Samhällsutmaningar utmärker vår tid vilket inverkar på arbetet med att säkra hälsa och välfärd. Detta påverkar i synnerhet det sociala arbetets innehåll och utförande samt medför nya krav på hur arbetet ska ledas och organiseras. Förbättringsarbete och kvalitetssäkring är intimt förknippade med väl genomförda implementeringsprocesser. Arbetet med implementering är dock förenat med ett åtagande som kräver en noggrann och genomtänkt planering. Det är främst ett ansvar för arbetsledningen, samtidigt är det en interaktiv process som involverar många deltagare på en arbetsplats. Syftet med detta bidrag är att uppmärksamma och diskutera värdet i att arbeta med genomtänkta implementeringsplaner i en policydriven verksamhet. Implementeringsprocesser diskuteras dels i relation till forskning och teoribildning och dels med utgångspunkt från lärdomar som renderats från utbildningssatsningar för enhetschefer inom kommun och hälso- och sjukvård. Vidare är exempel i texten hämtat från författarens egna erfarenheter av över tjugo års arbete som socialsekreterare och IFO-chef. Kunskapsbidraget är tänkt att vara ett praktiknära och användbart stöd vid implementering av nya arbetssätt i en verksamhet.  

This thesis is written in a forensic nursing context. It reflects both the patients’ and the nursing staff´s experiences associated with turning points in reduced violence risk and recovery. The overall aim of the thesis was to examine factors related to the turning points associated with reduced risk for violence and factors which contribute to recovery, based on the salutogenic approach in forensic mental health nursing.

För att förstå vilken typ av våld som lagstiftningen fokuserar på så behövs kunskaper om de specifika våldsformerna som ofta är kännetecken för hedersrelaterat våld och förtryck. I detta kapitel följer en beskrivning av våldets uttryck och de konsekvenser våldet leder till. För den yrkesprofessionella handlar det om att ha kunskaper nog att synliggöra, uppmärksamma och bistå hedersvåldsutsatta när det handlar om frågor som berör könsstympning, barn- och tvångsäktenskap, bortförda barn och unga vuxna samt att värna och skydda individer som är utsatta för vardagliga begräsningar som kan övergå till extrem kontroll.

Många är begreppen som inryms i det nya examensmålet gällande mäns våld mot kvinnor och våld i nära relationer. I detta kapitel har ett försök gjorts för att förklara begreppen om de olika våldsformerna. Vid arbetet med det nya examensmålet, vare sig det gäller kursutveckling, undervisning eller ex-amination så är kunskap och förståelse om de olika våldsformerna av stor nödvändighet. Det som ytterligare försvårar är att det inte råder konsensus i forskarsamhället kring de begrepp som ingår. 

Ett gemensamt åtagande för ett flertal myndigheter är att uppmärksamma, stödja och skydda vuxna och barn som befaras vara utsatta för våld inom familjen. I detta kapitel, förs ett resonemang om vikten av samverkan samt myndigheters lagstadgade skyldigheter att samverka. Därefter beskrivs hur myndigheter går till väga vid en orosanmälan till socialtjänsten. Vidare behandlas viktiga skyddsaspekter som bör beaktas när det gäller hedersrelaterat våld och förtryck.

I detta kapitel behandlas för det första regeringens och andra myndigheters handlingsplaner. För det andra beskrivs UKÄ:s kartläggning av professions-utbildningar. För det tredje beskrivs regeringens sex jämställdhetspolitiska mål. För det fjärde lämnas några råd till universitetsläraren för implementering av den nya examensordningen och för det femte universitetsledningens betydelse vid implementering av nya arbetsuppgifter. 

Objectives

One of the starting point for work with human rights is to prevent and combat men's violence against women and children (VAW), including honor-related violence and oppression (HRV). According to the WHO (2013), a large part of the global burden of disease was related to VAW. In Sweden, fifteen new legislative changes were introduced to clarify the authorities' responsibility for violence within the family. Recently, a regulation was established in Sweden, which stipulates that a number of higher education programs in Sweden must include teaching on VAW and HRV. This presentation will describe the findings from an interview study, which investigated Swedish social workers' experience of working with honor-related violence and oppression. 

Method

A convenience sample of eleven social workers from seven different social welfare offices participated in the study. The interviews were analysed using qualitative content analysis.

Results

Participants state that teaching about VAW and HRV has been lacking in their undergraduate education and that that creates difficulties in their operational work. Furthermore, work with HRV was perceived as a controversial area, associated with many dilemmas. This despite the fact that many social workers know that violence within the family is often an important factor when people end up in different forms of distress and misery. The lack of knowledge makes it difficult for the social services to develop methods and approaches to assist the victims of violence and their relatives.

