Att balansera mellan stringens och relevans - Kuratorers perspektiv på standardiserade vårdprocesser i Barn- och Ungdomspsykiatrin

Sammanfattning: The aim of this study was to examine the experiences and thoughts of health care social workers regarding working according to standardized care processes in child and adolescent mental health care (Barn- och Ungdomspsykiatrin). The research questions concerned what challenges and opportunities standardized care processes bring and how it affect the health care social workers professional role and discretion. The method chosen was semi-structured interviews with seven health care social workers, all operating in outpatient care within child and adolescent psychiatry in the county of Skåne. The theoretical basis in the analysis of the empirical data concerned humanism and aspects of professional expertise; knowledge based expertise and agent based expertise. The results show that the standardized care process impact on health care social workers can be boiled down to a balance between rigor and relevance. The standardized care processes offer opportunities for framing, transparency and equity and provide legitimacy in the dialogue within treatment teams, with collaborative partners and parents. On the other hand, the health care social workers struggle with the challenge of making complex problems fit into standardized models based on a basic humanistic view that each individual and situation is unique. The health care social workers find a way around the standardization by creating their own arrangements or continuing to work as they did before and argue that their way of working does not contradict the counter-goals of the care processes. They also use their discretion to prioritize and pursue influence. A concern expressed that the standardization is being pushed to its extreme and that would exclude patient groups with complex needs. The study shows that the health care social workers role both approaches that of the psychologist when they perform the same work tasks, but that the standardized care processes also give legitimacy to the family-based perspective and treatment methods traditionally carried out by the health care social workers.