Syftet med denna studie är att undersöka eftervård för klienter som vårdats under Lagen (1988:870) om vård av missbrukare i vissa fall (LVM). Detta genom att undersöka avgörande faktorer för utfall av eftervård för klienterna. Vidare ämnar studien att undersöka klienternas motivation till eftervård från socialarbetares perspektiv. Studien syftar till att belysa en verklig bild av eftervården och eventuella utmaningar gällande eftervården för dessa klienter. För att undersöka detta utgår studien från följande frågeställningar:-Vilka faktorer avgör vilken eftervårdsinsats klienter som vårdats med stöd av LVM får? -Hur upplever och förstår socialarbetare sina klienters motivation till eftervård?För att besvara dessa frågeställningar användes semistrukturerade intervjuer som metod för att samla information från åtta informanter. Fem arbetar på socialtjänsten i olika kommuner och tre arbetar på institutioner styrda av Statens Institutionsstyrelse (SiS). Resultatet av studien visar att alternativen för eftervård är begränsade. När olika alternativ är tillgängliga påverkar andra faktorer eftervården, såsom kommunernas budget, klienters komplexa problematik och klienters förmåga att tillgodose sig behandling. Informanterna anger även att vissa klienter likställer tvångsvården med att sitta i fängelse, vilket innebär en utmaning i motivationsarbetet som socialarbetarna utför. Vidare visar resultatet på att motivationen är låg för klienter som återkommer inom tvångsvård. Klienternas motivation till eftervård tenderar att gå igenom olika faser under tiden på institutionen vilket skapar utmaningar för socialarbetarna. Studien visar även på att ett samarbete mellan socialtjänsten och SiS är grundläggande för positiva utfall för klienterna. / The aim of this study is to examine aftercare for clients who have been in compulsory treatment under the Substance Abusers (Special Provisions) Act 1988. This is done by examining determining factors for what kind of aftercare the clients receive. Furthermore the study aims to find out clients motivation to aftercare from the perspective of social workers. The study aims to highlight the reality of aftercare and the challenges of providing care to clients post-compulsory treatment. To examine this, the study is based on the following questions:-What factors impact clients post-compulsory treatment paths?-How do social workers experience and understand their clients’ motivation for care post-compulsory treatment?To answer these questions, the used method was semi-structured interviews to gather data from five informants working at social services in different municipalities, and three informants working at institutions run by the National Board of Institutional Care. The result of this study show that the options for care post-compulsory treatment are limited. When options are available other factors impact the aftercare, such as organisational budgets, the clients’ other complex life situations apart from yet related to the addiction and the clients’ ability to embrace the treatment. The respondents also state that for some clients, compulsory treatment is like being in jail, which means engaging in motivating clients can be very challenging. Furthermore, motivation for change is low for clients who re-entry compulsory treatment. The clients’ motivation for aftercare tends to go through different phases during the time they are under care at the institutions which provide challenges for the professionals working with them. The study also found that cooperation between the relevant organisations is essential for good outcomes for clients.

Opioid use disorder impedes dependent parents' abilities to care for their children. In turn, children may languish in unpredictability and persistent chaos. Societal responses to these children are often guided by a belief that unless the drug dependent parent receives treatment, there is little help for the child. While a preponderance of the drug dependence research is adult-centric, a significant body of research demonstrates the importance of not only addressing the immediate well being of the children of drug dependent caregivers but preventing the continuing cycle of drug dependence. The present commentary demonstrates through a brief review of the US history of drug dependence crises and research from the 1980s and 1990s, a range of “tried and true” family, school, and community interventions centered on children. We already know that these children are at high risk of maladjustment and early onset of drug dependence; early intervention is critical; multiple risk factors are likely to occur simultaneously; comprehensive strategies are optimal; and multiple risk-focused strategies are most protective. Where we need now to turn our efforts is on how to effectively implement and disseminate best practices, many of which we learned in the 1980s and 1990s. The greatest opportunity in both changing the nature of the opioid epidemic at scale and influencing rapid translation of existing research findings into policy and practice is not in asking what to do, but in asking how to do the right things well, and quickly.

