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Samordnad individuell plan (SIP): Professionellas samt barn och föräldrars erfarenheter
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
2016 (Swedish)Licentiate thesis, comprehensive summary (Other academic)Alternative title
Coordinated Indivdual Plan (CIP) - professionals’, children and parents’ experiences of coordinated individual plan (CIP) (English)
Abstract [sv]

Introduktion. Många barn och unga idag har så pass komplexa behov att de behöver samtidiga insatser från olika huvudmän. Insatserna blir alltmer specialiserade och fragmenterade, vilket kräver att professioner inom hälso- och sjukvård, socialtjänst och skola samverkar. Det finns också ett lagstiftat krav sedan 2010 på samverkan i form av Samordnad individuell plan (SIP). SIP möjliggör för barn och föräldrar att få överblick och få samordnade insatser av hälso- och sjukvården och socialtjänsten genom möte, planering och dokumenterade insatser.

Syftet med avhandlingen var att beskriva professionellas, barn och föräldrars erfarenhet av samordnad individuell plan (SIP).

Design och metod. Två deskriptiva studier genomfördes i ett län i södra Sverige. Delstudie 1 bestod av tolv fokusgruppsintervjuer med sammanlagt 71 personer med olika yrkeskategorier inom hälso- och sjukvården, socialtjänsten och skolan. Delstudie 2 bestod av semi-strukturerade intervjuer med sammantaget tretton barn och föräldrar från olika familjer. Bägge studierna analyserades med kvalitativ metod.

Resultat. Resultatet i delstudie 1 visar att verksamheterna gör en primär avvägning mellan samverkan och sitt respektive kärnuppdrag; vårdande, pedagogisk och utredande. Samverkan skedde genom en pendling mellan hindrande och främjande faktorer. Hindrande faktorer består av olika mandat och behov, tvång till närvaro, ifrågasättande och klander, samt tidsramar och prioriteringar. Främjande faktorer är likartad tolkning av gemensamma avtal, ömsesidig respektoch kollegialt lärande, gemensam terminologi och dokumentation, samt intresse för samverkan. Delstudie 2 visar att barn och föräldrars upplevelse av delaktighet i form av SIP ökade över tid och att de över tid upplevde att de fick ett samordnat stöd från olika vårdgivare, som barnen och/eller föräldrarna innan SIP ofta själva fick samordna. Detta mål uppnåddes först efter initialt motstånd och konkurrens mellan olika verksamheter, och det underlättade att skapa relationer och allianser med professionella för att nå detta mål. Resultatet diskuteras utifrån fyra olika stadier av samverkan och förutsättningar för att intentionerna med SIP avseende delaktighet skall uppnås.

Konklusion och praktiska implikationer. SIP tycks ha potential att bidra till en förbättrad samverkan om de professionella visar ömsesidig kollegial respekt och har fokus på barn och föräldrars behov. Detta kan lättare uppnås om professionella inte lägger för stor vikt vid skydda den egna verksamhetens agenda istället för en samverkansagenda. Detta bekräftas av delstudie 2 som visar att barn och föräldrar uppfattar att det finns intentioner att göra brukaren delaktig, men att denna intention hindras av oenighet, skilda intentioner och bristande samsyn mellan verksamheter, och barn och föräldrar får utstå förvirring och fragmentering av insatserna under lång tid, vilket kan utsätta barnet för risker. Om SIP skall bli det verktyg för helhetslösning och brukardelaktighet som det är avsett att vara, så behöver de berörda professionerna uppnå en bredare samsyn kring SIP för att uppfylla intentionen med en samverkan med utökad brukardelaktighet.

Abstract [en]

Introduction. Many children and adolescents today have complex needs which require simultaneous action by the two principal’s health care and social services. There is also a legislated requirement since 2010 on interaction in the form of Coordinated Individual Plan (CIP). CIP allows children and parents to get an overview and make concerted efforts of health and social services through the meeting, planning and documented efforts.

The aim of the thesis was to describe professionals’, children and parents’ experiences of coordinated individual plan (CIP). Paper 1 consists of a qualitative analysis of 12 filmed and transcribed focus group interviews with a total of 71 staff with different professions in health care, education and social services about their experiences of CIP. Paper 2 consists of a descriptive qualitative interview study with 13 participants (3 children, 10 parents).

