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  • 1.
    Andersson, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Frames for choice and market characteristics - a Swedish case study of community mental health services in change2015In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, Vol. 5, no 3, 227-243 p., 1059772Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe and analyse structural frames for choice, as well as characteristics of a free-choice market, implemented in community mental health services in Sweden. Day centres were focused. A case study was conducted. Documents were collected and semi-structured interviews were conducted with twenty-eight agents involved in the implementation process. Content analysis of data showed that users’ freedom of choice was influenced by detailed regulation. Freedom of choice was extended, but it was also substantially reduced. The gain or loss of freedom of choice depended on which aspects of the system were emphasised. Features, which could be interpreted as paternalistic, were once again structurally embedded, despite a system addressing individual freedom of choice. Further, the market did not seem to be adjusted for the average user of community mental health services.

  • 2.
    Andersson, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Lunds universitet.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Freedom of choice or cost efficiency?: the implementation of a free-choice market system in community mental health services in Sweden2016In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 18, no 2, 129-141 p.Article in journal (Refereed)
    Abstract [en]

    This case study investigates the implementation of a free-choice market system in community mental health services using the example of day centres for people with psychiatric disabilities. It was conducted in a major city that was about to implement a free-choice market system due to a new legislation that made it feasible. Eighteen semi-structured interviews were conducted. Agents situated in different parts of the organization were interviewed one year before and two years after the free-choice system was launched in 2010. Data showed a top–down political process. A majority of the intentions of the legislation advocated individual autonomy as the market system's main purpose; only one concerned organizational efficiency. Data reflected, however, that financial efficiency dominated the agents' experiences of the implemented system. The twofold market purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for the users, whereas managers mainly focused on the market as a resource allocator.

  • 3.
    Andersson, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Extended freedom attained?: A case study of a free-choice market system in community mental health care.2013Conference paper (Other academic)
    Abstract [en]

    Background/Objectives Systems for freedom of choice within mental health has been implemented in several western countries to increase citizens’ freedom of choice, conduce diversification in service and providers of service, reduce inequalities by providing equitable choice to all users while contribute higher quality of service and facilitate efficient use of public funds. In Sweden “Act of Free Choice Systems” (2008:962) was introduced in 2009, and optional for municipalities to use. Community mental health is organized within the municipalities. The aim of this study is to describe the process of designing and constructing a market of free choice within community mental health, and analyse what kind of freedom of choice the citizen in need of community mental health have, in the example of Daily occupation.

    Methods A case study was conducted in Stockholm, the capital of Sweden, where free choice was implemented in January 2010. The study consists of semi-structured interviews with twenty-eight actors’ involved in the process, complemented with political documents. Interviews were conducted 2009 and 2012. To analyse the material direct content analysis was used, and theories regarding quasi-markets, market design and regulation of markets were applied.

    Results The design and construction of the market of community mental health have determined the degree of clients’ freedom of choice. The volume of the market was regulated by national legislation, but sometimes influenced by the local political budget, and users sometimes appealed their decisions in court to have their rights assessed by law. Admission rules set by authorities concerning management and staff qualifications, financial stability and technical documentation equipment, determined which providers could enter the market. Many user-led organisations were not able to enter due to the admission rules. Quality regulation was developed by authorities to examine providers within the system. The client should be provided neutral and rich information, though full information was hard to access.

    Discussion/Conclusion Freedom of choice seems to have been both extended and reduced by the design and construction of the new system. All users theoretically had the same possibilities to choose providers in the system. However the construction limited the actual client choice significantly.

  • 4.
    Andersson, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Lunds universitet.
    I valet och kvalet: implementering av valfrihetssystem inom svensk socialpsykiatri genom exemplet meningsfull sysselsättning2014Report (Other academic)
  • 5.
    Andersson, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Lunds Universitet.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The implementation of a Free-choice Market System in Swedish Community Mental Health Services by the Example of Day Centres2014In: Jubilee Congress 50 years WASP World Association of Social Psychiatry, London, November 13-15, 2014., 2014Conference paper (Refereed)
    Abstract [en]

    Marketization in community mental health services is a new phenomenon and might be the most comprehensive reform in the field since the deinstitutionalisation that occurred during the second half of the twentieth century. Historically, mental health services have been characterized by discipline and paternalistic practices.There has been an absence ofwhat is now, due to the new organizational model based on individual freedom of choice, is to be introduced.

     

    The aim of this study was to investigate the implementation of a free-choice market system in community mental health services, using the example of day centres for people with psychiatric disabilities. The study was conducted in a major city that was about to implement a free-choice market system due to a new legislation.

     

    Eighteen semi-structured interviews were conducted. Agents situated in different parts of the organization were interviewed one year before and two years after the free-choice system was launched in 2010. Data showed a top-down political process. The policy intentions of the new Act were in focus when studying the relation between policy and practice during the implementation process. A majority of the policy intentions of the new Act advocated individual autonomy as the market system’s main purpose, only one intention concerned organizational efficiency. Interview data reflected, however, that financial efficiency dominated the agents’ experiences of the implemented system. The twofold market purpose was clearly reflected in the interviews. Front-line staff hoped for improvements mainly for the users, when managers mainly focused on the market as a resource allocator.

  • 6.
    Bejerholm, Ulrika
    et al.
    Lunds universitet, Institutionen för hälsovetenskaper.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bergmark, Magnus
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Svensson, Bengt
    Lunds universitet, Institutionen för hälsovetenskaper.
    From national incentives of implementing Individual Placement and Support to the impact on the service users' quality of life, and view on support2015In: Closing the gap between research and policy in mental health: ENMESH 2015 : Eleventh International Conference of the European Network For Mental Health Service Research : Book of Abstracts, ENMESH , 2015Conference paper (Refereed)
  • 7. Bengtsson-Tops, A
    et al.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Social Welfare.
    Lewin, B
    The prevalence of abuse in Swedish female psychiatric users, the perpetrators and places where abuse occured2005In: Nordic Journal of Psychiatry, Vol. 59, 504-510 p.Article in journal (Refereed)
  • 8.
    Bergmark, Magnus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bejerholm, Ulrika
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Critical Components in Implementing Evidence-based Practice: A Multiple Case Study of Individual Placement and Support for People with Psychiatric Disabilities2016In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515Article in journal (Refereed)
    Abstract [en]

    When developing Community Mental Health Services to support people with psychiatric disabilities, European countries are advocating evidence-based practice (EBP). Individual Placement and Support (IPS) is an evidence-based model designed to support people in acquiring and maintaining competitive employment. Implementation science is a growing research field, with a focus on components that impact the process of implementing EBP programmes. In this multiple case study, we have followed three IPS demonstration sites for two years, in order to describe and analyze barriers and facilitators for implementation, according to constructs described in the Consolidated Framework for Implementation Research (Damschroder et al. 2009). The results highlight the importance of strategic networking, as well as the need for planning and preparations carried out before the start of an EBP programme, since deficiencies related to these constructs are difficult to compensate for.

