Ståhl Christian, Andersén Åsa, Anderzén Ingrid, Larsson Kjerstin
Department of Medical and Health Sciences, National Centre for Work and Rehabilitation, Linköping University, 583 81, Linköping, Sweden.
Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
BMC Public Health. 2017 May 11;17(1):431. doi: 10.1186/s12889-017-4357-x.
This study analyzes the process of establishing and developing a cooperative vocational rehabilitation project with special focus on organizational and professional aspects. In the project, officials from the Swedish Social Insurance Agency and the Swedish Public Employment Service worked cooperatively with participants on long-term sick leave, youths with disability benefits, and people receiving social allowances. The officials used Motivational Interviewing (MI) as a method when meeting participants, and were able to offer flexible and tailored case management. The goal was to improve work ability and promote self-sufficiency.
The process evaluation was carried out through continuous data collection throughout the project (2012-2014), resulting in a total of 28 individual interviews and 17 focus groups with officials and managers. The material was categorized through an inductive content analysis, and analyzed using social capital as a theoretical frame.
The evaluation points to how issues related to design, organization and management contributed to the project not reaching its goals, e.g. problems with recruitment of participants, the funding structure, and staffing problems on the managerial level. Still, officials reported positive effects of close cooperation, which was perceived as facilitating the case management by fostering a mutual understanding and access to resources and rehabilitation measures from more than one authority.
Cooperative work combined with the use of MI and flexible case management seem to promote an increased trust between officials from different authorities and participants, which in the study is conceptualized as bonding and bridging social capital (between officials) and linking social capital (between officials and participants). The organizational problems combined with the relatively large differences in approaches between the project and regular practice obstructed implementation, where the authorities involved did not appear to be ready for implementing methodologies that require organizational restructuring.
本研究分析了一个合作职业康复项目的建立和发展过程，特别关注组织和专业方面。在该项目中，瑞典社会保险局和瑞典公共就业服务局的官员与长期病假人员、领取残疾福利的青年以及领取社会津贴的人员合作。官员们在与参与者会面时采用动机性访谈（MI）作为方法，并能够提供灵活且量身定制的个案管理。目标是提高工作能力并促进自给自足。
通过在整个项目（2012 - 2014年）期间持续收集数据进行过程评估，共对官员和管理人员进行了28次个人访谈和17次焦点小组访谈。材料通过归纳性内容分析进行分类，并以社会资本作为理论框架进行分析。
评估指出与设计、组织和管理相关的问题如何导致项目未达成目标，例如参与者招募问题、资金结构问题以及管理层面的人员配备问题。尽管如此，官员们报告了密切合作的积极效果，这种合作被认为通过促进相互理解以及从多个部门获取资源和康复措施来便利个案管理。
合作工作结合MI的使用和灵活的个案管理似乎促进了不同部门官员与参与者之间信任的增加，在该研究中这被概念化为结合型社会资本（官员之间）、桥接型社会资本（官员之间）以及连接型社会资本（官员与参与者之间）。组织问题加上项目与常规实践在方法上的较大差异阻碍了实施，相关部门似乎尚未准备好实施需要进行组织重组的方法。