Conclusions

It is important to create legitimacy for social workers to work on issues relating to human rights, including VAW and HRV. The research community’s knowledge of the field needs to be implemented as soon as possible in a variety of higher education programs. Relevant professionals must be offered training and education in dealing with social inequality and developing approaches that can realize human rights in practice, in particular the violence that occurs within the family. Further research may be developed by examining:

- Are there ideological contradictions among researchers that hinder development in the field?

- Do social workers experience acceptance and a mandate to work with VAW and HRV?

Swedish social services play a pivotal role in preventing men’s violence against women, including honour-based violence. This type of family-based violence is based on norms that disregard human rights. Individuals growing up in an honour context have limited possibilities to choose their own paths in life. The study comprises young women aged eighteen to twenty-five who look back on their vulnerable positions and the circumstances resulting in their seeking help from social services. They also share their experiences of the support that they had received from social services. Semi-structured interviews with ten women were conducted. The data were analysed through a qualitative content analysis. The findings show that the interviewees are not a homogenous group; circumstances, needs and exposure varied considerably between participants. Professional attention is necessary when threats ensue after divorce, for example, in the case of a bride price refund. Child perspectives must be better considered in the event of a divorce. Women or families that reject standards of honour are subject to harassment in public by people aiming to coerce them into adopting honour norms. Leaving the family was facilitated if one’s fears were taken seriously and experiences of being met with understanding and being well cared for.

Introduction

Swedish social services play a pivotal role in preventing men’s violence against women. Men’s violence against women includes honor-based violence (HBV). This type of family-based violence consists of norms that disregard human rights. Individuals that grow up in an honor culture have limited possibilities to choose their own paths. Family members who challenge prevailing norms risk being subject to psychological and physical violence. The aim of this study is twofold. First, this study examines the circumstances that lead victims of HBV to seek help from social services. Second, the study examines victims of HBV’s experiences of support and relief offered by social services. This study consists of young women between the age of 18-25 who look back on their vulnerability and the circumstances that resulted in that they sought help from social services. They also share their experiences of the support that they received from social services. 

Methods

Semi-structured interviews with ten women about their experiences of HBV. A qualitative content analysis was conducted to analyze the data.   

Results and conclusions

The interview persons do not constitute a homogenous group; circumstances, needs and exposure varied considerably between participants. The women showed a great need to share their experiences about the violence and their exposure. Honor norms affect entire families and extended families. Interview persons’ access to long-term relations based on trust benefitted their break-up processes from families. Social services’ measures should not be limited and undermined by the prevalence of honor norms in public spaces and municipal activities. Joint efforts from the local community are therefore necessary to identify and prevent honor-based oppression. The findings of the study are discussed in light of previous research and Axel Honneth’s recognition theory.

Semi-structured interviews with 13 forensic psychiatric inpatients that had decreased their assessed risk of violence were analyzed using interpretive description. The main contribution from this study is a detailed description of patients' own strategies to avoid violence. Participants described having an ongoing inner dialog in which they encouraged themselves, thereby increasing their self-esteem and trying to accept their current situation. An unsafe and overcrowded ward with uninterested and nonchalant staff increased the risk of aggressive behavior. In the process of decreasing violence, the patients and the forensic psychiatric nursing staff interacted to create and maintain a safe environment.

Som ett led i länsstyrelsernas arbete med krisberedskap, uppdrog regeringen åt Länsstyrelsen i Dalarnas län att, utveckla arbetsformer för att motverka sociala risker med fokus på rasismoch extremism. I uppdraget ingick att sprida resultaten av arbetet samt att lämna förslag till eventuella fortsatta insatser inom området. Arbetet har genomförts av universitetslektor Helén Olsson, som också har närmare trettio års erfarenhet från socialsekreteraryrket. Bidrag av skrivarbetet har givits avdocent Tomas Axelson och professor Jonas Stier.

Societal norms and values along with laws and regulations strongly influence social work, as do megatrends as globalisation and migration. International agreements on human rights with special focus on violence against women have drawn attention to domestic violence, including honor-based violence (HBV). The purpose of this paper is to identify the factors that affect social workers' ability to work within the area of HBV and their experiences of their current work situation. Based on a qualitative approach using in-depth interviews with Swedish social workers, the study shows that HBV is not a new phenomenon in social work, but that unfamiliarity and a lack of legitimacy have made it difficult for social workers to deal with the issue. Inspired by recognition theory, a picture emerges of a profession with low mandates and low recognition that lacks resources regarding education, guidelines and a common view on how HBV should be identified and handled, both within the social workers' own organisation and in other authorities. The dynamics of HBV and approaches to the issue require a present state and legislative support. Social workers also need support from researchers in the field to develop effective interventions in their practical social work with HBV.

