This article brings together the experiences of parents whose children are placed in out-of-home care (OHC) with the theoretical concept of moral injury. The findings are based on empirical data from a research and development project conducted in seven Swedish municipalities with the aim of developing support for such parents. This article draws on a data set of qualitative interviews with 40 parents, 30 mothers and 10 fathers, with children in OHC. The interview transcripts were analysed thematically, with an abductive approach to theories and the empirical data. The findings illustrate how parents of children in OHC experience moral injury in relation to seven aspects: professionals' morally problematic and distressing behaviour, problematic services, an adversarial system, systemic bias, parent's actions, children's withdrawal and feeling excluded. The injuries are related to events in several periods—prior to the child's removal, during the execution of removal and during OHC—and tend to last for many years. These findings stress that the social services must be aware of the injuries parents experience and must minimize the possible harm and moral injury. We also suggest that parents of children in OHC should have an appointed social worker as a means of support.

This article reports from a research and development project aiming to improve support for parents with children in out-of-home care in Sweden. The project was carried out in collaboration between the authors and around 60 social workers organized in improvement teams during 2019-2021. The aim of the article is to explore the turnout in three of the participating teams. At the start of the project, social work with parents of placed children was described as 'stuck in a rut', in spite of numerous alerts on improvement needs. As parent support can concern a wide range of actions, and as there was no specific evidence-based programme to recommend, the collaborative project focused on nurturing new ideas and practices. In the initial phase, the teams formulated about 30 ideas covering new forms of support and improved prerequisites for a shared parenthood. A fourth of these ideas were turned into new practices that were tested in the services. The most frequent practices concerned information, crisis support and contact visits. The findings indicate that the breakthrough of new practices was dependent on a new translation of parents' rights and parent support which resulted in a new understanding of how to perform support without outcompeting a child's perspective. The translation process was highly influenced by the project interactions and knowledge circulation in which service user voices seem to have been especially vital.

Parents of children in out-of-home care receive little support from social services. Drawing on qualitative data collected in the project 'Parent at a distance', in which social services in seven municipalities in Sweden aimed to improve support to parents whose children are placed in foster care, this paper explores social workers' discourses about parents to children in care. The analysis is based on focus group data in which a total of 52 social workers reflected on parents to children in care and how they can be supported by social services. The concept of interpretive repertoires was used to analyse how social workers in interaction construct parents and their support needs. The identified repertoires of change, acceptance, permanency, biology and non-biology may contribute to the understanding of why so few parents receive support, even though legislation stipulates that placements should be temporary. The paper concluded that discourses may shape support practices and thus it is crucial that social workers reflect on and develop their awareness about their constructions of parents and their role for children in out-of-home care.

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.

The purpose of this study was to explore how older people experience and perceive decisions to seek hospital care while receiving home health care. Twenty-two Swedish older persons were interviewed about their experiences of decision to seek hospital while receiving home health care. The interviews were analyzed using qualitative content analysis. The findings consist of one interpretative theme describing an overall confidence in hospital staff to deliver both medical and psychosocial health care, In Hospital We Trust, with three underlying categories: Superior Health Care, People’s Worries, and Biomedical Needs. Findings indicate a need for establishing confidence and ensuring sufficient qualifications, both medical and psychological, in home health care staff to meet the needs of older people. Understanding older peoples’ arguments for seeking hospital care may have implications for how home care staff address individuals’ perceived needs. Fulfillment of perceived health needs may reduce avoidable hospitalizations and consequently improve quality of life.

Background: Nursing home residents are at a higher risk of hospital care as they represent the oldest and most frail segment of the population. At the same time, hospitalization is associated with a greater risk of various diseases, such as iatrogenic disorders, physical impairments and other adverse outcomes. Knowledge about factors associated with greater risk of hospitalization among nursing home residents is scarce. The aim of this study was to identify predictors of hospitalization among nursing home residents. Methods: Four hundred twenty-nine Swedish nursing home residents (mean age 84.9 years, ± 7.27, 71% females) were followed during three years in the longitudinal SHADES study. Participants were examined on physical, psychological, and social functioning, and information about hospitalization was recorded across the study period. Results: Of the 429 participants, 196 (45.7%) had at least one hospital admission during the three year follow-up period. The most common cause of admission was cardiovascular diseases (CVD) and complications due to falls.  Cox proportional hazard regression model controlling for dependency within nursing homes and municipalities showed that nursing home residents with previous falls (HR=1.59, p=.000), cognitive impairment (HR=1.28, p=.008) and malnutrition (HR=1.51, p=.018) were at a greater risk of hospitalization. Discussion: The results suggest that nursing home residents are at high risk of hospitalization, especially due to CVD and falls. Several modifiable factors associated with an increased risk of hospitalization were identified, including nutritional status and falls. Hospital admissions for older people could potentially be reduced by preventive measures aiming at fall reduction and malnutrition. 

This paper reports on an empirical study of how patient resources are explicitly utilized in intervention. A qualitative analysis of five videorecorded and observed first encounters between patients with nonspecific low back pain (NSLBP) and physiotherapists in primary care was conducted in southern Sweden. The analysis focuses on physiotherapists’ various ways of explicitly utilizing patient resources in intervention. The findings illuminate a gap between the number of occurring patient resources and the explicit utilization of these resources in intervention. Resources like objects, condition, personal characteristics and energies were identified and followed during the first encounter with physiotherapists. These resources were checked by the therapists or initiated by the patients. Resources concerning personal characteristics (such as optimism and motivation) and energies (such as experience-based knowledge) seem to be the underutilized. The findings raise questions about professional challenges beyond professional skill, indicating a need for clinical improvement regarding interaction, with potential implication for back pain recovery. The findings are discussed in relation to patient participation and professional ethics.