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The role of personligt ombud in supporting the recovery process for people with psychiatric disabilities
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim was to explore the experiences and knowledge of Personligt Ombud (PO) (a Swedish version of Case Management) and how they relate to the client's recovery as well as their own role of supporting clients in the recovery process. The thesis consists of four original papers (I-IV), and both quantitative and qualitative methods were used. Paper I showed that there were differences in knowledge and attitude toward recovery between three personnel groups: psychiatric outpatient services (POPS), the supported housing team (SHT) and the PO service, where the POs showed greater knowledge about recovery than both POPS and SHT. The results also indicated that university education and training in recovery was positive related to knowledge and attitudes towards recovery. Findings from papers II - IV showed that the clients' choices permeated all of the work that the POs and clients did together. The strategies used by the POs put the client in an active changing process, where he/she became involved in every aspect of the process. The work of the PO included discussions and collaboration with clients. The relationship with the client was the foundation of the work, and it was important to build a working alliance, which also involved a personal dimension. The findings also showed that POs experienced their role as unbounded, where they didn't have to consider any organizational frames, and POs solely represent the client. However, the free role was also connected with responsibilities concerning their work, and POs had to be able to work independently. The role as POs also enables to get a holistic view to both the client as well as to the welfare system. However, the freestanding role demanded legitimacy, and the POs had to work for this. It was important for the PO service to develop good platforms for cooperation with other actors in the society. In conclusion, it is interesting and leads to the question of whether POs and personnel in POPS can relate to two different kinds of recovery: personal vs. clinical. It may be important to consider the need for university education and training in recovery developing recovery-oriented practices. Findings showed that the PO service has developed a method in accordance to the NBHW guidelines, which in many cases, may benefit the clients' recovery process; however, there were aspects the PO service needed to develop. They seemed to use a problem-oriented approach, and they need to change this and look at the clients' strengths, both individual and environmental, and use them in order to support the client to reach goals in life. In Strengths Model Case Management, the Strengths assessment exists, that may be useful. The POs' service also needs to strengthen their organization and possibly develop support among colleagues.

Abstract [sv]

