In Sweden, all school staffs are obligated to notify suspected of child abuse or neglect. The study's purpose is to investigate how the notification requirements in Social Services Act, chapter 14, section 1, are applied in primary schools and how to best collaborate among the team of professionals responsible for dealing with suspected child neglect or abuse. The study's research question is: How do the various professions at school (apart from the teachers) deal with suspicions of child neglect or abuse? How does this affect the school management and structural management of suspected neglect? How is the report prepared and submitted to the social services? The results are based on in-depth interviews with nine people of different professions within the school health. Collaboration within the pupil health team worked mainly very well, but in one case, it did not work well at all. Many times, however, it was a lack of communication between student health teams and the teachers. The main conclusion of the study is that the importance of a well-functioning student health team is of paramount importance for dealing correctly with suspected child neglect. Firstly, this is best achieved by ensuring the quality training for school heads in matters relating to the notification obligation. Secondly, the student health personnel have to be well known faces among the teachers. Thirdly, it is crucial that horizontal cooperation is initiated by the principal. Fourthly, it also emerged that team members, teachers and other staff within the school has to be continuously updated with the details of the notification requirement.

Bakgrund: Sedan år 2000 har andelen barn i åldrarna 6–15 år som erhåller vård vid psykiatrisk inrättning stadigt ökat. Upptäckten av psykisk ohälsa hos barn är beroende av att människor i barnets närhet såsom föräldrar, sjukvård eller skola noterar ett ökat behov av stöd. Skolsköterskan har en unik möjlighet att tidigt upptäcka psykisk ohälsa hos barnen. Syfte: Syftet var att beskriva skolsköterskors erfarenheter av elever med psykisk ohälsa.  Metod: En intervjustudie med kvalitativ design genomfördes. 13 kvinnliga specialistsköterskor i åldrarna 33 – 69 år från södra och mellersta Sverige intervjuades. Intervjuerna genomfördes digitalt och på plats samt analyserades enligt Graneheim och Lundmans innehållsanalys. Resultat: Resultatet presenteras i fyra kategorier: Skolsköterskans erfarenheter av psykisk ohälsa, Skolsköterskans professionalitet, Förutsättningar för god psykisk hälsa och Stödjande samverkan för eleven. Det framkom att psykisk ohälsa yttrade sig på olika sätt. Skolsköterskorna saknade djupare kunskap i bemötande av psykisk ohälsa. Trygghet var en förutsättning för god psykisk hälsa. Vikten av fungerande stödjande samarbete med familj och sjukvård påtalades. Slutsats: Mer undervisning kring psykisk ohälsa behövs i specialistutbildningen till skolsköterska, samt större tillgång av resurser i elevhälsan. Psykisk ohälsa inleds oftast i hemmiljön varför det behövs resurser på samhällsnivå för att möta eleverna redan i hemmet. / Background: During the 21st century there has been a steady increase of children, between 6-15 years old, who have received psychiatric care. Children do not seek psychiatric treatment for mental illness of their own accord. The detection of mental illness in children depend on people in their surroundings, such as parents, medical- or school personal, to express the need of increased support. The school nurse has a unique opportunity to detect mental illness in children at an early stage. Aim: The aim was to describe nurses’ experiences of pupils with mental illness.  Method: An interview study with qualitative design was conducted. 13 female specialist nurses’ ages 33 - 69 years from southern and central Sweden were interviewed. The interviews were conducted digitally and on site and analyzed according to Graneheim and Lundman's content analysis. Result: Four categories emerged: Nurses’ Experience of mental illness, The school nurse’s professionalism, Prerequisites for good mental health and Supportive collaboration for the pupil. Mental illness is expressed in different ways. The school nurses lacked a deeper knowledge in dealing with mental illness. Safetiness was a prerequisite for good mental health. The importance of effective cooperation with family and healthcare was emphasized. Conclusion: The residency needs more education concerning mental health problems, as well as greater access to resources in student health. Mental health issues usually initiate in home environments, hence means to connect with pupils at home are necessary at society level.