  • 9.
    Bergmark, Magnus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bejerholm, Ulrika
    Lunds universitet, Institutionen för hälsovetenskaper..
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Implementation of Evidence-Based Interventions: Analyzing Critical Components for Sustainability in Community Mental Health ServicesManuscript (preprint) (Other academic)
    Abstract [en]

    This study analyses the implementation and sustainability of evidence-based community mental health services in the form of publicly financed Individual Placement and Support programs. Critical implementation components and program fidelity were assessed after one year. After two years, program fidelity was assessed once again. After three years, the programs’ sustainability was assessed and semi-structured interviews performed, in order to deepen the understanding of implementation. Interviews and documents provided the quantitative and qualitative data, which were analyzed by the use of the Supported Employment Fidelity Scale, the Sustainable Implementation Scale (which was developed in a connecting study), and qualitative content analysis. Despite promising fidelity results after one year, eight out of 14 programs were terminated within three years. Implementation of integrated evidence-based programs in community-based settings is a delicate undertaking. Implementing agencies can benefit from rigorous preparation before program start, especially concerning the circumstances at the organizational level, such as making plans for collaboration, financing and assessments of program fidelity.

  • 10.
    Bergmark, Magnus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bejerholm, Ulrika
    Lunds universitet, Institutionen för hälsovetenskaper..
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Policy Changes in Community Mental Health: Interventions and Strategies Used in Sweden over 20 Years2017In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 51, no 1, 95-113 p.Article in journal (Refereed)
    Abstract [en]

    The deinstitutionalization of mental health care has changed the responsibilities of involved authoritiesand has led to a continuous need for new treatment forms and interventions. This articledescribes this development in Europe, and in particular how these new conditions have been handledin Sweden over the past 20 years at the level of governmental policy-making. Three major policydocuments from 1994, 2009 and 2012 were included in this study. To increase our understandingof the policies’ contents, we have used theoretical concepts concerning governance,implementation and political risk management. Although our main interest was to find out howthe government handles interventions for users of the mental health care system, we found that thepolicy work is progressing stepwise. The first document, from the deinstitutionalization era, did notdiscuss interventions clearly. Instead, it was mainly concerned with both practical and economicalareas of responsibility. The second document, from the post-deinstitutionalization era, was morefocused on what services should be delivered to the users, while the most recently published documentto a greater extent addressed the question of how the support is supposed to be designed. The trendin European community mental health policy has been to advocate services in open forms that areintegrated into the society’s other care systems. This is also the case in Sweden, and continuous workis being done by the government to find strategies to support the development, and to meet the needs atboth political and local levels.

  • 11.
    Bergmark, Magnus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bejerholm, Ulrika
    Lunds universitet, Institutionen för hälsovetenskaper..
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Svensson, Bengt
    Lunds universitet, Institutionen för hälsovetenskaper..
    Incorporation of evidence-based programs in local contexts: Components of importance for implementation, fidelity and sustainability.2015Conference paper (Refereed)
    Abstract [en]

    The trend toward evidence-based practice has lead to an increased use of internationally tested programs. This development has been questioned because of translation problems, including the lack of fit with national welfare systems and local organizations. This study has followed the implementation process of 14 Individual Placement and Support (IPS) programs that have received national stimulus startup grants.

     

    The overarching aim was to explore whether a high fidelity implementation of IPS in a real life Swedish context is possible. The study’s focus was directed towards implementation components at different organizational levels, program fidelity, and the sustainability of the initiatives.

     

    Fourteen IPS programs that started during 2012 were selected. Based on research findings that described essential implementation components, an interview protocol and an analysis scale were developed and used. The Sustainable Implementation Scale (SIS) includes components at organizational level, team level, and continuous support. Representatives from the IPS programs were interviewed at baseline, after 12 and 24 months. The 24-month follow-up was conducted 6 months after the disbursement of stimulus grants had ended; therefore questions about the programs sustainability were included. The Supported Employment Fidelity Scale (SEFS) was used to monitor program fidelity after 12 and 24 months.

     

    Five of the municipalities with IPS programs had shut them down, while 3 municipalities had partly integrated IPS in regular programs.

    Six of the programs were fully integrated in the organizations’ regular activities. These 6 programs were characterized by high scores in SIS, primarily on the components concerning recruitment of staff, management, education and access to support structures. There was a significant correlation between the scores on SEFS, SIS, and the sustainability of the program. Collaboration between authorities was a challenge for the programs. An engaged, joint steering group and strategies for local financing were important for the survival of the initiatives.

     

    A high fidelity, real-life implementation of IPS in Sweden is possible, but requires a strong focus on essential implementation components and strategies that address contextual barriers. The SIS is a promising tool for monitoring implementation.

  • 12.
    Bergmark, Magnus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bejerholm, Ulrika
    Lunds universitet, Institutionen för hälsovetenskaper..
    Svensson, Bengt
    Lunds universitet, Institutionen för hälsovetenskaper..
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Complex Interventions and Interorganisational Relationships: Examining Core Implementation Components of Assertive Community TreatmentManuscript (preprint) (Other academic)
    Abstract [en]

    Introduction: There is increasing interest in implementing evidence-based integrated models of care in community-based mental health service systems. Assertive Community Treatment (ACT) is seen as an attractive, and at the same time challenging, model to implement in sectored service settings. This study investigates the implementation process of such an initiative.

    Methods: Interviews were conducted with ACT team members, the process leader, steering group members, and collaboration partners. The “Sustainable Implementation Scale” helped to identify critical implementation components, and these were further explored using the qualitative interview data. The “Tool for Measuring Assertive Community Treatment” addressed programme fidelity, and the initiative’s sustainability was assessed.

    Results: High-fidelity implementation of ACT in a sectored service setting is possible. Prominent components that facilitated implementation were careful preparations, team members’ characteristics, and efforts by the process leader and the steering group to improve networking. Implementation was hampered by conflicting goals among the involved authorities and a mismatch between the ACT model’s characteristics and existing organisational traditions and regulations.

    Discussion and Conclusions: Reducing the uncertainty caused by conflicting goals is an important step in improving the implementation of ACT. In order to facilitate implementation, the goals, regulations, and availability of resources should be aligned horizontally and vertically through the involved organisations.

  • 13.
    Bergmark, Magnus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bejerholm, Ulrika
    Lunds universitet, Institutionen för hälsovetenskaper..
    Svensson, Bengt
    Lunds Universitet.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Facilitators and Barriers for Sustainable Implementation of Integrated Support in a Sectored Community Mental Health Service System: Experiences from a Swedish Project.2017Conference paper (Other academic)
    Abstract [en]

    Aim

    The present research project, reported in several published articles, have studied the implementation of integrated support models (IPS and ACT). Implementation strategies used at several levels have been analyzed, including the national political level, organizational level and team level. This presentation aims to discuss the main findings of barriers and facilitators for sustainable implementation of these interventions in a sectored community mental health service system.