Länsstyrelsen i Dalarnas län har i uppdrag av regeringen att stödja samordningen av insatser i länet som syftar till att motverka mäns våld mot kvinnor, att barn bevittnar våld, hedersrelaterat våld och förtryck samt prostitution och människohandel för sexuella ändamål. Länsstyrelsen har även en viktig roll i att kontinuerligt verka för utveckling av samverkan mellan kommuner och ansvariga myndigheter. Ett led i länsstyrelsens arbete att motverka hedersrelaterat våld och förtryck är forskningsprojekt om Socialtjänstens arbete med hedersrelaterat våld med Högskolan Dalarna som projektägare. Projektet har finansierats av 2015 års utvecklingsmedel för Hedersrelaterat våld och har pågått under perioden 2016–2017. Rapportens resultatdel baseras på intervjuer med socialsekreterare som inom ramen för sin myndighetsutövning, ansvarar för ärenden som gäller våld i nära relationer och hedersrelaterat våld och förtyck. Målet med rapporten har varit att få en nulägesuppfattning om socialtjänsternas arbete med våld i nära relationer, med särskilt fokus på hedersrelaterat våld och förtryck samt att identifiera områden som kan förbättras och utvecklas vidare. Implementering av nya arbetssätt med fokus på hedersrelaterat våld och förtryck, förefaller fortfarande befinna sig i ett inledningsskede hos många socialtjänster i Dalarnas län. Vidare framgår att arbetet med hedersrelaterat våld och förtryck uppfattas som ett kontroversiellt arbetsområde som är förenat med många dilemman. Det ges uttryck för att stödet från arbetsledningen är viktigt för att hantera osäkerhet och skapa legitimitet i arbetet. Beskrivningar ges av arbetsplatser som präglas av personalomsättning och brist på kontinuitet. Samtidigt ges goda exempel på arbetsplatser där det förekommer ett utvecklingsarbete som präglas av ett kollegialt ansvarstagande. Resultatet visar att socialtjänsten förfogar över en ytterst begränsad mängd insatser och metoder för att bistå de våldsutsatta och deras anhöriga. Framgår att det föreligger behov av fortsatta utbildningssatsningar inom området för socialtjänstens personal.

In this study, we investigated social workers' use of risk assessments and risk management in cases concerning intimate partner violence. The study examined social workers' experiences of work performance, organizational conditions, internal and external collaboration and challenges and opportunities at work. We interviewed twelve respondents in Swedish social work offices about what structures, supports and foundations they found essential for work sustainability and resilience. Support from colleagues and managers, experience, openness and trust were critical factors for work satisfaction. The study showed that work experience created trust and security, partly because the social worker became better at translating laws and regulations into practical work. Concerning the severity of the cases, collaboration was essential for building workplace confidence and well-being. A well-functioning internal and external collaboration was described as trust, reducing stress and access to open and straightforward communication with others. Sustainable routines and access to guidelines facilitated the work. An unsupportive work climate included a culture of silence, a lack of trust and generated feelings of stress. Feelings of vulnerability in the professional role arose when the workgroup and/or the management did not take a supportive approach to operational work. This study describes and discusses social workers' use of risk assessments and risk management and their experience working with challenging cases concerning intimate partner violence. Key factors that support the work were strongly linked to organizational factors, such as opportunities to work in pairs, have access to supervision or a mentor and receive support from a senior social worker colleague. Well-functioning internal and external collaboration was connected to trust, manageable stress levels and open and straightforward communication. An unsupportive work climate was linked to a culture of silence, lack of trust and high stress levels. When the team and the management did not take a supportive approach to operations, feelings of vulnerability in the professional role evolved.

Background: The legislation of Swedish forensic psychiatric care states that the risk of further violence must beassessed before a patient is granted release from a forensic psychiatric hospital. The aim of the study was todescribe the experiences of forensic nurses with in-patient risk assessment processes, and their implication fordaily clinical forensic praxis.

Method: Semi-structured interviews with staff who were involved in the patients risk assessment process. Theinterview texts were analyzed using qualitative latent content analysis.

Discussion: The forensic nursing staff has to deal with many contradictory realities. The description was aboutbeing able to balance between supporting their work with an EBP approach of risk assessment while trying toestablish interpersonal relationships and to allow for positive meetings with the patient. The study indicated thatstaff used a multiple sources of knowledge in order to make credible and accurate risk assessments.

Conclusions: If the risk assessment process are to be used in a legally secure manner, the staff must receive regularsupport from team leadership that can provide both guidance and training. Based on a holistic approach, the linkbetween the instinct of staff and their work with structured risk assessment must be founded on routines and solidplatforms.

Background: Forensic psychiatry is characterized by involuntary treatment and risk of violence. The concept of recovery is rarely in focus as the primary focus is on risk assessment, violence prevention and reducing coercion in care.

Aim: To determine what resources forensic staff use to avoid or prevent violent situations, and to explore how these practices resemble the domains of recovery-oriented care.

Method: Semi-structured interviews with staff who were identified by forensic patients as key workers in their recovery process. Interview texts were analyzed using interpretive content analysis.

