Bakgrund och problem: Självbestämmanderätt är en grundprincip i socialtjänstlagen och ska genomsyra allt socialt arbete. Socialtjänstlagen gör ingen skillnad på friska eller sjuka människor, vilket kan skapa dilemman för biståndshandläggare vid behovsbedömning. Syfte och frågeställningar: Studiens syfte är att uppnå en förståelse kring hur bistånds-handläggare arbetar med självbestämmanderätt och inflytande vid behovsbedömning. Studiens frågeställningar är följande: Hur ser biståndshandläggare på äldres självbestämmanderätt när det finns en bristande insikt i de egna behoven? Hur hanterar biståndshandläggare anhörigas inflytande? Metod: Studien är influerad av en kvalitativ och kvantitativ metodblandning och består av en vinjett besvarad av 24 biståndshandläggare, samtliga arbetande utifrån socialtjänstlagen inriktat mot äldreomsorg. Det insamlade empirimaterialet från biståndshandläggarna har bearbetats genom en tematisk analys. Resultat och slutsatser: Resultatet visar att biståndshandläggare menar att den äldre har självbestämmanderätt trots bristande insikt i sina egna behov. Biståndshandläggarnas utsagor visar att den moraliska aspekten att göra gott för den äldre väger tyngre än dennes självbestämmanderätt. Resultatet visar att anhöriga har ett stort inflytande och spelar en viktig roll vid behovsbedömning.

Utvärdering av Individuella utvecklingsplaner Föreliggande arbete är en utvärdering av ett system för individuella utvecklingsplaner som utgår från en bedömning av barnets behov. Detta system för individuella utvecklingsplaner ingår som en del i ett kvalitets- och utvecklingsarbete på flera nivåer. Utvärderingen bygger på intervjuer av personalgrupper inom förskola, förskoleklasser och grundskola årskurs 1 till 9 samt enkätundersökning genomförd med föräldrar och skolledare inom Kävlinge och Svalövs kommuner. Genom studien avses följande frågeställningar belysas: Är individuella utvecklingsplaner en bra metod att sätta fokus på barnets behov? Leder individuella utvecklingsplaner till ökad delaktighet för föräldrar? Leder individuella utvecklingsplaner till kvalitetsutveckling av verksamheten? Ett sammanfattande resultat av denna utvärdering är att individuella utvecklingsplaner leder till att barnets behov sätts i fokus, men att detta faktum inte med självklarhet får effekter för den verksamhet barnet vistas i. Individuella utvecklingsplaner kan inte i nämnvärd grad anses leda till ökad delaktighet för föräldrar. Individuella utvecklingsplaner som ett kvalitetsutvecklande instrument har svårt att få genomslag i förskola och skola.

<p>Abstract</p><p>Title:                                                                                                                  The individual elder care?Author:                                                                                                              Dennis JonssonSupervisor:                                                                                                        Kerstin GynnerstedtExaminator:                                                                                                       Course:                                                                                                             2SA46E,  Programme for social workDate:                                                                                                                 20100526Key words:                                                                                                       public assistance, need assessments                                                                                                                                                              methods, individual public help service</p><p>Summary</p><p>The purpose of this paper is to describe and analyze the practices of needs assessment, and put them in relation to municipal policies and the autonomy of the elderly. Development managers are characterized as grassroots bureaucrats, then they are officers who are in the organization, but also has a direct contact with the elderly applicants for municipal assistance. I wanted to explore how these policies relate to the older people's autonomy and their implications for officer assistance in their daily work. As a theoretical starting point I have used out of a närbyråkratiskt perspective, and a negotiation perspective. Study was conducted using a qualitative approach. The material for analysis were collected from six interviews with the assistance officer from six different municipalities, and an analysis of these municipalities' municipal guidelines for needs assessments. For the result shows that there are three main methods used for needs assessment. These are needs assessment calls, home visits and care planning. Something else that govern aid administrators needs assessment is the investigation finished templates available in the various municipalities. The results also showed that aid administrators are faced with a number of considerations in its work. This could depend on how the local guidelines were formulated and the elderly did not receive municipal assistance. Aid managers agreed that the autonomy of the elderly, it is applicable to a needs assessment, yet there are only a certain range of actions which they transformed into mature through negotiations and "coaxes".</p>

