimed at summarizing and discussing the research on organizational structures in the social services, and these structures' impact on work with clients. The review suggests that, to function adequately, social service organizations need to combine and balance aspects of both specialization and integration. Article two aims to describe and analyse how clients with complex needs perceive and value the service conditions of the organizationally specialized PSS. The main findings are that clients primarily perceive and value their encounters with the specialized PSS negatively, and that they experience several elements of service fragmentation. The aim of article three is to describe and analyse how clients with complex needs account for their handling of service conditions within specialized PSS. A key finding is that clients combine different approaches (categorized as consensus, resignation, fight, and escape) in a balancing act intended to promote their own best interests. Article four aims to describe and analyse how clients with complex needs perceive the conditions for helping relations in a PSS setting marked by organizational specialization. A lack of system trust, the people-processing dimensions of work, and an organizational and professional emphasis on formal organizational structures and boundaries were found to constitute unfavourable conditions. Conversely, the occurrence of individual trust, the people-sustaining and people-changing dimensions of client work, and the boundary-spanning efforts of both informal organizations and individual social workers constituted favourable conditions. The thesis concludes that there seems to be a substantial lack of fit between the logics and features of organizational specialization on one hand, and the complex and interwoven nature of clients’ actual needs and everyday lives on the other. It is also argued that organizational specialization means that the complexity involved in encounters between clients and the PSS is overlooked or obscured. Further research on the structural arrangements and service conditions that surround encounters between clients and the social services is suggested, especially research that adopts a client perspective.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. 82 p.
Series
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 83
Keyword
Organizational specialization, personal social services, complex needs, client perspective
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-124733 (URN)978-91-7601-537-7 (ISBN)
External cooperation:
Public defence
2016-09-16, Krusenstjärnasalen, sal 23:213, Kungsbäcksvägen 47, 801 76 Gävle, Gävle, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2016-08-26 Created: 2016-08-23 Last updated: 2016-08-25Bibliographically approved

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