     

    Method

    Qualitative content analysis was used to analyze political steering strategies.

    The Sustainable Implementation Scale, based on findings from implementation science, was used to assess effectiveness of implementation.

    The Supported Employment Fidelity Scale and Tool for Assessment of Assertive Community Treatment was used to assess program fidelity of 15 programs.

    Data of the selected programs’ target groups and sustainability was used in order to assess the programs establishment in the welfare system’s regular services.

     

    Results

    Sustainable implementation of the selected models is possible, but several barriers in and between different organizational levels exist. Preparations and collaboration strategies are crucial for teams and organizations. The system level includes several inconsistencies that hamper effective implementation.

     

    Conclusions

    Political steering, involved agencies’ organizations and the models supposed to be implemented has to be better aligned. A more holistic approach is needed in order to promote supportive horizontal and vertical inter-organizational relationships.

  • 14.
    Fjellfeldt, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Implementation of choice from participants' perspectives: a study of community mental healthcare reform in Sweden2016In: Journal of Social Work in Disability & Rehabilitation, ISSN 1536-710X, E-ISSN 1536-7118, Vol. 15, no 2, 116-133 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore participants' experiences and opinions about a free-choice system in relation to policy objectives articulated by the national government and local authorities. A case study was conducted. Thirty-five informants participated. Qualitative interviews were undertaken. Results are discussed on how to address different dimensions of choice, not only where, but also what, by whom, how much, and when. They also concern how to design systems that in some ways ensure predictability and continuity to avoid unwanted harm caused by the unpredictability embedded in competitive choice systems. Finally, different aspects of quality need to be addressed.

  • 15.
    Fjellfeldt, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Competing Logics and Idealistic Professionalism: Development of a Swedish Community Mental Health Serivce MarketManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to explore the longitudinal development of an organisational fieldafter the implementation of a freedom-of-choice system in terms of the range and characteristicsof providers and services as well as the dynamics and professionalism that appeared as a resultof these changes. Our findings suggest that the expected effects of the reform in terms of varietyof providers and services within the organizational field did not materialise due to a lack ofmarket competition. Providers complemented each other rather than competed with each other,and the logics of care, choice, and advocacy challenged each other within the quasi-market. Allinformants described financial conditions in the market as extremely strained. Strong personalcommitment characterized providers entering and exiting the market, and this strongcommitment suggests a nuanced professionalism we refer to as idealistic professionalism. Agap was found between policy goals and experiences among stakeholders, and efficiency wasfound to be the policy goal achieved most often in practice. This raises the questions of howthe Swedish community mental health service market will develop in the future and what theimplications are for the participants.

  • 16.
    Fjellfeldt, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Lunds universitet.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Implementation of Choice from Participants' Perspectives: A study of Community Mental Healthcare reform in Sweden2017Conference paper (Other academic)
  • 17.
    Fjellfeldt, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Rosenberg, David
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Psykisk hälsa: ett mångfacetterat uppdrag: Analys av behovsbilder och handlingsstrategier i 21 länsplaner sammanställda inom ramen för statens satsning inom området psykisk hälsa2017Report (Other academic)
    Abstract [sv]

    För att få del av de statliga stimulansmedlen inom ramen för överenskommelsen mellanRegeringen och Sveriges Kommuner och Landsting (SKL) 2016 var kommuner och landstingskyldiga att länsvis sammanställa en handlingsplan med avseende på området psykisk hälsa.Forskare vid Umeå universitet fick i uppdrag att analysera dessa planer. Både kvantitativa ochkvalitativa sammanställningar och innehållsanalyser genomfördes. Under en forskarpanelbidrog experter inom olika områden med sina kunskaper till att fördjupa och nyanseraanalyser av preliminära resultat. Preliminära resultat presenterades under en seminariedag iStockholm där representanter för länen samt företrädare för SKL, Socialstyrelsen ochFolkhälsomyndigheten samlats. I samband med denna presentation inkom kompletterandeuppgifter som innebar att vissa revideringen av rapporten genomfördes.Inför länens arbete med handlingsplanerna föreslog regeringen i överenskommelsen med SKLatt kommuner och landsting skulle beakta fem fokusområden: 1, förebyggande och främjandeinsatser 2, tillgängliga tidiga insatser 3, enskildas delaktighet och rättigheter 4, utsatta grupperoch 5, styrning, ledning och organisation. Dessa fem områden är aktuella för barn och unga,vuxna och äldre. I samtliga handlingsplaner förhåller sig länen till dessa fokusområden. I 18av 21 län har man strukturerat sina handlingsplaner i relation till fokusområdena. Tre länförhåller sig friare till de angivna fokusområdena.Sveriges län skiljer sig åt på många sätt, vilket återspeglas i handlingsplanerna som varierartill form och innehåll. Vissa län har gjort behovsanalyser utifrån ett folkhälsoperspektiv påpsykisk hälsa, medan andra behovsanalyser undersöker faktorer som är mer relaterade till ettperspektiv på manifest ohälsa och sjukdom. I vissa län finns detaljerade målsättningar somspecificeras i långsiktiga mål och kortsiktiga delmål. I andra län har målformulerandet justpåbörjats. I en del handlingsplaner finns detaljerade åtgärdsförslag medan det i andra länpresenteras mer övergripande och generella åtgärder. Variationsrikedomen ihandlingsplanerna är mycket stor.När det gäller beskrivningen av arbetsprocessen i samband med att handlingsplanernautarbetats varierar graden av insyn i hur arbetet gått till. I vissa handlingsplaner beskrivsprocessen i detalj, och personer som deltagit är namngivna. I andra handlingsplaner går detinte att utläsa vare sig hur arbetsprocessen har gått till eller vilka som varit delaktiga. I ett länhar ett ägarskap skrivits in i handlingsplanen som innebär att instanser utsetts som ansvarigaför att handlingsplanen i sin helhet omsätts i praktik. I några län utses ansvariga inomrespektive insatsområde, medan vissa län inte berör ansvarsfrågan alls.I såväl den nationella policyn som i handlingsplanerna finns en komplexitet när det gäller dentredelade målgruppsbeskrivningen om ”allas” psykiska hälsa, utsatta gruppers psykiska hälsaoch personer med omfattande psykiatrisk problematik.