<p>The aim of this dissertation is to illustrate the manner in which assistance is distributed to the elderly according to the social services law in Sweden. It will focus on the processing officers/"street-level bureaucrats" who have been assigned, based on their profession, the task of assessing and deciding about the distributing of assistance. Central issues include the manner in which process officers go about their assignement and how their actual performance appears in comparision with the prescribed course of action. The dissertation´s starting pionts are in part, the legal regulations in the form of the social service law´s material and procedural rules, and in part the role as street-level bureaucrat and the construction of the client. The data which forms the basis for the conclusions of the dissertation consists of four studies conducted during the period 1995-2001. The first investigation - The Sundsvall study - is explorative and gives a first insight into how the process officers act and document the processing of a case. The process officers study is a national investigation with process officers from 27 municipalities. This second study focuses on the various ways to organise the handling process, and how these may influence the finding for assistance. The documentation study is also a national investigation of 29 municipalities. In this third study the written documentation of the case handling process is primarily exposed. Focus groups comprise the final sorce of data in which a group of processors in tree municipalities discuss their work. The process officers in the focus group describe several usual situations. With support from the various investigations, a picture appears which does not agree with prescribed course of action according to the legislation. What appears instead is a pattern of action which probably already existed before we began this work and which likely continues. This pattern of action has as we have established two faces, one of which constitutes an informal process where the actual construction of the "help-seeker" take place. Whitin the frame for this aspect, the so-called "service catalouge" has a decisive meaning, which in it´s own way is directed towards satisfying primarely physical and medical needs. The other "face" displays the formalised expresson of the informal process. This formal expression does not reveal all that is going on, only chosen elements. The action that we have found are institutionalized as an officially sanctioned institution since the practice is widely accepted and legitimized. The public intstitution is therefore built upon a pattern of action that consists both of formal rule, but primarily standards and routines which in many regards occur outside the formal rules. The consequences of a pattern of action that has been institutionalized and legitimized affects those seeking help who do not receive the individual assessment that they have a right to according to the law.</p>

The aim of this dissertation is to illustrate the manner in which assistance is distributed to the elderly according to the social services law in Sweden. It will focus on the processing officers/"street-level bureaucrats" who have been assigned, based on their profession, the task of assessing and deciding about the distributing of assistance. Central issues include the manner in which process officers go about their assignement and how their actual performance appears in comparision with the prescribed course of action. The dissertation´s starting pionts are in part, the legal regulations in the form of the social service law´s material and procedural rules, and in part the role as street-level bureaucrat and the construction of the client. The data which forms the basis for the conclusions of the dissertation consists of four studies conducted during the period 1995-2001. The first investigation - The Sundsvall study - is explorative and gives a first insight into how the process officers act and document the processing of a case. The process officers study is a national investigation with process officers from 27 municipalities. This second study focuses on the various ways to organise the handling process, and how these may influence the finding for assistance. The documentation study is also a national investigation of 29 municipalities. In this third study the written documentation of the case handling process is primarily exposed. Focus groups comprise the final sorce of data in which a group of processors in tree municipalities discuss their work. The process officers in the focus group describe several usual situations. With support from the various investigations, a picture appears which does not agree with prescribed course of action according to the legislation. What appears instead is a pattern of action which probably already existed before we began this work and which likely continues. This pattern of action has as we have established two faces, one of which constitutes an informal process where the actual construction of the "help-seeker" take place. Whitin the frame for this aspect, the so-called "service catalouge" has a decisive meaning, which in it´s own way is directed towards satisfying primarely physical and medical needs. The other "face" displays the formalised expresson of the informal process. This formal expression does not reveal all that is going on, only chosen elements. The action that we have found are institutionalized as an officially sanctioned institution since the practice is widely accepted and legitimized. The public intstitution is therefore built upon a pattern of action that consists both of formal rule, but primarily standards and routines which in many regards occur outside the formal rules. The consequences of a pattern of action that has been institutionalized and legitimized affects those seeking help who do not receive the individual assessment that they have a right to according to the law.