Result of paper 1 indicates that the participants act according to their core mission: nurturing, teaching and investigation.

Result of paper 2 shows that children and parents experience of participation in the form of CIP increased over time and enabled a coordinated support from various health care providers, that children and/or the parents often had to coordinate themselves before CIP.

Conclusions and practical implications. The analysis of paper 1 indicates that CIP was perceived as alternating between, on the one hand, a pro-active and service-focused tool, and on the other hand, a competing and compelling professional instrument. CIP seems to have the potential to contribute to an improved collaboration if the professional shows mutual peer respect and has a focus on children’s’ and parents' needs, in that they do not put too much emphasis on protecting their own business agenda instead of a partnership agenda. This is confirmed by paper 2 which shows that children and parents perceive that there are intentions to make the service user involved, but that this intention is hampered by disagreements, differences of intentions and lack of consensus between professionals, and children and parents may suffer confusion and fragmentation of efforts over a long period of time, which may put the child at risk. The service users need for coordination is limited by professionals’ exercise in power. The importance of good relations and personal support to accomplish functional coordination is outlined. If CIP will become the tool for comprehensive settlement and service user participation as it is meant to be, the relevant professions need to achieve a broader consensus on CIP to comply with the intent of a collaboration with expanded user participation.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2016. , 79 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 71
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:hj:diva-31223ISBN: 978-91-85835-70-6OAI: oai:DiVA.org:hj-31223DiVA: diva2:951970
Presentation
2016-09-05, School of Health and Welfare, Jönköping, 13:00
Opponent
Supervisors
Available from: 2016-08-11 Created: 2016-08-11 Last updated: 2016-08-12Bibliographically approved
List of papers
1. Agenda för samverkan eller verksamhetens agenda? Om professionellas erfarenheter av samverkan enligt samordnad individuell plan (SIP)
Open this publication in new window or tab >>Agenda för samverkan eller verksamhetens agenda? Om professionellas erfarenheter av samverkan enligt samordnad individuell plan (SIP)
2016 (Swedish)In: Socialvetenskaplig tidskrift, ISSN 1104-1420, no 1, 1-22 p.Article in journal (Refereed) Published
Abstract [en]

Agenda for collaboration or an agency agenda? Professionals’ experiences of colla­boration according to a coordinated individual plan (CIP)

An increasing number of children and adolescents develop complex needs that require simultaneous action by different professionals. Several reports state that efforts for these children and adolescents have become increasingly specialized and fragmented. Since 2010, there are statutory requirements for collaboration according to a coordinated individual plan (SIP) between health care and social services. Pre-school and school can after regional agreement be involved in the co-ordination as equal partner. Collaboration in line with CIP is expected to offset the fragmentation for benefit of the service users’ ability to monitor and comprehend interventions. The aim was to investigate professionals’ experiences of CIP. The study consists of qualitative analysis of 12 focus group interviews with a total of 71 staff with different professions in health care, education and social services about their experiences of CIP. The results indicate that the participants act according to their core mission: nurturing, teaching and investigation. Two main categories with four sub-categories each appeared in the analysis. The main category, hindering factors, contains the categories: different mandates and requirements, requirements for presence initiative, questioning and censure, and timelines and prioritization. The main category of facilitating factors contains the categories: similar interpretation of common agreement, mutual respect and shared learning, common terminology and documentation, and willingness to collaborate. The analysis indicate that CIP was perceived as alternating between, on the one hand, a pro-active and service-focused tool, and on the other hand, a competing and compelling professional instrument.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-30943 (URN)
Available from: 2016-06-29 Created: 2016-06-29 Last updated: 2016-08-11Bibliographically approved
2. "We found a solution, sort of”: qualitative interview study withchildren and parents on their experiences of the coordinatedindividual plan (CIP) in Sweden
Open this publication in new window or tab >>"We found a solution, sort of”: qualitative interview study withchildren and parents on their experiences of the coordinatedindividual plan (CIP) in Sweden
(English)Article in journal (Other academic) Submitted
Keyword
alliances, children, coordinated individual plans, coordination, service user involvement
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-31222 (URN)
Available from: 2016-08-11 Created: 2016-08-11 Last updated: 2016-08-11

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