The continuous advancement of new technology, specifically in the area of internet technology, has led to an increase in concerns surrounding children and young people’s safety when online. The following thesis describes a study of protection and security on the internet from the perspective of children and young people and contributes and expands on the findings of my Masters Dissertation which examined parents’ perceptions of children at risk on the internet. The research focuses on young people’s perspectives about what risks they face and what would keep them safe and is set within literature on child sex abusers and internet grooming. The thesis is based on an online survey which gathered information about the behaviour and opinions of 859 children and young people living in Scotland. Findings were separated into four main topics: children and young people’s behaviour on the internet, children and young people’s perception of strangers both online and offline, children and young people’s opinion of education on internet safety and children and young people’s opinion of the government’s role in relation to their safety online. Respondents’ stated that they wanted to be protected when on the internet (whilst acknowledging their own responsibility when online), either by the government or through those responsible for the content of the internet. They also provided several suggestions on how schools and the government can do more to listen to their voices and improve internet safety education. There were a number of children and young people who reported that they disclosed personal information over the internet (their own and that of their friends and family) and that they were willing to meet people in the real environment whom they had been communicating with online: many respondents’ viewed internet ‘strangers’ as different from ‘strangers’ in the real environment. Vygotsky’s (1978) theory of the Zone of Proximal Development (ZPD) and Wood et al.’s (1976) development of the concept of scaffolding, which has been developed in an educational rather than criminological context, were identified as offering some promise for explaining the behaviour of both the victims and the offender as other theories of sexual offending (either specific theories or explanations developed from general theories) are incapable of fully providing an explanation that will encompass grooming in general and online grooming in particular. It is argued that if these theories are applied to internet safety education they have the potential to empower children and young people and make grooming tactics and approaches less effective. The findings also indicated that more child and young people-oriented protection measures may be needed. Perceptions of protection and security on the internet were wide ranging but respondents were keen to provide possible solutions and examples of how to improve their safety when online. This would suggest that communicating with children and young people when developing policy, legislation, research and educational materials is the way forward if we wish to improve their safety and eliminate or reduce the dangers they face when using the internet.