    Hur kommuner och landsting hanterat frågan om brukarmedverkan i arbetet med planernavarierar; alltifrån att inte ha någon brukarmedverkan dokumenterad alls, till att enbrukarorganisation är en av tre jämbördiga parter. I ett län anläggs ett folkhälsoperspektiv påbrukarmedverkan genom att representanter från ett brett spektrum av brukar- anhörig- ochpatientföreningar finns representerade, liksom representanter för skola.Att använda sig av länsnivån som avsändare för planerna innebär utmaningar. Vilken grad avstruktur som finns varierar mellan länen – se Länsinventering Psykisk Hälsa (SKL 2015). Detfinns ingen självklar politisk struktur vilket innebär att det är svårt att förankrahandlingsplanerna i en politisk kontext. I 9 län beskrivs politisk förankring av varierandegrad. I återstående 12 län framgår det inte om handlingsplanerna är politiskt förankrade ellerinte. Graden av politisk förankring påverkar möjligheten att omsätta handlingsplanen ipraktiken. En annan utmaning rör tillgången till tjänstemän på länsnivå som kan arbeta medlänsgemensamma uppdrag. Även detta skiljer sig åt mellan länen och påverkar arbetet medlänsgemensamma planer och målsättningar.När det gäller målsättningar presenteras det i drygt hälften (12 av 21) av handlingsplanernalångsiktiga mål som är nedbrutna i kortsiktiga delmål. I fyra län är långsiktiga och kortsiktigamålsättningar fristående ifrån varandra. Målsättningar strukturerats antingen utifrån de femfokusområdena eller tematiskt utifrån prioriterade områden i länen. I fem av länen har manhanterat målsättningar på andra sätt.De slutsatser som dragits utifrån analysen av de 21 länens handlingsplaner är följande:• Strukturer för att arbeta på länsnivå ser mycket olika ut i länen. Därför skiljer sighandlingsplanerna åt, både till form och innehåll. I vissa län tycks arbetet medlänsplanen innebära ett mervärde för de inblandade aktörerna, i andra inte. Omprincipen från regeringen och SKL att använda sig av länsnivån i kommunikationenska bestå, bör strategier för stöd till länen övervägas.• Generellt sett rör länsplanerna utvecklingsarbete och endast i liten utsträckningorganisationernas kärnverksamhet.• Länsplanerna handlar främst om kommunerna och landstingens gemensamma arbeteoch om samverkan mellan organisationerna. Detta innebär att de enskildahuvudmännens verksamheter endast uppmärksammas i mycket liten utsträckning.Följaktligen saknas en stor del av den reguljära kärnverksamhet som bedrivs avkommuner och landsting var för sig, som till exempel den specialiserade psykiatrinsbehandlingsarbete eller primärvårdens insatser. Inriktningen är särskilt tydligt underfokusområdet ”ledarskap och organisering” där handlingsplanerna företrädesvis rörsamordning och samverkan.• Det finns en hög ambition i länen att främja psykisk hälsa hos barn och unga, och attsamarbeta mellan huvudmännen kring barn och unga som har utvecklat någon form avpsykisk ohälsa.• I länen finns en hög ambition att samarbeta huvudmän emellan och tillsammans meddet civila samhället för att bli bättre på hälsofrämjande insatser riktade till asylsökandeoch nyanlända, samt att bli bättre på insatser som riktas till asylsökande och nyanländasom utvecklat någon form av psykisk ohälsa.• Två insatsområden som återkommer frekvent i länen är arbetet med suicidpreventionoch arbetet med att erbjuda dem som får stöd från de båda huvudmännen ensamordnad individuell plan (SIP) samt att utveckla formerna för SIP.6• I handlingsplanerna finns en ansats att främja den psykiska folkhälsan i länen. Dettasker parallellt med att insatser riktas till riskgrupper och grupper där psykisk ohälsaredan utvecklats. Detta innebär att kommuner och landsting tagit emot de nationellastyrsignalerna, och fortsatt vidga sitt fokus från PRIO-satsningen till att omfattafolkhälsoperspektivet inom området psykisk hälsa. Dock sker detta endast i mindreutsträckning för grupperna vuxna och äldre personer.Avslutningsvis ges exempel på några aspekter utifrån vilka ”en lyckad plan” kan förstås. Enlyckad plan kännetecknas av ett tydligt ägarskap, systematisk analys, realistiska mål och ettval av tydliga aktiviteter som kan implementeras och följas upp. Vi ger även trerekommendationer till länen i det fortsatta arbetet med att formulera länsgemensammahandlingsplaner: 1, att skriva planerna för sin egen skull 2, att öka genomförbarheten iplanerna genom aktiva prioriteringar mellan de breda och olikartade målsättningar som statenlanserat 3, att ta frågan om ansvar för planerna på allvar genom att klargöra vem eller vilkasom ansvarar för handlingsplanen och dess implementering.

  • 18.
    Hansson, Lars
    et al.
    Lunds universitet.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    The effectiveness of an anti-stigma intervention in a basic police officer training programme: a controlled study2014In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 14, 55- p.Article in journal (Refereed)
    Abstract [en]

    Background: Stigma and discrimination are still prominent features of the life situation of persons with mental illness, adding to the burden of the illness, causing a lowered self-esteem, quality of life and affecting possibilities of adequate housing and work. It is also a major barrier to help seeking. The deinstitutionalization of mental health services has led to a significant increase in contacts between the police and persons with mental illness. It has been argued that police officers should be provided education and training to enable them to interact adaptively and with good outcomes with people with mental illness. The present study is investigating the effectiveness of an anti-stigma intervention in a basic police officer training programme at a university in Sweden. Methods: The study was performed as a controlled pre-post intervention study using a comparison group, and a 6-month follow-up of the intervention group. Attitudes, mental health literacy and intentional behaviour were assessed. Main analyses were made on an intention to treat basis using repeated measures ANOVA. A total of 120 participants at a basic police officer training programme were included. Results: Time by group analyses showed improvements in the intervention group in overall score of attitudes and regarding the subscale Open minded and pro integration, in intentional behaviour (willingness to work with) and in 4 out of 6 items assessing mental health literacy. At the 6-month follow-up the intervention group had, as compared to baseline, improved attitudes in both overall score and in two of the subscales. Intentional behaviour had also improved in terms of an increased willingness to live or work with a person with mental health problems. Mental health literacy had improved in 3 out of 6 items. Conclusions: The anti-stigma intervention proved to be effective in changing attitudes, mental health literacy and intentional behaviour. Improvements mainly endured at the 6-month follow-up. The intervention seems promising in facilitating encounters between the police and persons with mental illness. Further studies are needed to disentangle the relative effectiveness of the components of the intervention before further implementation.