I denna studie med syftet att beskriva hur rektorer verksamma inom årskurs 7-9 upplever sitt arbete att leda och samordna elevhälsan kopplat till utbildningen mål, har 14 rektorer och biträdande rektorer deltagit i en enkätundersökning. De underliggande frågorna som utforskas i studien är hur rektorerna beskriver sin egen roll inom elevhälsan, vilka verktyg de använder för att styra mot utbildningens mål, hur beskriver de samverkan mellan elevhälsan och övrig personal och i vilken omfattning de upplever att elevhälsans kompetens används hälsofrämjande, förebyggande och åtgärdande. Studien har utformats utifrån ett systemteoretiskt perspektiv. Enkät har använts som metod där rektorerna med egna ord har fått beskriva sitt arbete kopplat till elevhälsa. Resultatet visar att det finns en stor variation hur elevhälsa organiseras i skolor och kommuner vilket påverkar rektors roll. Alla rektorer är inte chef för alla eller vissa av elevhälsans professioner och får då uppdrag från centralt håll som rektor inte kan påverka. Elevhälsans arbete är dock något som de prioriterar och anser vara viktigt, både för måluppfyllelse men även elevernas personliga utveckling. Det framkommer dock att begreppet elevhälsa har olika innebörder, då det kan tolkas som de lagstadgade professionerna inom elevhälsa men det kan även beskriva ett tillstånd som alla som arbetar i skolan ska försöka uppnå. För att skapa samverkan mellan elevhälsan och övrig personal beskrivs olika former av möten som kan ha både formell och informell karaktär. De hinder som beskrivs handlar om tid och bristande förståelse för varandras uppdrag. Rektorerna upplever att samtliga professioner inom elevhälsan främst används åtgärdande, även om de själva har intentionen att arbetet ska ha ett hälsofrämjande och förebyggande perspektiv. Den psykologiska kompetensen är den som beskrivs användas minst inom samtliga områden medan den specialpedagogiska kompetensen hamnar högst. / In this study, with the aim of describing how principals working in grades 7-9 experience their work to lead and coordinate student health linked to the educational goals, 14 principals and assistant principals have participated in a survey. The underlying intension is to explore how the principals describe their own role in student health, what tools they use to steer towards the goals of education, how they describe the interaction between student health teams and other personal and the extent to which they feel that the competence of student health is used for health promotion, prevention and remediation. The study has been designed from a system theoretical perspective. Questionnaires have been used as a method where the principals in their own word had to describe their work related to student health. The result shows that there is a great variety of how student health is organized in schools and municipalities, which affects the role of the principal. Not all principals are the head of all or some of the student health professions and are then commissioned from central sources which the principal cannot affect. The work of student health is, however, something that they prioritize and consider important, both goal effectiveness but also for the personal development of the students. However, it appears that the concept of student health has different meanings, as it can be interpreted as the statutory profession in student health, but it can also describe a condition that everyone who works in the school should try to achieve. To create interaction between student health and other staff, different forms of meetings are described that can have both a formal and informal character. The obstacles described are about time and a lack of understanding of each other’s tasks. The principals feel that all the professions in student health are primarily used remedying, although they themselves have the intention that the work should have a health promoting and preventive perspective. The psychological competence is the one described to be used least in all areas, while special education skills are used the most in all areas.