Abstract Title:                                                                                                                  The individual elder care?Author:                                                                                                              Dennis JonssonSupervisor:                                                                                                        Kerstin GynnerstedtExaminator:                                                                                                       Course:                                                                                                             2SA46E,  Programme for social workDate:                                                                                                                 20100526Key words:                                                                                                       public assistance, need assessments                                                                                                                                                              methods, individual public help service Summary The purpose of this paper is to describe and analyze the practices of needs assessment, and put them in relation to municipal policies and the autonomy of the elderly. Development managers are characterized as grassroots bureaucrats, then they are officers who are in the organization, but also has a direct contact with the elderly applicants for municipal assistance. I wanted to explore how these policies relate to the older people's autonomy and their implications for officer assistance in their daily work. As a theoretical starting point I have used out of a närbyråkratiskt perspective, and a negotiation perspective. Study was conducted using a qualitative approach. The material for analysis were collected from six interviews with the assistance officer from six different municipalities, and an analysis of these municipalities' municipal guidelines for needs assessments. For the result shows that there are three main methods used for needs assessment. These are needs assessment calls, home visits and care planning. Something else that govern aid administrators needs assessment is the investigation finished templates available in the various municipalities. The results also showed that aid administrators are faced with a number of considerations in its work. This could depend on how the local guidelines were formulated and the elderly did not receive municipal assistance. Aid managers agreed that the autonomy of the elderly, it is applicable to a needs assessment, yet there are only a certain range of actions which they transformed into mature through negotiations and "coaxes".

Bakgrund: Närståendestöd är en av de fyra hörnstenarna för god palliativ vård. Sjuksköterskor inom palliativ vård ska identifiera och bedöma behov hos närstående. Specialistsjuksköterskor inom palliativ vård ska arbeta för utveckling, kvalitetssäkring och implementering av validerade metoder för bedömning av behov. Studier har visat att närstående har behov som sällan bedöms med strukturerade metoder. Enligt de befintliga riktlinjer som finns i Sverige för palliativ vård ska närståendes behov bedömas, men det finns inga rekommenderade metoder.  Syfte: Syftet var att beskriva metoder som sjuksköterskor kan använda för identifiering av närståendes behov.  Metod: En litteraturöversikt har genomförts där både kvantitativa och kvalitativa artiklar har använts i resultatet. Narrativ syntes har använts för att analysera resultaten från artiklarna, med inspiration från guiden av Popay et al. (2006).  Resultat: Fyra instrument för bedömning av närståendes behov har identifierats. Carer Support Needs Assessment Tool (CSNAT), Needs Assessment Tool (NAT), Carer Alert Tool (CAT) och Family Inventory of Needs (FIN). Fyra teman framkom i syntetiseringen: bedömningsinstrumentens användbarhet, bekräftar närstående, öppnar upp för kommunikation samt lyhördhet har betydelse.  Slutsats: Denna litteraturöversikt tillför en översikt över befintliga metoder för att bedöma närståendes behov. Av de fyra instrumenten som identifierades bedömdes CSNAT ha starkast evidens. Regelbunden användning av CSNAT kan bidra till en mer jämlik vård för närstående. Bedömningen med CSNAT skulle även medföra att aktuella riktlinjer för närståendestöd inom palliativ vård följs. / Background: In palliative care there are four cornerstones, one of them is support of the next of kin. Nurses in palliative care should identify and assess the needs of next of kin. Specialized nurses in palliative care should work for the development, quality assurance and implementation of validated methods for assessing needs. Studies have shown that next of kin have needs that are rarely assessed with structured methods. According to the existing guidelines in Sweden for palliative care, the needs of next of kin must be assessed, but there are no recommended methods.  Aim: The aim was to describe methods that nurses can use to identify the needs of next of kin.  Method: A literature review has been carried out where both quantitative and qualitative articles have been used in the result. Narrative synthesis has been used to analyze the results from the articles, with inspiration from the guide by Popay et al. (2006). Results: Four instruments for assessing the needs of next of kin have been identified. Carer Support Needs Assessment Tool (CSNAT), Needs Assessment Tool (NAT), Carer Alert Tool (CAT) and Family Inventory of Needs (FIN). Four themes emerged in the synthesis: The usefulness of the assessment instruments, confirms next of kin, opens up for communication and sensitivity matters.  Conclusion: This literature review provides an overview of existing methods for assessing the needs of next of kin. Of the four instruments identified, CSNAT was estimated to have the strongest evidence. Regular use of CSNAT can contribute to a more equal care for next of kin. The assessment with CSNAT would also mean that current guidelines for support of next of kin in palliative care are followed.