  • 19.
    Hultqvist, Jenny
    et al.
    Lunds universitet.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Tjörnstrand, Carina
    Lunds universitet.
    Eklund, Mona
    Lunds universitet.
    Programme characteristics and everyday occupations in day centres and clubhouses in Sweden2017In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 24, no 3, 197-207 p.Article in journal (Refereed)
    Abstract [en]

    Background: Meaningful everyday occupations are important for mental health and recovery and are provided by both community-based day centres (DCs) and clubhouses. It is unknown, however, if any of the two has more recovery-promoting features. Objective: This nine-month longitudinal study compared DC and clubhouses, concerning the users' perceptions of unit and programme characteristics, and aspects of everyday occupations in terms of engagement and satisfaction. Stability over time in these respects, as well as motivation for participation and relationships with occupational engagement and satisfaction, were explored. Methods: Participants from 10 DCs (n = 128) and 5 clubhouses (n = 57) completed self-report instruments. Results: DC attendees rated lower levels on two organizational factors; choice and ability to influence decisions, and the unit's social network. Motivation showed to be an important factor for perceived occupational engagement, which did not differ between the two groups. DC attendees were more satisfied with their everyday occupations at baseline, but that factor increased more in the clubhouse group and there was no group difference at follow-up. The unit and programme characteristics and occupational engagement showed stability over time. Discussion: Clubhouses seemed more advantageous and DC services may consider developing users' opportunities for choice and decision-making, and peer support.

  • 20.
    Hultqvist, Jenny
    et al.
    Institutionen för hälsovetenskaper, Lunds universitet.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Tjörnstrand, Carina
    Institutionen för hälsovetenskaper, Lunds universitet.
    Eklund, Mona
    Institutionen för hälsovetenskaper, Lunds universitet.
    Social networks and social interaction among people with psychiatric disabilities: comparison of users of day centres and clubhouses2017In: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 9, no 6, 107-120 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of the study was to compare users of community-based mental health day centres (DCs) and clubhouses in Sweden regarding reported social networks and social interaction and the stability of these over time. A further aim was to investigate social network predictors both cross-sectionally and longitudinally. METHODS: People regularly attending DCs (n=128) or clubhouses (n=57) completed questionnaires about social network and social interaction (social engagement and social functioning), self-esteem and socio-demographics at baseline and a nine-month follow-up. RESULTS: Perceived social engagement and social functioning did not differ between the groups and remained stable over time. Fewer in the DC reported having a close friend but there was no difference regarding having recently (the past week) seen a friend. When naming "someone with whom you can share your innermost thoughts and feelings", the DC group named more professional contacts, fewer friends and more often "nobody" compared to the clubhouse group. Finally, on both occasions the DC group scored significantly lower on size of the social network compared to the clubhouse users. Self-esteem and having recently seen a friend could predict size of the social network in the cross-sectional perspective. Strong indicators of belonging to the group with a larger social network at follow-up were being a woman, attending a clubhouse programme and having scored high on social network at baseline. CONCLUSION & IMPLICATION FOR PRACTICE: Having friends and strengthening one’s self-esteem may be essential factors for the social network of people with psychiatric disabilities in a short-term perspective. Visiting clubhouses seems advantageous in a longer-term perspective.

  • 21.
    Hultqvist, Jenny
    et al.
    Lunds universitet, Institutionen för hälsovetenskaper.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Tjörnstrand, Carina
    Lunds universitet, Institutionen för hälsovetenskaper.
    Eklund, Mona
    Lunds universitet, Institutionen för hälsovetenskaper.
    Users perceptions of programme characteristics and everyday activities in day centres and clubhouses - a longitudinal study.2015Conference paper (Refereed)
  • 22.
    Johansson, Suzanne
    et al.
    Lunds universitet.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bejerholm, Ulrika
    Lunds universitet.
    Enabling the return-to-work process among people with affective disorders: a multiple-case study2017In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014Article in journal (Refereed)
    Abstract [en]

    Background: The Individual Enabling and Support (IES) model is an adapted, supported employment program developed to meet motivational, cognitive and time-use needs of people with affective disorders. Vocational programs for this target group have been developed but more knowledge is needed about the important characteristics and perceived usefulness of the programs. The aim of this study was to illustrate the IES model and process from multiple perspectives.

    Methods: Five participants were included in this multiple-case study. The material comprised interviews with participants, intervention documents, memos and interviews with employment specialists. Within and cross-case analyzes and an analytical generalization were performed.

    Results: The cases illustrated different IES processes, and the theme; Enabling engagement in return to work (RTW) was formulated. Continuous support from the employment specialist and a focus on personal resources and motivation were essential to overcome low self-confidence regarding RTW. Motivational, cognitive and time-use strategies gave an opportunity to learn new behavior and coping strategies for job seeking, getting employed and working.

    Conclusion: Providing a combination of these strategies integrated with supported employment could promote self-efficacy and engagement in the RTW process among people on sick leave due to an affective disorder.

  • 23.
    Karlsson, Magnus
    et al.
    Ersta Sköndal Högskola.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Idealitet i omvandling?: om det civila samhällets organisationer på psykiatriområdet2013 (ed. 1)Book (Other academic)
  • 24.
    Karlsson, Magnus
    et al.
    Ersta sköndal Högskola.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Idealitet i omvandling?: om det civila samhällets organisationer på psykiatriområdet2013Book (Refereed)
  • 25. Karlsson, Magnus
    et al.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Non-profit organizations in mental health: their roles as seen in research2012In: VOLUNTAS - International Journal of Voluntary and Nonprofit Organizations, ISSN 0957-8765, E-ISSN 1573-7888, Vol. 23, no 2, 287-301 p.Article in journal (Refereed)
    Abstract [en]

    Non-profit organizations (NPO) for mental health are becoming significant actors. Here, their roles in welfare society as understood in research are identified and analyzed. Results from recent research publications on the mental health field are synthesized and categorized in order to find out their origin, theoretical orientation, and view on mental health NPO’s in relation to the public welfare systems. Relevant publications are primarily from the US, empirically oriented, and addressing surveys on both individual and organizational level. NPOs were most often seen as consensus-oriented service organizations, while very few (4%) were seen as conflict-oriented advocates (i.e., anti-professional). It is concluded that these NPOs are most often studied as complements or alternatives to existing public welfare services rather than on their own terms, and that research on the topic lacks more complex theoretical attempts.