Tidigare forskning visar samband mellan psykisk ohälsa bland grundskoleelever och höga krav i skolan, samt stressen som detta medför. En viktig del i skolans hälsofrämjande och förebyggande arbete är elevhälsoteamen, vars centrala uppgift är att medverka till att stärka elevernas hälsa. Syftet med denna studie var att undersöka svenska elevhälsoteams erfarenheter av psykisk ohälsa bland grundskoleelever. För att besvara syftet användes kvalitativ metod i form av åtta individuella forskningsintervjuer med olika professioner inom ett flertal elevhälsoteam i grundskolan. En innehållsanalys utfördes med hjälp av teorin känsla av sammanhang (KASAM). Resultatet visade att det ofta är flertalet samverkande faktorer som leder till att en ung människa utvecklar psykisk ohälsa, och att det ofta handlar om krav och stressen som kraven medför. Studiens slutsats är att det finns en hel del metoder och sätt att arbeta hälsofrämjande inom skolvärlden, exempelvis genom att stärka föräldrar i sin roll, eller genom undervisning i värdegrundsarbete. Tiden räcker dock inte till på grund av bristande resurser i form av ekonomi och arbetskraft. Det är av vikt att få till förändringar som resulterar i att mer tid kan läggas på hälsofrämjande och förebyggande arbete för att kunna förbättra den psykiska hälsan bland eleverna i ett långsiktigt perspektiv. / Previous research shows a connection between mental illness among compulsory school students and high demands within school, as well as the stress that this entail. An important part of the school's health promotion and prevention work are the student health teams, whose central task is to contribute to strengthening students' health. The purpose of this study was to investigate Swedish student health teams' experiences of mental illness among compulsory school students. To answer the purpose, a qualitative method was used in the form of eight individual research interviews with different professions within several student health teams in compulsory school. The results of this study were analyzed using the theory sense of coherence (SOC). The results showed that there are often several interacting factors that lead to a young person developing mental illness, and that it is often about demands and the stress that the demands entail. The study's conclusion is that there are a lot of methods and ways of working to promote health within the school world, for example by strengthening parents in their role, or by teaching students about basic values. However, there is often not enough time due to a lack of resources in terms of finances and manpower. It is important to bring about changes that result in more time being spent on health promotion and prevention work to improve the mental health among students in a long-term perspective.

Syftet med undersökningen är att öka kunskapen om skolors elevhälsoarbete utifrån beskrivningar från medlemmar i tre elevhälsoteam. Det är medlemmarnas berättelser om elevhälsoarbetets organisation, meningsskapande insatser och utvecklingsområden som är utgångspunkten i studien. I undersökningen ingår tre skolors elevhälsoteam kallade X, Y och Z. Skolorna kommer från tre olika kommuner. Det är en undersökning med kvalitativ data från observationer, intervjuer och dokumentanalys av tre elevhälsoplaner. De teoretiska utgångspunkterna är teorin om praktikgemenskap samt det kommunikativa relationsskapande perspektivet, som är ett specialpedagogiskt perspektiv. Båda har sin grund i den sociokulturella teoribildningen, där samspel och kommunikation utgör grunden i lärandet. I den föreliggande studien visar resultatet både likheter och variationer i medlemmarnas beskrivningar av skolornas elevhälsoarbete. Det framkommer i undersökningen att tydliga mål, uppdrags- och ansvarsfördelning, samt samspel i elevernas lärmiljö är några av förutsättningarna för ett framgångsrikt elevhälsoarbete, vilket också överensstämmer med tidigare forskning. / The aim of this study is to increase the knowledge about schools' student health care work based on the experiences of members in three student health teams. The core of this study is the members' stories about the student health care´s organization, intentional actions and the areas of development. The study includes three schools' student health care teams called X, Y and Z. The schools are from three different municipalities. The empirical research consists of qualitative data from observations, interviews and document analysis of three student health plans. The theory of community of practice and the communicative relational perspective are the theoretical foundations in the study. Both of them are founded on the socio-cultural theory in which interaction and communication are basis for learning. In the study, the results show both similarities and variations in the members' stories of the schools' student health care work. The results show that clear goals, distribution of roles and responsibilities, as well as interaction in the students' learning environment are some of the conditions or a successful student health care, which is in line with previously conducted research.

There are various health promotion and preventive measures that can be done in schools. Creating accessible learning environments is such a way. In this qualitative study interviews are made with professionals in School Health Teams on what they think is important in the process of creating accessible learning environments for pupils with neuropsychiatric disorders. The results show that the different perspectives as well as the way in which the different professionals work in Student Health Teams affect the orientation of the work in Student Health Teams. It affects whether the efforts become general or individual and whether they become promotion, prevention or remedial action. The Lundin model - the pyramid of change (2017) that describes a possible way of running an accessibility work has proved to be partly in line with the informants' percep-tions. I have revised the model to include the National Agency for Education's definition of ac-cessible learning environments that also include socially and educationally accessible learning environment. The results show the need to raise the level of knowledge of the staff and the need to work with their core values because they affect the way the teachers treat pupils, and the op-portunities to make the school more accessible physically, pedagogically and socially. The study also shows practical examples of ways of making the learning environment accessible and that efforts that are good for students with neuropsychiatric disorders are good for all students. Suc-cessful perspectives for the work with accessible learning environments have proven to be a re-lational perspective and a salutogenic perspective. What all occupational groups emphasized was the importance of relationships and creating structure and comprehensibility for students with neuropsychiatric disorders, as well as for all other pupils. The empirical material is grouped under three themes: Awareness and approach, Accessible learning environments - in practice and Di-lemmas and governance. These themes also show that the revised model also needs to include dynamic aspects of change work as well as dilemmas and governance. The result also shows the need to obtain views from more types of informants such as pupils, teachers, principals and other staff.