Results: Staff prevent violent situations using tacit knowledge and experience, and through a shared collegial responsibility. Staff safeguard patients, encourage patient participation, and provide staff consistency.Conclusions: The results have implications for forensic care as well as psychiatry regarding the process of making recovery a reality for patients in the forensic care setting.

Many individuals sentenced to forensic psychiatric care fail in the rehabilitation process, resulting in long-term inpatient hospital care. The concepts of turning points and treatment readiness in forensic settings should therefore be afforded more attention. Much can be learned from the features that characterize trajectories of recovery and processes related to turning points. The aim of this study was to explore forensic nursing staff’s experiences of forensic psychiatric patients’ turning towards recovery. A qualitative content analysis was used to analyse interviews with 13 forensic psychiatric nursing staff. Analysis of the data revealed two main themes with implications for clinical practice: promoting a turning point and recognizing a turning point. In the first of these, the emphasis was on actions and conditions that must exist to promote a turning. In the second, the main experiences related to recognizing a turning point were stories about visible and perceptible changes in the patient. The experiences that stood out most distinctly were those of being able to wait out the patient, and having patience when there was a lack of progression. The composition of staff and patients contributed to whether or not the environment was perceived as salutary.

In Sweden, the duration of treatment is increasing for patients admitted to forensic psychiatric care. To reduce the length of stay, it is important for the forensic rehabilitation and recovery process to be effective and safe. Not much is known about how the process of recovery and transition begins and how it is described by the forensic patients. The purpose of this study was to explore how forensic patients with a history of high risk for violence experienced the turn towards recovery. A qualitative content analysis was used to analyse interviews with 10 patients who had decreased their assessed risk for violence on the risk assessment instrument HCR-20 and who were successfully managed a lower level of security. Three themes were identified: (i) the high-risk phase: facing intense negative emotions and feelings (ii) the turning point phase: reflecting on and approaching oneself and life in a new way (iii) the recovery phase: recognising, accepting and maturing. In the high-risk phase, chaotic and overwhelming feelings were experienced. The turning point phase was experienced as a sensitive stage, and it was marked by being forced to find a new, constructive way of being. The recovery phase was characterised by recognising personal circumstances in life, including accepting the need for structure, a feeling of maturity and a sense of responsibility for their own life. In order to ensure a successful recovery, the forensic nursing staff needs to recognise and support processes related to treatment motivation and turning points. Recommendations for best nursing practice are given accordingly.

AIM: The aim of this study was to explore if patients admitted to forensic psychiatric care decreased their assessed risk for violence over time, to identify patients who decreased their assessed risk for violence exceptionally well (30% or more) on the clinical (C) and risk management (R) scales in the (HCR-20), and to compare them in terms of demographic data.

METHODS: The HCR-20 risk assessment instrument was used to assess the risk for violence in 267 patients admitted to a Swedish forensic psychiatric clinic between 1997 and 2010. Their assessments at admission were compared with a second, and most recent, risk assessment.

RESULTS: The risk for violence decreased over time. Demographic criteria had no impact on differences on decreased risk. Only two factors, namely gender and psychopathy showed a difference. Risk factors associated with stress and lack of personal support were the items that turned out to be the most difficult to reduce.

CONCLUSION: The results show that risk prevention in forensic care does work and it is important to continue to work with risk management. The study highlights the importance of a careful analysis of the patient's risk for violence in order to work with the patient's specific risk factors to reduce the risk.

Jämställdhetsmyndigheten har fått i uppdrag av regeringen att forsätta stärka arbetet mot att barn och unga respektive vuxna utnyttjas i prostitution och människohandel. Jämställdhetsmyndigheten ska, kartlägga förekomsten av, samt sprida kunskap om behov av särskilda insatser för både vuxna och barn som utsätts för hedersrelaterat våld och förtryck och som utnyttjas inom prostitution eller utsätts för människohandel. För att genomföra uppdraget har Jämställdhetsmyndigheten samarbetat med ett antal experter. Uppdraget har genomförst av Helén Olsson, lektor i socialt arbete vid Karlstads universitet i samarbete med Susanne Strand, docent i kriminologi  och Emma Källvik, adjunkt kriminologi vid Örebro universitet.

Risk assessment for future violence is an important area to do research on, since it concerns both the individual patient and the society. The occurrence of threats of violence and violence is a reality for patients and staff in psychiatric institutions therefore, the clinical work to reduce the risk for violence is important. To decrease the risk of violence by patients in forensic psychiatric care it is essential to look further into nursing. The nursing staff works closely with the patients on a daily basis. They create a relationship with the patient based on trust and hope, but at the same time they also assess the risk for violence continuously. Risk assessments are done as a routine as a part of the forensic care. In a further perspective this is done to protect society from patient related violence.