Sweden is among those countries traditionally ranked highly in international comparisons of children’s well-being and conditions for development. However, in recent years a development towards greater inequality in health has occurred. The general welfare model’s capacity to safeguard both the universal provisions for the general population’s standard of living and targeted support for those in need has also been doubted. System-related deficiencies such as collaborative breakdown, inadequate effectiveness and lack of clarity concerning how to uphold the best interests of the child are cited as examples, and several calls for policy reformations have been raised. The Scottish model for supporting child well-being, Getting It Right for Every Child (GIRFEC) has garnered keen interest in Sweden and is an example of how ideas for policy reformation flow both between and within countries, and thereby undergo more or less radical transformations. This article analyses the first-phase implementation of GIRFEC in a Swedish county. It emerges that although there is a great deal of enthusiasm for the original model, the intention is to implement an adapted version. What similarities and differences would be realized is not clarified from the start, but is left for the implementation process. The positive reception is understood as arising from a perceived familiarity of the model, based on current practice and discourse. GIRFEC can therefore be regarded as part of a pendulum swing in which ideas are borrowed and lent between countries and contexts.

Det finns ett stort intresse för tidiga och samordnade välfärdsinsatser för barn och unga, såväl i Sverige som internationellt. Ambitionen är att komma in med stödjande insatser i så tidigt skede att en framtida problemutveckling kan förhindras eller vändas i positiv riktning. Den skotska modellen GIRFEC (Getting it Right for Every Child) har rönt stort intresse i Sverige och utgör förebild för lokalt utvecklingsarbete på flera platser. Denna kunskapsöversikt beskriver och analyserar policyutvecklingen i Skottland för att få till stånd en fungerande samordning kring barn och unga i utsatta livssituationer. Två nyckelfunktioner har varit centrala för detta: en kontaktperson ”named person” som barn och föräldrar lätt ska kunna vända sig till och en samordningsansvarig ”lead professional” med ansvar att länka samman olika aktörer kring ett barn med mer omfattande stödbehov. I rapporten redovisas modellens antaganden, föresatser och kunskapsbas men också att införandet inte varit konfliktfritt, samt att en del oförutsedda konsekvenser uppstått undervägs. Kunskapsöversikten är en del av följeforskningen ”Tillitsskapande organisering” som knutits till det utvecklingsarbete i Kronobergsregionen som hämtar inspiration från GIRFEC. 

Sweden has been held up as one of the most advanced states when it comes to legal realisation of human rights for older persons with dementia, and there are national policies that propose how welfare professionals are to fulfil these rights. However, previous research has repeatedly shown that care managers in Sweden make decisions that leave these persons and their families without suitable interventions, which is especially problematic in cases of self-neglect (an inability to care for oneself combined with resistance to receiving care from others) when basic living standards for health and well-being are jeopardised. This problem is increasing around the world as dementia becomes more common, but there has been little national or international research on policies affecting this matter. This article examines how national policies in Sweden guide care managers to work ethically in cases of self-neglect among older persons with dementia. Through a policy narrative approach, the findings specify care ethical standards that aim to support decision-making abilities in such cases. The discussion dwells on how weaknesses in the identified narrative, in the context of dementia-associated self-neglect, can explain why these standards seem to have little impact on practice.

Following an international trend, current Swedish child welfare policy making centres around the development of early and coordinated support. The Scottish praxis-model “Getting It Right For Every Child” is held as a role model and inspires today development efforts at several places in Sweden. Previous research, however, indicates a paradox for social work in that despite the model’s intentions of providing early support based on a holistic and ecological understanding, it may weaken the role of social work – placing professionals at (even) longer distance from children and youth and given a narrow administrative function. With an understanding of professionalism as a situated practice balancing between theory and (local) ideals, this presentation analyses whether this paradox is acknowledged and translated in a regional development work in Sweden. Data is obtained from a three-year study, including regional level (health services) and eight municipalities (pre-schools, schools, social services) and consists of observations of (43) steering board meetings, documents and (42) interviews with stakeholders at managerial and operative level. The analysis reveals that due to the pre-existing uncertain position of social work in the appointed prevention and coordinating arenas (the health sector and the schools), the role of social work may not only become weak, but rather even weaker and at an increased distant position, something also indicated in initial piloting during the implementation. The findings call for more attention of the roles social work could/should take and being pro-active when new frameworks of prevention are introduced and translated locally.

This chapter reports on a cross-national exploration on manifestations and drivers of exclusion from social relations, in rural Britain and Belgium. Each study was composed of a quantitative and qualitative phase. The quantitative phases operationalised exclusion from social relations using existing datasets within each country while both qualitative phases comprised life history interviews with older people. The results demonstrate that although social relations are vital for several reasons (e.g. health and care, practical support in times of poverty, safety), older participants in both countries regularly face exclusion from social relations (e.g. feelings of loneliness, isolation, “bad” social relations). The results show a strong interrelationship between exclusion from social relations and other domains of exclusion (e.g. economic and material exclusion). In terms of drivers of exclusion from social relations, the life stories revealed micro risk factors (e.g. marital status and gender), exo (e.g. being remote and rural living) and macro drivers of exclusion from social relations (e.g. inadequate social security and population change). The conclusion discusses the main limitations of this cross-national exploration and offers some tangible policy and further research recommendations.

