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"We found a solution, sort of”: qualitative interview study with children and parents on their experiences of the coordinated individual plan (CIP) in Sweden
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).ORCID iD: 0000-0001-8952-8773
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
2018 (English)In: Cogent Medicine, ISSN 2331-205X, Vol. 5, no 1, article id 1428033Article in journal (Refereed) Published
Abstract [en]

Children and adolescents receiving services from two professional parties may obtain support with a coordinated individual plan (CIP). The Swedish law prescribes that CIP must incorporate service user participation. This study aims to explore children and parents’ experiences of participating in CIP-process to generate knowledge with practical implications of how children and parents may be involved in the CIP-process. A descriptive qualitative interview study with 13 service users was conducted during November 2014 to March 2016. Data were audio-recorded and transcribed, and further subjected to qualitative content analysis. Three main descriptive categories with six subcategories emerged. The category “Struggle for coordination” includes service users’ need for participation which are limited by professionals’ lack of consensus. The category “Alliance for coordination” points out the importance of relationship and personal support to accomplish functional coordination. The category “Structure for coordination” shows how the structure facilitate service user involvement on a high level. Service user involvement seemed limited by professionals’ actions, but could be facilitated by support of professionals working in the child’s daily life. Structured coordination seems to relieve the pressure on parents, as well as children, but CIP needs to be individually tailored to reach its full potential.

Place, publisher, year, edition, pages
Cogent OA , 2018. Vol. 5, no 1, article id 1428033
Keywords [en]
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: urn:nbn:se:hj:diva-31222DOI: 10.1080/2331205X.2018.1428033OAI: oai:DiVA.org:hj-31222DiVA, id: diva2:951955
Note

Included in thesis in its submitted form.

Available from: 2016-08-11 Created: 2016-08-11 Last updated: 2018-06-26Bibliographically approved
In thesis
1. Samordnad individuell plan (SIP): Professionellas samt barn och föräldrars erfarenheter
Open this publication in new window or tab >>Samordnad individuell plan (SIP): Professionellas samt barn och föräldrars erfarenheter
2016 (Swedish)Licentiate thesis, comprehensive summary (Other academic)
Alternative title[en]
Coordinated Indivdual Plan (CIP) - professionals’, children and parents’ experiences of coordinated individual plan (CIP)
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. p. 79
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 71
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-31223 (URN)978-91-85835-70-6 (ISBN)
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

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Hedberg, BerithNordström, ErikKjellström, Sofia

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