  • 26.
    Lindqvist, Rafael
    et al.
    Sociologioska institutionen, Uppsala Universitet.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Rosenberg, David
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Psykiska funktionshinder i samhället2010 (ed. 1)Book (Other academic)
  • 27. Lundvik Gyllensten, Amanda
    et al.
    Svensson, Bengt
    Björkman, Tommy
    Hansson, Lars
    Leufstadius, Christel
    Bejerholm, Ulrika
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Östman, Margareta
    Eklund, Mona
    Brunt, David
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Attitudes in healthcare students towards mental illness: a pre- and post multicenter university program study2011In: The Internet Journal of Allied Health Sciences & Practice, ISSN 1540-580X, E-ISSN 1540-580X, Vol. 9, no 3Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the study was to investigate the effects of naturalistic educational interventions on attitudes towards persons with mental illness. Methods: In a pre-post test design, 456 students in vocational University programmes to become nurses, social workers, occupational therapists, physiotherapists, psychologists, and public health workers were studied after a course in mental illness, using questionnaires focusing on familiarity with mental illness and attitudes towards the mentally ill in general and towards schizophrenia in particular. Results: The results revealed a significant improvement for the total group in their being afraid of people with mental illness in general and being more positive towards having mentally ill people living in their neighbourhood. Differences between the student groups were found. Some educational features positively influencing stigmatizing attitudes were identified. Conclusion: Education has some effect on attitudes towards patients with mental illness, mostly on fear. To understand the effective educational ingredients for change, further research is needed.

  • 28.
    Lövgren, Veronica
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sauer, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Forskningsöversikt om arbetsfrämjande stöd för personer med funktionsnedsättning2016In: Arbetsliv för alla: funktionsnedsättning och arbete / [ed] Berth Danermark & Susanna Larsson Tholén, Malmö: Gleerups Utbildning AB, 2016, 1, 129-148 p.Chapter in book (Other academic)
  • 29.
    Lövgren, Veronica
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sauer, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Från sysselsättning till arbete: kunskapssammanställning om stöd till arbete för personer med funktionsnedsättning2014Report (Other academic)
    Abstract [sv]

    I Sverige, liksom i övriga OECD-länder, deltar personer med funktionsnedsättning i arbetslivet i betydligt lägre utsträckning än befolkningen i övrigt. Detta förhållande verkar dessutom öka i omfattning, och framförallt unga med intellektuell funktionsnedsättning och neuropsykiatriska tillstånd samt personer med psykisk funktionsnedsättning verkar stå inför en svår situation i relation till arbetsmarknaden. För dessa grupper har det utvecklats olika former av insatser med fokus på sysselsättning. Socialstyrelsens öppna jämförelser visar att mycket få personer som deltar i kommunala sysselsättningsinsatser, meningsfull sysselsättning enligt Socialtjänstlagen respektive daglig verksamhet enligt Lag om stöd och service till vissa funktionshindrade, går från dessa verksamheter till anställning på den öppna arbetsmarknaden, lönebidragsanställning, praktikplats, Samhall eller annat skyddat arbete. Detta trots att en tidigare kartläggning visade att det inom drygt 40 % av de dagliga verksamheterna fanns personer (ca tio procent av det totala antalet deltagare) som både skulle kunna och vill gå från daglig verksamhet till annan sysselsättning alternativt arbete.

    Föreliggande rapport är en kunskapssammanställning om insatser och aktiviteter som skapar förutsättningar för arbete för personer som omfattas av, eller kan komma att omfattas av, sysselsättningsinsatser från socialtjänsten. Kunskapssammanställningen grundar sig på två datainsamlingar: en forskningsöversikt omfattande 110, huvudsakligen internationella, studier om arbetsfrämjande insatser, metoder och aktiviteter för personer med funktionsnedsättning, samt två fokusgruppintervjuer med totalt 18 verksamhetsföreträdare. Dessa representerade verksamheter som tillhörde en grupp kommuner respektive stadsdelsförvaltningar som via Socialstyrelsens arbete med öppna jämförelser under perioden nov 2011–nov 2012 identifierats som framgångsrika i arbetet med att slussa ut personer från daglig sysselsättning respektive daglig verksamhet till arbete.

    Resultatet visar att arbetsfrämjande stöd är komplext och att om man vill skapa bättre förutsättningar för inträde i arbetslivet för personer med funktionsnedsättning behöver man verka på flera nivåer samtidigt. Forskning har visat att ett systematiskt, riktat och individualiserat arbetssätt är mer framgångsrikt än generella insatser, och att arbetsfrämjande aktiviteter bör initieras tidigt, löpa parallellt och samordnas över myndighets- och verksamhetsgränser. Med individualiserade insatser menas att stödet ska vara grundat på den enskildes önskemål, färdigheter och att behov matchas med förutsättningar och förhållanden på en reell arbetsplats. Rekrytering av och placering på en arbetsplats bör, enligt forskningsöversikten, utgå från principen ”place-then-train” där stöd till den enskilde kombineras med stöd och information till arbetsplatsen. Detta individualiserade stöd utmanas dock av standardiserade och icke-flexibla strukturer. Med arbetsfrämjande stöd inbegrips också att undanröja eller minska barriärer som kan uppstå på grund av icke-arbetsrelaterade faktorer i den enskildes livssituation. Till detta ska adderas att både tidigare forskning och fokusgruppintervjuerna pekar på att ett långvarigt samt ett över tid vidmakthållet erbjudande om stöd är en väsentlig komponent för framgångsrikt arbetsfrämjande stöd.

    Analysen av den tidigare forskningen och fokusgruppintervjuerna identifierade nio utvecklingsområden för arbetsfrämjande stöd, områden som är angelägna oavsett hur man för närvarande arbetar med dessa. Det handlar om hur man i den egna organisationen kan utveckla sitt sätt att arbeta med:

    1)   att inventera, stötta och över tid bibehålla den enskildes motivation till arbete,

    2)   individualiserade planeringar som uppmärksammar arbete,

    3)   att befrämja individers syn på sig själva i framtida arbete,

    4)    att befrämja personalens och omgivningens syn på individers möjligheter till arbete,

    5)   att skapa reell samverkan över gränserna med andra myndigheter och verksamheter,  

    6)   att skapa goda relationer och samverkan med potentiella och befintliga arbetsgivare, samt rekrytera arbetsplatser,

    7)   att få till stånd en god matchning mellan individ och arbete,

    8)   att ge stöd som samtidigt gagnar både den enskilde och arbetsplatsen,

    9)   att ge stöd för att undanröja barriärer för arbete som uppstår inom andra delar av livet

     

    Sammantaget visar kunskapssammanställningen att ovanstående områden har en nyckelroll när man inom olika verksamheter utvecklat strategier som tycks bidra till att underlätta övergångar från sysselsättningsinsatser till arbete. Det finns också en viss optimism inom området arbetsfrämjande stöd. Forskningsöversikten och fokusgruppintervjuerna speglar ett engagemang för dessa frågor och en ambition att finna framkomliga vägar. Konklusionerna av kunskapssammanställningen har kondenserats till följande områden: organisatorisk och individuell beredskap för arbete, individualiserad planering, stödfunktioner och samverkan. Dessa områden kan vara vägledande i arbetet med övergången från sysselsättning till arbete.