Att lyckas i skolan är den viktigaste faktorn för att också lyckas i livet och är än mer viktig för elever som har diagnosen adhd, eftersom de har större risk att hamna i en negativ livsspiral. Skolan har ett kompensatoriskt uppdrag och specialpedagogen kan vara en viktig del i att hjälpa till med att skapa en integrerad och bra lärmiljö för elever med diagnosen adhd. Elevhälsoarbetet i skolan förutsätter en hög grad av samverkan med olika interna och externa aktörer. Barn- och ungdomspsykiatrin är en av dessa. Syftet med denna studie är att belysa personalens beskrivningar av framgångsfaktorer och utmaningar i samarbetet mellan personal, på barn- och ungdomspsykiatrin och skolors elevhälsa, för att kunna stödja elever som har diagnosen adhd i deras utveckling och lärande. Den här kvalitativa studien bygger på intervjuer med personal från dessa verksamheter. Intervjuerna bestod av både fokusgruppsintervjuer och individuella semistrukturerade intervjuer. Intervjuerna transkriberades och sammanställdes utifrån studiens frågeställningar. Studiens urval var målinriktad och gjordes enligt bekvämlighetsprincipen. Informanterna från elevhälsan arbetade i en glesbygdskommun och deltagarna från barn- och ungdomspsykiatrin var verksamma i en stad men samverkar med informanterna i elevhälsan. Resultatet i studien visar att både skolan och barn- och ungdomspsykiatrin tycker att samverkan och samarbete mellan parterna är viktiga och nödvändiga. De största utmaningarna i samverkan tycks vara otydliga ramar för hur samarbetet ska fungera och oklarheter kring de olika professionernas uppdrag. De långa väntetiderna till barn- och ungdomspsykiatrin skapar också oro vid samverkan. I studien framkom också att samverkan i glesbygdskommuner innebär försvårande omständigheter. Resultatet tyder på att tydligare samverkansavtal bör arbetas fram och att all berörd personal bör göras delaktiga. / Success in school is the most important factor for success in life, and it is even more important for students with an ADHD-diagnosis, since they are in more danger of developing a negative spiral in life. Education has a compensatory duty and teachers in special education can be an important part in helping to create an integrated and meaningful learning environment for students with an ADHD-diagnosis. The work with the student health team within a school demands a high degree of cooperation between different internal and external players. BUP (child and adolescent psychiatry), which provides specialist care for children with mental health problems, is one of these players. The intention of this paper is to illustrate the personnel’s descriptions of not only the factors for success but the challenges as well, when it comes to the cooperation between the school´s student health team and BUP´s work to support students with the ADHD-diagnosis with their development and their learning. This qualitative study is based on interviews with personnel from these different arenas. The interviews where made with both focus groups, as well as semi structured interviews. The interviews where transcribed and compiled based on the intentions of this study. The selection was targeted and made according to the comfort principle. The informants from the student health team worked in a rural municipality, while the participants from BUP where based in a nearby city, but worked with the informants from the student health team. The result of the study shows that the school, as well as, BUP believes that cooperation and collaboration between these different arenas are important and necessary. The main challenges seem to be the lack of a defined framework that specifies how the cooperation should work as well as confusion about the responsibilities of the different professions. The long wait to BUP is also a cause for concern while striving for cooperation. The study also showed that cooperation within rural municipalities involves complicating circumstances. The result indicates that more clearly defined frameworks for cooperation should be developed and that all concerned personnel should be involved.