O objeto deste estudo são as práticas de Atenção Básica (AB) desenvolvidas nos serviços de saúde voltadas para pessoas e grupos sociais que consomem drogas de forma prejudicial. Este objeto foi recortado a partir do referencial teórico da Saúde Coletiva e se conforma na interface entre as políticas públicas voltadas para a população que faz uso prejudicial de drogas e a realidade concreta dos serviços de saúde. O estudo tem por objetivo geral analisar as práticas voltadas para consumidores problemáticos de drogas na AB, a partir do levantamento dessas práticas junto a trabalhadores de uma UBS da região periférica do município de São Paulo. Trata-se de estudo qualitativo, de natureza descritiva e analítica, que se desenvolveu na perspectiva dialético-crítica. A coleta de dados foi realizada a partir de entrevistas semiestruturadas e individuais com 10 trabalhadores de uma UBS mista, ou seja, que atua com a Estratégia de Saúde da Família (ESF) e com o modelo tradicional de produção dos serviços de saúde. As práticas desenvolvidas pelos trabalhadores e direcionadas aos usuários de drogas são analisadas a partir da categoria analítica processo de trabalho, que permite analisar os modos e as dificuldades de operacionalização das políticas públicas nos espaços concretos de produção dos serviços de saúde. Os resultados mostram que: 1) os trabalhadores desenvolvem o processo de trabalho, na perspectiva funcionalista da moderna saúde pública, que compreende o consumo de drogas como doença e considera usuários de drogas como desviantes; 2) as práticas existentes são consideradas frágeis e os trabalhadores valorizam muito a formação técnico-clínica, que em suas opiniões proporcionaria melhores respostas para as demandas relacionadas ao uso de drogas; 3) reproduz-se um ciclo infértil de explicação sobre a incapacidade e as sensações de fracasso que tomam conta do discurso de muitos trabalhadores que lidam com demandas relacionadas ao consumo prejudicial de drogas; 4) todo o processo de trabalho parece ficar centrado num único elemento, o trabalhador em si, já que os demais elementos não se encontram estruturados para atender a demanda. Pode-se concluir que as formas como se organizam os processos de trabalho na AB e como se estrutura o processo de produção dos serviços de saúde brasileiro dificulta e/ou impede o acesso da população usuária de drogas à rede de atenção à saúde. A AB carece de elementos estruturais inerentes ao processo de produção em saúde, e da dinamicidade interna aos processos de trabalho, que favoreçam a implementação de práticas voltadas aos indivíduos e grupos sociais que usam drogas de forma prejudicial. Este trabalho contribui com a finalidade do estudo de promover denúncia em relação à fragilidade das práticas desenvolvidas na AB frente às desafiadoras e crescentes demandas relacionadas ao consumo de drogas pela população. / The object of this study was the practices developed at Primary Health Care services focused on individuals and social groups who use drugs in a harmful way. The study object derived from the theoretical framework of collective health and was constructed at the interface between public policies focused on the population that uses harmful drugs and the reality of health services. The aim of the study was to analyze the practices towards drug users at Primary Health Care based on a survey of these practices with workers of a Primary Health Center (PHC) in the outskirts of São Paulo. It is a qualitative, descriptive and analytical research developed within a critical-dialectical approach. Data were collected from semi structured interviews with 10 workers of a PHC, which has two different health care models, namely: the Family Health Strategy and the traditional model of primary health services. The practices developed by workers and directed towards drug users were analyzed from the analytical category of the work process, which allows the analysis of the modes and difficulties to operationalizing public policies as practices that take place in the real spaces of the health production process. Results show that: 1) workers develop the work process within the functionalist perspective of the modern public health, which understands drug consumption as a disease and considers users as deviants; 2) the existing practices are actually considered fragile and the workers greatly value technical and clinical training that in their opinions would provide better responses to the demands related to drug use; 3) a cycle of infertile explanation about the incapacity and the feeling of failure of the workers who deal with demands related to drug use is reproduced; 4) the entire work process seems to be focused on a single element, the workers itself since the other elements seem not to be structured. It may be concluded that the ways the work process is organized in the PHC and how the process of the Brazilian primary health services is structured makes it difficult or constitute a barrier for drug users to access the health care network. The PHC lacks structural elements inherent to the health care process and internal dynamics of the work processes that favor the implementation of practices directed towards individuals and social groups who use drugs in a harmful way. The purpose of the study is to report the fragility of the practices developed at the PHC due to the challenging and increasing demands of drug consumption.

Research on the determinants of injection drug use behavior has traditionally concentrated on factors operating at the individual level. However, more recent studies have found that behaviors surrounding injection drug use are shaped, not only by individual-level characteristics, but also by the environment in which they occur. The risk environment paradigm, proposed by Rhodes and colleagues, describes how factors exogenous to the individual influence high-risk injection behavior and blood borne virus (BBV) transmission among people who inject drugs (PWID). To date, few elements of the risk environment have been evaluated as potential determinants of high-risk injection behavior. The purpose of this dissertation was to study the influence of two elements of the risk environment on unsafe injection practices among PWID – neighborhood socioeconomic disadvantage and social discomfort surrounding the acquisition of sterile syringes from syringe exchange programs (SEPs) and pharmacies. To this end, a systematic literature review was conducted on the relation between neighborhood context and injection drug use behavior. Research gaps and methodological challenges identified in this review were used to design analyses exploring relations among neighborhood disadvantage, social discomfort, and high-risk injection behavior. These analyses were conducted using data collected from 484 PWID enrolled in the Pharmacists as Resources Making Links to Community Services (PHARM-Link) study, combined with data from the American Community Survey. Poisson regression with robust error variance was used to estimate associations between measures of neighborhood socioeconomic disadvantage and high-risk injection behavior. SEP accessibility and drug-related police activity were evaluated as potential modifiers of these relations. Similar methods were used to estimate associations between measures of social discomfort and high-risk injection behavior, including neighborhood socioeconomic disadvantage as a potential effect modifier. The systematic literature review on neighborhood context and injection drug use behavior identified few articles pertaining to this relation (n=22). Selected studies primarily investigated the influence of structural aspects of the neighborhood environment on behaviors surrounding injection drug use, while aspects of the social environment and potential modifiers of neighborhood-behavior relations were understudied. Subsequent quantitative analyses revealed that neighborhood socioeconomic disadvantage was associated with safer injection behaviors among PWID. Injectors in disadvantaged neighborhoods reported less receptive syringe sharing and less unsterile syringe use than their counterparts in relatively better off neighborhoods. Drug-related police activity attenuated associations between neighborhood disadvantage and unsterile syringe use, while the direction of associations between neighborhood disadvantage and the use of unsafe syringe sources varied with levels of SEP accessibility. In neighborhoods with high SEP accessibility, neighborhood disadvantage was associated with decreased use of unsafe syringe sources, while in neighborhoods with low SEP accessibility, neighborhood disadvantage was associated with increased use of unsafe syringe sources. Social discomfort was not associated with high-risk injection behavior, but effect modification was detected between neighborhood disadvantage and two items measuring the quality of relationships between participants and syringe staff: “Pharmacists care about my health and well-being” and “The staff at syringe exchange programs seems to care about my health and well-being.” In disadvantaged neighborhoods, participants who reported positive relationships with syringe staff were less likely to engage in receptive syringe sharing. However, in relatively better off neighborhoods, positive relationships with syringe staff were associated with increased receptive syringe sharing. Overall, the results of this dissertation support the validity of the risk environment paradigm in shaping high-risk injection behavior among PWID. Future studies should continue to investigate contextual factors as determinants of behavior surrounding injection drug use. Understanding how aspects of local-area environments influence injection risk behavior will be essential to eliminating the transmission of BBVs among PWID.