    Rapporten har också identifierat aspekter av arbetsfrämjande stöd som inte fullt ut varit möjliga att analysera inom ramen för denna rapport, bland annat formell och reell kompetens och förhållningssätt. Vilka attityder som finns gentemot personer med funktionsnedsättning, och hur de kommer till uttryck i samhället, inverkar sannolikt också på arbetsgivares syn på personer med funktionsnedsättning som medarbetare. Här kan man skönja viss optimism. Synen på funktionsnedsättning som ett permanent tillstånd håller på att luckras upp, kanske mest påtagligt när det gäller personer med psykisk funktionsnedsättning. En växande medvetenhet om att grupperna är heterogena och att funktionsförmåga inte är en över livet statisk egenskap börjar få genomslag. 

  • 30.
    Lövgren, Veronica
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sauer, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Towards employment: what research says about support-to-work in relation to psychiatric and intellectual disabilities2017In: Journal of Social Work in Disability & Rehabilitation, ISSN 1536-710X, E-ISSN 1536-7118, Vol. 16, no 1, 14-37 p.Article in journal (Refereed)
    Abstract [en]

    This paper presents an overview of research about support-to-work in relation to psychiatric and intellectual disabilities. The overview shows that support-to-work services are multifaceted, and that work can be seen as a tool for individual rehabilitation or as a set of goals to achieve. Providers are presented with specific components, which are characterised by systematic, targeted, and individualized interventions. The overview illustrate a need of long-term engagement and cooperation of and between welfare services and agents within the labour market to dissolving the Gordian knot that transition from welfare interventions to employment seems to be.

  • 31.
    Markstrom, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Implementing evidence-based practice in mental health systems - the influence of policy instruments2011In: Psychiatrische Praxis, ISSN 0303-4259, E-ISSN 1439-0876, Vol. 38Article in journal (Refereed)
  • 32.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Social Welfare.
    Arbetet med personer med psykiska funktinshinder - verksamheterna och de anställda2005In: Från psykiskt sjuk till psykiskt funktionshindrad, Studentlittertur, Lund , 2005Chapter in book (Refereed)
  • 33.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Social Welfare.
    FoU och psykiatrireformen2004In: FoU i det sociala arbetets tjänst.: En reflekterande antologi om forksnings- och utvecklingsarbete i socialtjänsten, UFFE, Umeå kommun , 2004Chapter in book (Other academic)
  • 34.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Psychology.
    Från mentalsjukhus till samhälle2005In: Att leva med psykiska funktionshinder i samhället - livssituation och effektiva vård- och stödinsatser, Studentlitteratur, Lund , 2005Chapter in book (Refereed)
  • 35.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Implementering av evidensbaserade metoder2012In: Rehabilitering och stöd till återhämtning vid psykiska funktionshinder: Möjlighetens metoder för en ny praktik / [ed] Camilla Bogarve, David Ershammar, David Rosenberg, Stockholm: Gothia Förlag AB, 2012, 255-261 p.Chapter in book (Other academic)
  • 36.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Social Welfare.
    Professionaliseringen av det ideella2006In: Organisation och omvärld - Nyinstitutionell analys inom människobehandlande organisationer, 2006Chapter in book (Refereed)
  • 37.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Staying the course?: Challenges in implementing evidence-based programs in community mental health services2014In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 11, 10752-10769 p.Article in journal (Refereed)
    Abstract [en]

    This paper focuses on the second phase of the deinstitutionalisation of mentalhealth care in which the development of community-based interventions are supposed to beimplemented in local community mental health care systems. The challenge to sustainableimplementation is illustrated by the Swedish case where the government put forwarda national training program that sought to introduce Assertive Community Treatment(ACT) for people with severe mental illness. This study is based on document analysis andqualitative interviews with actors at the national, regional, and local levels covering a total offive regions and 15 municipalities that participated in the program. The analysis of the nationalexperiences is put in relation to both research on public administration and policy analysis aswell as to current research on implementation of evidence-based programs. The results showeda “drift” of the original model, which had already begun at the policy formulation stage andended up in a large number of different local arrangements where only a few of the originalcomponents of ACT remained. We conclude that issues with implementation can only be fullyunderstood by considering factors at different analytical levels.

  • 38.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Social Welfare.
    Utvecklingen i Sverige - en historia om vilja och ansvarsgränser2005In: Social psykiatri, Bonnier utbildning, Stockholm , 2005Chapter in book (Refereed)
  • 39.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Social Welfare.
    Vad gör socialtjänsten för personer med psykiskt funktionshinder2008In: Socionomen, no 4, 10-14 p.Article in journal (Other academic)
  • 40.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bejerholm, Ulrika
    Lunds universitet.
    Svensson, Bengt
    Lunds universitet.
    Bergmark, Magnus
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Implementeringen av nationella riktlinjer för psykosociala insatser vid schizofreni: exemplen IPS och ACT2015Report (Other academic)
    Abstract [sv]

    Rapporten baseras på ett uppdrag från Socialstyrelsen att undersöka implementeringen av de nationella rikt- linjerna för psykosociala insatser för personer med schizofreni. För att göra frågan mer greppbar valdes två av de insatser som beskrivs i riktlinjerna ut, Individual Placement and Support (IPS) och Assertive Community Treatment (ACT). Urvalet gjordes utifrån angelägenhetsgrad och modellernas kännetecken. IPS är en modell för att stödja personer med psykisk funktionsnedsättning till lönearbete, genom ett individuellt anpassat stöd som sker integrerat med den psykiatriska behandlingen och direkt på reella arbetsplatser utan föregående träning. ACT är en uppsökande, intensiv och integrerad vård- och stödform riktad till personer med mycket stora och komplexa behov, där ett tvärprofessionellt team arbetar med hög tillgänglighet och ansvar för en rad olika insatser som samordnas och erbjuds inom teamet. Båda modellerna är utvecklade i Nordamerika och internationellt väletablerade med stark forskningsförankring. I riktlinjerna utmärks de båda av att erhålla prioritet 1, d.v.s. högsta möjliga angelägenhetsgrad. Modellerna utmärks vidare av en integrerad ansats. Både IPS och ACT innebär att samtidigt ge behandlingsinsatser och socialt och arbetslivsinriktat stöd genom en sammanhållen organisation. Det övergripande syftet har varit att undersöka i vilken omfattning och med vilka resultat som ACT och IPS kan implementeras i en svensk välfärdskontext, samt vilka omständigheter som haft betydelse för process och resultat. Av särskilt intresse har varit frågor om vilka implementationsfaktorer som har betydelse, vad som kännetecknar den svenska tillämpningen i förhållande till originalmodellerna, i vilken utsträckning de lokala försöken har omfattat den grupp av människor som modellerna utformats för och vilka förändringar som kan identifieras hos de individer som fått insatser. IPS studerades genom att följa 14 försöksverksamheter som fått ekonomiskt stöd från Socialstyrelsen för att utveckla metoden. Här genomfördes intervjuer med nyckelpersoner och programtrohetsskattningar vid två tillfällen samt en individuppföljning där information samlades in fortlöpande. Därutöver genomfördes en fördjupningsstudie på tre orter. ACT studerades genom en fallstudie av en försöksverksamhet, där processen följdes över tid genom upprepade intervjuserier och programtrohetsskattningar samt genom en individuppföljning bestående både av intervjuer och information från socialtjänst- och sjukvårdsregister. Implementationsprocessen analyserades genom en modell som inkluderade faktorer på system-, organisations- och utförarnivå samt aspekter som rör fortlöpande stöd.