Bakgrund: Andelen elever med problematisk skolfrånvaro ökar, och i takt med det ökar efterfrågan kring ökad kompetens hur skolan kan arbeta tillbaka dessa elever. I detta arbete är elevhälsans professioner och däribland skolsköterskans roll en viktig del. Skolsköterskan har genom sin yrkesroll kunskap om hälsa, hälsoproblematik samt fysisk och psykisk ohälsa. Syfte: Syfte är att beskriva skolsköterskors erfarenheter av att arbeta med elever som har problematisk skolfrånvaro. Metod: Datamaterialet insamlades genom enkät och sammanlagt 19 skolsköterskor besvarade frågeformuläret. En induktiv ansats valdes där datamaterialet analyserades med kvalitativ innehållsanalys. Resultat: Ur datamaterialet framträdde temat säkra en ömsesidig tillit, tre kategorier; anlitas som specialistkompetent, lättillgänglig och insatt i situationen, samordnande länk samt sex underkategorier. Slutsats: Skolsköterskorna upplever att de sällan är delaktiga, varken i det förebyggande eller i det direkta arbetet, med elever som har en problematisk skolfrånvaro utöver att de informeras via elevhälsoteamet. Skolsköterskor är delaktiga i arbetet om det föreligger fysisk eller psykisk orsak till frånvaron. / Background: The proportion of students with problematic school absenteeism is increasing, and in step with this, the demand for increased competence is increasing as to how the school can work back these students. In this work, the student health professions, including the role of the school nurse, are an important part. Aim: Aim is to describe school nurses´ experiences of working with students who have problematic school absence. Method: The data material was collected through a survey and 19 school nurses answered the questionnaire. An inductive approach was chosen where the data material was analyzed with qualitative content analysis. Results: From the data material, the theme of securing mutual trust emerged, three categories; hired as a specialist competence, easily accessible and familiar with the situation, coordinating link and six subcategories. Conclusion: The school nurses experience that they are rarely involved, neither in the prevention nor in the direct work, with students who have a problematic school absence in addition to being informed via the student health team. School nurses are involved in the work if there is a physical or mental reason for the absence.

The aim of the study was to investigate how staff in student health teams at high school perceives how the pressure to perform socially in the social arena of school affects the students and how staff prevent, or perceive that they should work preventively against this. The study is based on eight qualitative, semi-structured interviews with staff from student health-teams at high schools. The collected data was analyzed using thematic analysis. The results show that staff from the student health-teams perceived that students may feel pressure and stress to live up to some form of expectations set by themselves and others. This can lead to psychosomatic issues, condescending thoughts and self-valuations. The results also show that preventive work can focus on making norms visible and talk about what they mean and how they affect us. That can give the students an understanding of what unconsciously affects them and their well-being. / Syftet med studien var att undersöka elevhälsans uppfattningar av hur pressen att prestera socialt, i skolan som social arena, yttrar sig hos eleverna, samt hur personalen arbetar, eller uppfattar att de bör arbeta förebyggande mot social prestationspress. Åtta kvalitativa, semistrukturerade intervjuer genomfördes med personal ur elevhälsoteam på gymnasieskolor. Den insamlade empirin analyserades med hjälp av tematisk analys. Resultatet visar att personal ur elevhälsoteam uppfattar att elever kan känna press och stress att leva upp till någon form av förväntan från sig själva och andra. Det kan yttra sig i psykosomatiska besvär och nedlåtande tankar och värderingar om sig själv. Resultaten visar även att det förebyggande arbetet kan fokusera på att synliggöra normer och prata om vad de betyder och vad de gör med oss. Detta för att ge eleverna en större förståelse för vad som omedvetet kan påverka dem och deras välmående.

The purpose of this study has been to examine and analyze school counselors’ experience of collaboration with other professions in the student health team and the preconditions for their work. The study is based on qualitative semi-structured interviews with six elementary-, and two high school student counselors in a medium-sized town in Sweden. The theoretical approach being used is: role theory, theory of professions and theory about collaboration. The study´s result shows that the school counselors’ experience an unclarity in their job assignments and their role is often described as diffuse and vauge. Furthermore, the result also shows that personality, different perspectives, education, lack of time, resources and confidentiality is affecting their possibility to execute an independent professional social work in the student health team. This study also shows that the school counselors valuate collaboration. A opportunity that sometimes is being obstructed through the different perspectives as compared to the other professions in the student health team, and therefore affects their experience of collaboration.