Det övergripande syftet var att undersöka Personligt Ombuds (PO) (en svensk variant av Case Management) erfarenheter och kunskap om återhämtning och hur de använder sig av detta samt deras roll i klientens återhämtningsprocess. Avhandlingen består av fyra originalarbeten (I - IV), där både kvantitativa och kvalitativa metoder användes. Paper I visade att det fanns skillnader i kunskap om återhämtning mellan tre personalgrupper: personal inom psykiatrisk öppenvård, boendestöd och PO verksamheter där det visade sig att POs hade mer kunskap om återhämtning än personal både inom psykiatrisk öppenvård samt boendestödet. Resultatet visade även att universitetsutbildning samt fortbildning i återhämtning hade positiv inverkan på kunskap om återhämtning. Resultaten från paper II - IV visade att klientens val genomsyrade allt arbete som PO och klienten gjorde tillsammans. De strategier som PO använde satte klienten i en aktiv förändringsprocess, där han/hon blev involverad i varje del av processen. Det var viktigt för PO att diskutera och samarbeta med klienterna. I klientarbetet var relationen med klienten en grundbult, där det var viktigt att bygga en allians med varje klient, som även innehöll en personlig dimension. Resultatet visade även att PO upplevde sig obundna i sin roll där de inte behövde anpassa sitt arbete utifrån organisatoriska ramar och tillhörighet, viket bidrog till att PO upplevde att de enbart representerade klienten. Men den fria rollen innebar även att ta ansvar i sitt arbete då PO måste kunna arbeta självständigt. Rollen som PO möjliggör att skapa en helhetssyn på både klienten samt välfärdssystemet. Den fristående rollen krävde legitimitet där PO där det är betydelsefullt att utveckla goda plattformar för samarbete med andra aktörer i samhället. Sammanfattningsvis är det intressant att reflektera om olika yrkesgrupper relaterar till två olika definitioner av återhämtning: personlig vs klinisk återhämtning. I utvecklingen av en återhämtningsinriktad praktik kan det vara betydelsefullt att beakta behovet av personal som är utbildade på universitetsnivå samt fortbildning i återhämtning. Resultaten visade att PO har utvecklat en metod utifrån Socialstyrelsens riktlinjer, vilket i många fall möjligtvis kan gynna klientens återhämtningsprocess, men det finns delar i PO verksamheten som behöver utvecklas. De verkade använda ett problemorienterat förhållningssätt och de bör utveckla verksamheten till att identifiera klienten styrkor, både individuella och miljömässiga och använda dessa för att stödja klienten att nå mål i livet. I Strength Model Case Management finns ett instrument där man tillsammans med klienten inventerar styrkor. Dessa kan bli användbara i processen. PO verksamheten bör även stärka organisationen och eventuellt utveckla stöd bland kollegor.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University , 2013. , 75 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 173
Keyword [en]
case management, psychiatric disabilities, recovery, rehabilitation
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:miun:diva-20187ISBN: 978-91-87557-19-4 (print)OAI: oai:DiVA.org:miun-20187DiVA: diva2:663432
Public defence
2013-12-06, M108, Mittuniversitetet, Sundsvall, 10:30
Opponent
Supervisors
Available from: 2013-11-11 Created: 2013-11-11 Last updated: 2016-04-28Bibliographically approved
List of papers
1. Knowledge and attitude regarding recovery among mental health practitioners in Sweden
Open this publication in new window or tab >>Knowledge and attitude regarding recovery among mental health practitioners in Sweden
2012 (English)In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 35, no 1, 62-68 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to investigate the knowledge and the attitude regarding recovery among practitioners working in the Swedish mental health system, Personligt Ombud (PO), Supported Housing Team (SHT) and Psychiatric Out Patient Service (POPS), to determine whether and how knowledge and attitude regarding recovery differ between the three services. A web-based questionnaire based on the Recovery Knowledge Inventory was sent to the participants. Participant selection ensured that different parts of Sweden were represented. A multiple linear regression was used to examine the result under control of Sex, Age, Educational Level, Further Education, Relevant Work Experience and Training in Recovery. The result of the regression showed that POs had higher scores than both SHT and POPS on the subscales, even under control of other variables. The SHT differed significantly from POs on two of the subscales and POPS differed significantly from POs on all subscales. Personnel with university education, more work experience or specific training in recovery also had a higher mean score. Swedish practitioners need to learn more about certain aspects of the recovery process. The differences between the services may possibly be due to the services’ organization, assignment and role. Other important aspects were the level of education and having specific training in recovery; the combination of these elements could facilitate the development of a recovery-oriented mental health system.

Keyword
Case management, psychiatric disabilities, recovery, Recovery Knowledge Inventory
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-15974 (URN)10.1097/MRR.0b013e3283508e2e (DOI)000300104000009 ()2-s2.0-84857195899 (Scopus ID)
Available from: 2012-03-01 Created: 2012-03-01 Last updated: 2013-11-11Bibliographically approved
2. Moving toward a recovery-oriented approach in the Swedish mental health system: an interview study of Personligt Ombud in Sweden
Open this publication in new window or tab >>Moving toward a recovery-oriented approach in the Swedish mental health system: an interview study of Personligt Ombud in Sweden
2012 (English)In: Vulnerable Groups & Inclusion, ISSN 2000-8023, Vol. 3, 1-16 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Personligt Ombud (PO) is a Swedish version of case management (CM) which was established with the Swedish Mental Health Reform in 1995. The main purpose of POs is to ensure that people with psychiatric disabilities receive the services needed to live an independent life in the community and to coordinate these services. Studies have shown that POs provide more support than this and it was interesting to investigate this further.

Aim: The aim of the study was to explore what supportive strategies Personligt Ombuds (POs) use in their work with the clients who have PO support.

Method: To obtain extensive descriptions of strategies that POs use in work, POs from different parts of Sweden were chosen and asked to participate in the study and 22 POs agreed to participate. The interviews were conducted over the telephone. The interviews were transcribed and analyzed using qualitative content analysis.