In the wake of the positive development of aging populations, self-neglect has become a more common problem in later life. Self-neglect is an inability, due to cognitive impairments, to care for oneself combined with resistance to receiving care from others. Striking a balance between self-determination, health and well-being in such cases, in accordance with international human rights, is a great ethical challenge for social workers in elder care. Soft governance provide guidelines on how to handle this challenge. This presentation informs about published results from a narrative analysis of nine policy documents in Sweden. Sweden is chosen as the case since it has been held up as one of the most advanced states when it comes to legal realisation of human rights for people with impaired decision-making ability. Eight identified themes for relational work to prevent and handle self-neglect is presented. The unclear knowledge base for these themes are discussed, as well as how they can be seen as care ethics standards for supported decision-making. It is also discussed how and why these themes seems to have rather limited impact on practice, especially in times of a pandemic. The conclusion is that there is need for further research on how national guidelines affect self-determination, health and well-being of people in social networks with self-neglecting older people. Further theoretical attention also needs to be paid to relations between soft governance, knowledge management and research in national guidelines for social work.

Nedsatt beslutsförmåga på grund av kognitiv funktionsnedsättning är något som kan drabba alla och envar som följd av en skada eller sjukdom. I den här boken behandlas begreppet nedsatt beslutsförmåga, relevant lagstiftning samt riktlinjer inom området. 

Boken belyser de utmaningar som lagstiftningens intentioner om individens självbestämmande, integritet och delaktighet innebär när du möter en person med nedsatt beslutsförmåga. Den ger inga slutgiltiga svar på hur dessa dilemman ska lösas, utan erbjuder kunskap som behövs för att kunna reflektera kring frågor när det gäller att nå bästa möjliga lösning i varje enskild situation. Flera exempel från praktiken visar på utmaningar och möjligheter när det gäller att stödja beslutsförmågan. Dessutom ingår ett arbetsmaterial som kan inspirera till reflekterande samtal.

Nedsatt beslutsförmåga – rätt, riktlinjer och praktik vänder sig till studerande på utbildningar som i någon del behandlar mötet med personer med nedsatt besluts-förmåga. Den kan även vara till nytta för exempelvis anhöriga och yrkesverksamma inom socialtjänst, omsorg samt hälso- och sjukvård och därtill även gode män, förvaltare, överförmyndare, jurister och lärare.

This presentation discusses interventions for economic security of older people with dementia ageing in place, counteracting financial abuse such as fraud and theft, from a capability approach. Research questions are: How do social services and social care practitioners handle the problem? Who is doing or is supposed to do what, where and when in order to prevent or act on financial abuse? What are the characteristics, causes and consequences of financial abuse against older people, according to these actual or potential interventions? How are interventions against financial abuse assigned, documented and evaluated? Preliminary findings are presented from qualitative interviews with managers of social services and social care, formal caregivers and employees who work specifically with preventing and taking action on violence in two municipalities in Sweden. Theoretically, the study takes its starting point in Sen’s capability approach and the emphasis on the value of peoples’ freedom to engage in economic transactions to achieve outcomes that they value or have reason to value. Of special interest is how identified interventions, or the lack of them, support or hinder this specific substantial freedom: financial security and well-being. Dilemmas in relation to the specific substantial freedom and interventions for people with impaired cognitive ability are also discussed. Conclusions are drawn with reference to further need of additional research, need of development of existing interventions and ideas for innovations. 

Cet article examine le parcours de vie des personnes âgées à faibles revenus en Suède et en Belgique, selon une approche comparative des politiques sociales de ces deux pays. L’étude porte sur les conditions de vie actuelles de ces personnes âgées, ainsi que sur les événements et parcours à l’origine de leur faible niveau de ressources. Une analyse secondaire qualitative de 49 récits de vie a permis d’identifier cinq parcours menant à un faible niveau de revenus, signe de la relation complexe entre parcours de vie et précarité économique. Les divers événements de la vie interagissent fortement entre eux, soulignant la nécessité de développer les interventions sociales afin d’apporter un soutien coordonné aux personnes confrontées à de multiples difficultés tout au long de leur vie et dans différents contextes sociaux. Les conclusions de l’étude soulignent également la nécessité de pousser plus avant les recherches sur les processus sociaux responsables des situations de faibles revenus chez les personnes âgées dans différents types d’État-providence.

This paper examines the life course of older people living on low incomes in Sweden and Belgium through a comparative social policy perspective. The research focuses on current experiences of living on a low income, as well as on the events and pathways that lead to a low income. A qualitative secondary analysis of 49 life stories identifies five pathways leading to a low income, revealing a complex relationship between a person’s life course and experience of economic hardship. Strong interactions among various life events indicate the need for the development of social intervention to provide coordinated individual support to people with multiple disadvantages throughout the life course and in different welfare contexts. The findings also suggest a need for additional research on the social processes behind low income in old age in different welfare states.