Background: Some persons with intellectual disability may express, e.g., distress, protest or pain in a manner that is perceived as challenging by staff and an entire organisation. Although these persons are few, their support requires knowledgeable staff who are supported by front-line managers within a capable organisation, as well as sufficient and adequate resources. The aim of this study was to explore organisational factors that enable or hinder good quality of support from the perspective of staff in group homes and day programmes.

Method: 96 staff in group homes and day programmes were interviewed in groups. Their experience with working in services for persons with intellectual disability ranged from 2 months to 35 years, with a median of 10 years. The interviews used the problem-centred interview method described by Witzel and Reiter, allowing interviewer and participants to explore and co-create topics of interest and importance.

Findings: According to staff, it was difficult to meet the needs of persons with intellectual disability when they experienced an organisational focus on budget and administrative procedures. Managers who lacked adequate knowledge or were seldom present in a service were of no help when difficulties arose. Participants described a lack of alignment and logical connection between decisions and procedures at the organisational level and the support provided by staff. They also maintained that preventing staff and manager turnover would enable continuity, stability and trustful relationships. Providing support of good quality would also require front-ine and senior managers who truly understood or recognised the needs of the service users.

Conclusion: Staff in group homes and day programmes report that staff satisfaction and good quality support require an organisation that can be trusted. This involves that managers have a clear focus on and knowledge about what is essential in supporting persons with intellectual disability.

Artikelns resultat baserar sig på en enkätstudie till handläggare inom funktionshinderområdet i Sverige och redovisar deras arbetssituation, med fokus på konsekvenser for enskildas rättssäkerhet. Det övergripande syftet med artikeln ar att belysa aspekter av rättssäkerhet i ärenden enligt LSS. Rättssäkerhet är ett begrepp som givits flera betydelser, framfär allt en formell och en materiell definition (Peczenik, 1995). Vi argumenterar för att den materiella definitionen hör bättre samman med lagmotivens, liksom funktionsrättskonventionens (CRPD) fokus på mänsklig värdighet och likvärdigt bemötande vad avser LSS tillämpning. Resultaten visar att flera LSS-handläggare inte anser att deras hemkommuner fattar rättssäkra beslut och att utförda bedömningar är lite av gissningar eftersom tydliga riktlinjer saknas. Vidare anges att arbetsledare ger instruktioner om vilka insatser som får beviljas och vilka som ska avslås, utifrån budgethänsyn snarare än bedömningar av behov. Enkätsvaren redovisar också situationer där brukare blivit kränkande bemötta. Sammantaget leder detta till en oförutsebar rättssäkerhet for brukaren.

På intensivvårdsavdelningen vårdas personer med kritisk sjukdom som är i behov av både omfattande medicinsk behandling och omvårdnad och har behov av psykosocialt stöd. En kvalitativ intervjustudie genomfördes i syfte att undersöka hälso- och sjukvårdskuratorns yrkesroll på IVA i relation till förutsättningar och handlingsutrymme där. Analysen, som skedde i en växelverkan mellan utsagor och sociologisk professionsforskning och rollteori, visar att yrkesrollen utvecklas både i förhandling med omgivningen och utifrån hur kuratorn hanterar sitt handlingsutrymme. Det finns en risk att kuratorns specialiserade roll på IVA blir personbunden, d.v.s. att kompetens inte förs vidare i organisationen eller till professionellt socialt arbete. Resultatet pekar på ett behov av fortsatta studier av hälso- och sjukvårdskuratorns yrkesroll – hur rollen utvecklas och vad utvecklingen får för konsekvenser för profession och organisation. 

Patients in the intensive care unit are in critical need of specialized medical treatment and care but also of psychosocial support. We conducted a qualitative interview study to explore the professional social work role in the ICU in relation to specific conditions and room for practice. Empirical data was analyzed through a sociological perspective on professions and role theory. The results reveal that the role develops through social negotiations but also according to how the social worker perceives and uses his/her room for practice. There is a risk that specialized competency is not integrated in the organization or profession at large but rather remains with the individual social worker. Further study of how professional social work roles in health care develop, and professional and organizational consequences is motivated.

This article investigates the need and sources of knowledge among LSS administrators in Sweden (i.e. social workers handling service and support for individuals with disability according to the Swedish Disability Act [LSS]). Changing and challenging working conditions and issues concerning professional status warrant the aim. A questionnaire distributed via gatekeepers in a number of municipalities demonstrated that knowledge about ‘disability’, ‘law’, ‘ethics’ and ‘augmentative and alternative communication’ was rated highly. This result is particularly interesting given that many social work education programmes do not have compulsory courses in disability. Colleagues appear to be relied upon as essential sources of support and knowledge, but the knowledge sharing seems unorganised. Findings are discussed in relation to communities of practice (CoP) and shows that, due to the lack of essential knowledge from formal education and the strong dependence on colleagues, a locally developed praxis might be established. Inadequate theoretical and research-based knowledge, together with this local praxis knowledge, may result in the LSS administrators’ work becoming inadequate. A specialist education in disability studies is proposed as a prerequisite for being employed as an LSS administrator, and the inclusion of a theoretical and scientific framework in the regular CoP interaction is also recommended.

Hälso- och sjukvårdskuratorernas legitimation infördes 1 juli 2019. Legitimationen har skapat en ny riktning för de socionomutbildade och samtidigt tydliggjort vikten av att placera hälso- och sjukvårdens hälsobegrepp i en samhällelig kontext. Därmed sätter förändringen ljus på viktiga frågor som hälso- och sjukvården brottats med under lång tid och som nu skulle kunna debatterats på allvar med kuratorn i centrum.