Findings: The findings of the study were reflected in a main category where PO could be described as a facilitator of an active changing process, where the clients make their personal changes in life, based on personal active choices. POs used several strategies, such as defining goals, acting to push the client forward, acting as mentors, strengthening the client and mobilizing external resources.

Conclusion: Many of the strategies POs used are similar to strategies in recovery-oriented services and, in particular, in Strengths Model Case Management. However, there are strategies that POs could develop to be even more recovery-oriented. There is a lack of systematic review of the strengths of a client, and this could be solved by using an already existing assessment instrument like the one in the Strengths Model Case Management.

Keyword
Case management; psychiatric disabilities; recovery; strengths model; support
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-17704 (URN)10.3402/vgi.v3i0.18879 (DOI)
Available from: 2012-12-13 Created: 2012-12-13 Last updated: 2016-10-17Bibliographically approved
3. Important components to create personal working alliances with clients in the mental health sector to support the recovery process
Open this publication in new window or tab >>Important components to create personal working alliances with clients in the mental health sector to support the recovery process
2014 (English)In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 37, no 1, 40-47 p.Article in journal (Refereed) Published
Abstract [en]

Personligt ombud (PO) is a Swedish version of case management that aims to support individuals with psychiatric disabilities. Guidelines to the PO service emphasize the different role that the PO plays with respect to the relationship with clients. The aim of this study was to investigate the components that POs found to be important in the relationship with clients. Telephone interviews with 22 POs across Sweden were carried out. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. The relationship with each client was described as the foundation of the POs' work; it was the only 'tool' they had. The findings were reflected in a main theme, which showed the importance of creating personal working alliances with each client where POs put the client at the center of the work and adjusted their support according to the client's needs at the time. Important components were that the PO and the client trusted each other, that the power between the PO and the client was balanced, and to be a personal support. Many of the components that POs found to be important are shown as essential in recovery-oriented services. POs followed the client in the process and remained as long as necessary and this is one way of bringing hope to the client's recovery process. However, the personal tone can be fraught with difficulties and to maintain professionalism, it is necessary to reflect, through discussions with colleagues, with the leader and in supervision.

Keyword
case management, psychiatric disabilities, recovery, relationship
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-20185 (URN)10.1097/MRR.0000000000000033 (DOI)000331217200007 ()24061407 (PubMedID)2-s2.0-84894084554 (Scopus ID)
Available from: 2013-11-11 Created: 2013-11-11 Last updated: 2015-06-30Bibliographically approved
4. Experiences of working from a freestanding position as a case manager when supporting clients in the Swedish welfare system.
Open this publication in new window or tab >>Experiences of working from a freestanding position as a case manager when supporting clients in the Swedish welfare system.
2016 (English)In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 39, no 2, 123-129 p.Article in journal (Refereed) Published
Abstract [en]

The Swedish state uses a case management function known as Personligt Ombud (PO). The role as PO differs from the traditional professional roles. It has a freestanding position in the welfare system. The aim of this study was to investigate POs' experiences of working from a freestanding position when supporting clients. Telephone interviews were conducted with 22 POs across Sweden. The interviews were recorded, transcribed, and analyzed by latent qualitative content analysis. The findings were reflected in three categories - freedom-promoted flexibility, surfing through a complex welfare system, and working for legitimacy. POs developed a holistic view to both the client as well as to the welfare system. POs experienced solely representing the client, which is a positive feature because part of the POs' role is advocating for the clients rights. The PO service differs from the PO service from other existing case management models and may need to develop strategies for decision-making and support in their own role. For example, they may use group supervision teams or 'reflective teams'. The freestanding position may also entail problems in terms of lack of legitimacy. It is important for POs to develop good platforms with the surrounding actors among others things to improve the co-ordination process. It could be interesting if the PO model would be tested in other countries that have a fragmented welfare system. The PO model may also be useful to other 'target groups' who are in need of co-ordinated rehabilitation services.

Keyword
case management, organization, coordination
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-27561 (URN)10.1097/MRR.0000000000000168 (DOI)000380762800004 ()27042767 (PubMedID)2-s2.0-84979462418 (Scopus ID)
Available from: 2016-04-28 Created: 2016-04-28 Last updated: 2016-12-22Bibliographically approved

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