The purpose of this study was to understand, by means of Connell’s and Hirdman’s gender theories, whether the older persons’ gender as well as the family situation affect the assessments in elderly care. Previous studies show that social workers do not consciously take gender into consideration, while also showing that gender is important for the assessment and decision. Based on the purpose, we asked the questions how are the assessments of care managers affected by the gender of older persons and in what way are the assessments of care managers affected by older persons family situation? This study was based on eight interviews with care managers in eldery care. The result was divided into the following two main themes assistance management and the older person. Connell’s and Hirdman’s gender theories helped us answer our main questions and analyze our result. The result showed that the unaware subconscious ideas of male and female, older persons’ perceptions of male and female as well as the elderly’s division of different chores in the household are affecting the care managers’ needs assessments in such a way that men and women are granted and apply for different assistance. Depending on who needs help in a couple, if the older person lives alone or with someone as well as other families’ perceptions of what the husband and wife are capable of doing affects the needs assessments of care managers.

The purpose of this study is to understand how eldercare managers, in their assessments of home care, needs to make individual decisions and at the same time keep to municipality’s guidelines. Our research questions deal with how eldercare managers make individual assessments and at the same time consider general municipality’s guidelines in their estimations of need for homecare assistance and how eldercare managers experience that individual assessments and general municipal guidelines relate to each other in estimations of needs for homecare assistance. Nine qualitative, semi-structured interviews were conducted with social workers working with needs assessments within the eldercare. The results were analyzed through Lipsky’s theory on street-level bureaucracy and the concept of discretion. Our main conclusions from this study is that it is a complex work to estimate needs for homecare assistance when considering both individual assessments and general municipal guidelines. Our results showed that the needs of the individual are more important in the cases where guidelines and the person’s needs differ. Our study also showed that the eldercare managers, as a rule, follow the guidelines as long as they coincide with the assessment of individual needs, but the guidelines function as a guidance and not as something definite. The eldercare managers don’t feel that the relation between municipality guidelines and individual decisions is a problem. The complexity was rather evident in the lack of judicial security and justice in the work with the assessment of individual needs.

I dagsläget finns det forskning om socialsekreterares handlingsutrymme. Men det saknas forskning som besvarar frågan hur socialsekreterare upplever sitt handlingsutrymme givet de organisatoriska utmaningar som tidigare forskning belyser. I relation till detta saknas forskning som mer specifikt analyserar vilka organisatoriska faktorer och sammanhang som påverkar handlingsutrymmet att agera som policy makers. Den här studien bidrar till att fylla detta forskningsglapp genom att genomföra kvalitativa intervjuer med socialsekreterare. För att vidare tolka det empiriska materialet med hjälp av ett teoretiskt ramverk byggt på Michael Lipskys teori om gräsrotsbyråkrater som policy makers och Roine Johanssons vidareutveckling av Lipskys teoretiska ramverk. Syftet med denna studie har varit att undersöka socialsekreterares upplevelse av vad som påverkar deras handlingsutrymme att utreda och bedöma risk och behov för barn och unga som riskerar att begå eller återfalla i brott. Detta upplevda handlingsutrymme har vidare tolkats och förståtts med hjälp av Johanssons tre teoretiska begrepp grad av regelbundenhet, specialiseringsgrad och avstånd. Begreppen topdown och bottom-up perspektiv används för att förstå hur gräsrotsbyråkratens,handlingsutrymme skapas i mötet mellan organisationens bestämmelser, riktlinjer och praxis (top-down) och deras egen möjlighet att tolka och tillämpa dessa riktlinjer och praxis (bottomup). För att besvara syftet har sex kvalitativa intervjuer med socialsekreterare från den sociala barn- och ungdomsvården genomförts. Studiens resultat visar att det som påverkar socialsekreterarnas upplevda handlingsutrymme är förankrat i vilken grad de ges möjlighet att anta rollen som policy makers eller inte. Vår studie har uppmärksammat gräsrotsbyråkraten, i det här fallet socialsekreteraren, som möter klienten och som samlar in underlaget för en riskoch behovsbedömning. Deras upplevelser är betydelsefulla för att se över det organisatoriska sammanhanget inom socialförvaltningar. Detta för att möjliggöra risk- och behovsbedömningarna som i enlighet med socialnämndens uppdrag verkar för att barn och unga växer upp under goda och trygga levnadsförhållanden.