  • 41.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Fjellfeldt, Maria
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Lunds universitet, Division of Occupational Therapy and Gerontology.
    Implementing Freedom of Choice System in Community Mental Health Services2017Conference paper (Other academic)
  • 42.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Grape, Owe
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Metod på drift: En studie om implementeringen av en nationell utbildningssatsning om Case Management enligt ACT-metoden för personer med psykiskt funktionshinder2011Report (Other academic)
  • 43.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hansson, Lars
    Lunds universitet, Institutionen för hälsovetenskaper.
    The effectiveness of an anti-stigma intervention in a basic police officer training programme. A controlled study.2015Conference paper (Refereed)
  • 44.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Karlsson, Magnus
    Ersta Sköndal Högskola, Institutionen för socialt arbete.
    Towards hybridization: the roles of Swedish non-profit organizations within mental health2013In: VOLUNTAS - International Journal of Voluntary and Nonprofit Organizations, ISSN 0957-8765, E-ISSN 1573-7888, Vol. 24, no 4, 917-934 p.Article in journal (Refereed)
    Abstract [en]

    In many parts of the Western world, interventions for people with mental illness have radically changed in recent decades. In the deinstitutionalized system of today, the role for non-profit organizations is generally characterized by dual goals: political advocacy and service provision. Here, the role and function of the user movement in the Swedish mental health system is examined through a case study of all local branches of the largest non-profit organization within the Swedish mental health field. The empirical material consisted of annual reports from all local branches, and was analysed through two analytical schemes, concerning voice/service and conflict/consensus. The analysis pointed to a user movement that still retained the basic ideas of peer support and mutual aid, but were also increasingly being asked by formal service providers to represent the need of users. A hybrid organization category, a ‘Social Movement Peer Organization’, was identified that where social recreational activities are combined with local political advocacy.

  • 45.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lindqvist, Rafael
    Institutionen för socialt arbete, Göteborg universitet.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Case management for people with psychiatric disabilities in rural Sweden: Experiences from the implementation of a national policy2009In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 12, no 4, 495-508 p.Article in journal (Refereed)
    Abstract [en]

    The aim is to analyse the implementation of a case manager-model in rural Sweden. A sample of 15 case managment team was selected. Written materials were collected and interviews on location were carried out. Results: rural case managers design their work methods themselves, wich entail several deviations from the national guidelines in this field. The case managers boards have a low capacity to direct and manage the activities of the case managers. Consequently, case managers develop into welfare entrepreneurs. One salient risk is that teams become isolated from the surrounding welfare system. In conclusion, the Swedish version of case management in rural areas is a result of local processes of adaptation and negotiations that result in services that differ from those envisaged in national policy guidelines.

  • 46.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundvik Gyllensten, Amanda
    Department of Health Sciences, Lund University.
    Bejerholm, Ulrika
    Department of Health Sciences, Lund University.
    Björkman, Tommy
    Department of Health Sciences, Lund University.
    Brunt, David
    School of Health Sciences and Social Work, Växjö university.
    Hansson, Lars
    Department of Health Sciences, Lund University.
    Leufstadius, Christel
    Department of Health Sciences, Lund University.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Svensson, Bengt
    Department of Health Sciences, Lund University.
    Östman, Margareta
    Faculty of Health and Society, Malmö University.
    Eklund, Mona
    Department of Health Sciences, Lund University.
    Attitudes towards mental illness among health care students at Swedish universities: a follow-up study after completed clinical placement2009In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 29, no 6, 660-665 p.Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to examine the changes in attitudes towards mental illness after theorethical education and clinical placement among students from university programmes preparing for different kinds of health professions. Three different questionnaries were used, measuring the level of familaritiy with mental illness and attitudes towards mental illness in general and toward specific mental illnesses. The data were collected on two occasions, before the theorethical course and after the completed clinical placement. The result showed that the attitudes toward mental illnes in general had changed in a less stigmatising direction after the clinical placement. On the other hand, attitudes toward specific illnesses did not show any major changes.

  • 47.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Nygren, Ulla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Arbete för alla?:  Införande och resultat av supported employment i en svensk kommun2011Report (Other academic)
  • 48.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lindqvist, Rafael
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Who is responsible for supporting "long-term mentally ill! persons?: Reforming mental health practices in Sweden2004In: Canadian Journal of Community Mental health, Vol. 23, no 2, 51-63 p.Article in journal (Refereed)
  • 49.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Svensson, Bengt
    Lunds universitet, Institutionen för hälsovetenskaper.
    Bergmark, Magnus
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Is ACT possible to implement in a highly sectorized system? A longitudinal analysis of outcomes and critical implementation components in a Nordic case.2015Conference paper (Other academic)
  • 50.
    Markström, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Svensson, Bengt
    Department of Health Sciences, Lund University, Lund, Sweden.
    Bergmark, Magnus
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hansson, Lars
    Department of Health Sciences, Lund University, Lund, Sweden.
    Bejerholm, Ulrika
    Department of Health Sciences, Lund University, Lund, Sweden.
    What influences a sustainable implementation of evidence-based interventions in community mental health services?: Development and pilot testing of a tool for mapping core components2017In: Journal of Mental Health, ISSN 0963-8237, E-ISSN 1360-0567Article in journal (Refereed)
    Abstract [en]

    Background: An important aspect of research regarding the implementation of evidence-based practice is the sustainability and long-term stability of a programme. There is a need to measure these critical components for establishing successful programmes.

    Aim: The aim was to develop and pilot test the sustainable implementation scale (SIS) for measuring the critical components in the sustainable implementation of community mental health services.

    Method: The scale was based on implementation research and consisted of three subscales regarding (1) the organisational level, (2) the team level and (3) continuous support. Data from interviews and documents were collected from 14 programmes implementing the Individual Placement and Support model of supported employment.

    Results: Internal consistency was acceptable for all subscales and for the scale as a whole. Regarding the scale, an analysis of the differences between fully established programmes and the programmes that were not established or were or only partially established after three years showed statistically significant differences, indicating that a greater number of implementation components were present in the fully established programmes.

    Conclusions: SIS showed both good reliability and acceptable internal consistency as well as the ability to predict programme survival.

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