<p>The Swedish and the Finnish compulsory care legislation that regards abusers differ in several ways. The arguments for compulsory care and for the time which one will receive compulsory care are dissimilar. The aim of this thesis is to describe and analyse which arguments for compulsory care and the length of the care time that has been expressed in the Swedish and the Finnish laws and in the statutes. The tools were an argumentation analysis, which is a form of qualitative text analysis method, combined with a hermeneutic scientific position. We have investigated the arguments that try to justify compulsory care and the care time that has been expressed in the laws and the statutes. The next step has been to analyse the text on the basis of an argumentation analysis and the theories. The theoretical starting point has been Michel Foucault's concept of power and discipline, the paternalistic and utilitarian values and four ethical perspectives. Important conclusions are that Sweden’s arguments for applying compulsory care are to inhibit, in particular the young abusers, from destroying their lives. The care time, on maximum 6 months, is justified with the arguments that motivation for continued voluntary treatment will be provoked. The arguments in Finland has focused on removing the abuser from the society during an acute stage of the abuse, where the abuser’s life or somebody else’s life in the abusers environment is in danger, this can take place for maximum 30 days. Our results have pointed out that Sweden has a more paternalistic view to the compulsory care of abusers than Finland.</p>

The Swedish and the Finnish compulsory care legislation that regards abusers differ in several ways. The arguments for compulsory care and for the time which one will receive compulsory care are dissimilar. The aim of this thesis is to describe and analyse which arguments for compulsory care and the length of the care time that has been expressed in the Swedish and the Finnish laws and in the statutes. The tools were an argumentation analysis, which is a form of qualitative text analysis method, combined with a hermeneutic scientific position. We have investigated the arguments that try to justify compulsory care and the care time that has been expressed in the laws and the statutes. The next step has been to analyse the text on the basis of an argumentation analysis and the theories. The theoretical starting point has been Michel Foucault's concept of power and discipline, the paternalistic and utilitarian values and four ethical perspectives. Important conclusions are that Sweden’s arguments for applying compulsory care are to inhibit, in particular the young abusers, from destroying their lives. The care time, on maximum 6 months, is justified with the arguments that motivation for continued voluntary treatment will be provoked. The arguments in Finland has focused on removing the abuser from the society during an acute stage of the abuse, where the abuser’s life or somebody else’s life in the abusers environment is in danger, this can take place for maximum 30 days. Our results have pointed out that Sweden has a more paternalistic view to the compulsory care of abusers than Finland.

Source: Masters Abstracts International, Volume: 45-06, page: 3146. Adviser: Lu-Yu Hwang. Includes bibliographical references.

published_or_final_version / Social Work and Administration / Doctoral / Doctor of Philosophy

Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / "May 2007." Includes bibliographical references.