Professional Discretion Research Articles

The Use of LGBT Films in Adolescent Victim-Turned Sex Offender Counseling: The Standard of Care and Professional Clinical Discretion of Psychologists Clinical Discretion of Psychologists

The Use of LGBT Films in Adolescent Victim-Turned Sex Offender Counseling: The Standard of Care and Professional Clinical Discretion of Psychologists Clinical Discretion of Psychologists

Professional Clinical Discretion and Crime of Negligence

Professional Clinical Discretion and Crime of Negligence

Navigating suicidality: swedish social workers’ approaches to identifying and supporting suicidal clients

ABSTRACT This study examines how Swedish social workers across various social work agencies identify and support suicidal clients. Thematic analysis of interviews with seven social workers reveals a reliance on strong client relationships and past experiences with suicidal clients. The social workers consistently assess severity of suicidal intent in clients. Despite variations in roles, social workers generally express comfort in dealing with suicidal clients by using intuition, discretion and professional and organizational logics to support suicidal clients in personalized ways. The exercise of professional discretion and interventions varies based on roles, work conditions, and relationships with suicidal clients. Notably, social workers in addiction recovery outpatient care exhibit a high degree of discretionary power, while youth treatment workers in residential care units prioritize continuity of care, involving psychiatry when needed. Case workers often view psychiatry as responsible for decisions about suicidal clients and routinely refer them to psychiatric care.

Legal Regulation, Financial Incentives and Professional Autonomy in the Prioritisation of Norwegian Specialist Health Services.

To study hospital physicians' awareness and perceptions of the legal and financial regulations, and their impact on professional discretion regarding equity in access to treatment and quality of care. A sample of 637 physicians in the Norwegian specialist healthcare services selected from a survey conducted by the Institute for Studies of the Medical Profession. The paper investigates how legal and financial policy instruments affect the application of professional discretion regarding the prioritisation of specialist health services. Descriptive statistics and regressions were conducted for the analyses. Compared with financial incentives, legal regulations (laws, priority rules and guidelines) were assessed to be less negative external interventions in the exercise of medical and professional judgement. The empirical analyses revealed a positive tendency in physicians' assessments of the impact of legal regulations on treatment equity and healthcare quality, but negative attitudes towards financial instruments. The variations revealed are attributable to various structural and epistemic features of the legal-bureaucratic and economic models of administration in this area of the welfare state. Legal and financial regulations are imposed to achieve certain social goals and values. The findings of this study can provide further insight for the health authorities in other countries concerning implementation of such regulations in the specialist healthcare services.

University Education in Kenya: Stakeholder Perspectives on Assessment Quality

Industry demand for skills whose application is dependent on changing technological innovations has been on the rise in Kenya. This has put a spotlight on professionals engaged in higher education and training roles. Society expects higher education institutions to not only provide opportunities for learning, but to deliver education in forms that are relevant to socio-economic productive processes. Decisions on teaching and examinations which were previously accepted on the basis of competence and professional discretion are now being challenged, based on the dynamic demands of the labour market. Universities are required to legitimize and communicate results of their activities to the public, which effectively means transferring control of education to a larger stakeholder constituency. Of interest to this research therefore, was the role of facilities and the effectiveness of internal institutional mechanisms for assuring assessment quality to stakeholders. This study sought to explore the extent to which universities in Kenya have embraced reforms to meet demand for increased quality and accountability in education assessment. A sample of 524 respondents from both public and private universities was selected for use in the study. Both qualitative and quantitative data was collected using questionnaires and interview guides. Qualitative data was transcribed, and presented in themes. Quantitative data was analysed using descriptive and inferential statistics (percentages, means, Chi square (X2)) to determine the effectiveness of quality assessment processes. All statistical inferences were done at α = 0.05, This study stands to benefit university managers by providing evidence on the state of assessment quality at institutional level. This can help empower students, and other stakeholders involved in supporting university education, to consider quality among criteria for support, and to help foster competition among institutions

”Det har inte bara att göra med teknik i sig, utan det är även ett sätt att arbeta”

“It's not just about the technology itself; it's also a way of working” - An Explorative Study of social care staff’s perspectives on welfare technology in the field of disability. The purpose of this qualitative study is to gain a better understanding of how the implementation of a welfare technology (WT) may affect the daily work of unit managers and social care staff in social care homes. It also aims to explore how residents' ability to participate, exercise self-determination, and be independent in their daily activities may be affected by this WT, as perceived by staff. The study focuses on one WT Boet, a digital support tool, created for care professionals and residents with intellectual disabilities and/or autism. Boet is a WT that comprises a staff application and an individual application for residents. The study is based on the experiences of care professionals working in social care homes in three Swedish municipalities covered by the Act (1993:387) on Support and Services for Certain Disabled People (LSS). Over a period of six months in 2023, semi-structured interviews were conducted with 10 care staff and three unit managers. The analysis highlights trust as a central theme and identifies three aspects that influence professional discretion: transparency, shifts in power, and safety. In conclusion, it can be assumed that the level of trust among staff plays a crucial role in establishing the framework for professional discretion concerning digitalisation, WT, and its additional working methods. This study indicates several different shifts in the professionals' discretion that may require trust in one's ability, the residents, the WT, management, and organisation.

Are we heroes or couriers? A phenomenological study on reappropriation of professional subjectivity and agency among health professionals during COVID-19 contact tracing in Türkiye

During the COVID-19 pandemic, Türkiye implemented a distinctive contact tracing approach involving in-person home visits by medical professionals to individuals who tested positive for the virus. This study examines the experiences of health professionals involved in contact tracing, exploring how they reappropriated their professional subjectivity and agency during their deployment in this role. It is an interpretive phenomenological qualitative study. We conducted 21 semi-structured in-depth interviews, subsequently carried out two separate focus group interviews with an additional 31 participants from various districts in Istanbul. Participants were selected from different medical professions (i.e. doctors, nurses, midwives), career stages, gender and age groups, and hierarchical levels (i.e. officers and directors). Data analysis was conducted collaboratively by the research team from sociology and public health disciplines.Our main finding is that for the majority of health professionals, contact tracing was a novel experience with challenges and ambivalances. Yet, regardless of their perceptions (positive, negative, or mixed), the experience promoted a reaffirmation of professional identity and reappropriation of professional subjectivity and agency, which discloses that professional subjectivity is not firm but dynamic, carrying stability as well as flexibility and adjustment. Four main themes are identified in their reappropriation of professional subjectivity and agency: uncovering professional fulfillment, feeling restrained in professional dissatisfaction, assessing the job, and engaging in professional and bureaucratic negotiations.The profound exploration into the dynamics of contact tracing amidst the pandemic illuminates a multidimensional narrative that transcends the conventional discourse on physical and psychological stress experienced by medical professionals. Contact tracing experience had a transformative impact on meaning and purpose of professional identity. Our findings highlight a need for a balanced approach between centralized decision-making, mobilization of professionals, quantitative evaluation, and professional autonomy and discretion, qualitative assessments, and meaningful engagement.

The quest for standardisation in adult social work: Municipal guidelines and premises for professional discretion

AbstractLittle is known about how the tools and guidelines, which are central to current social work practice, are designed. The purpose of this article is to improve understanding of the conditions for social workers' discretion by analysing how the municipal responsibility to meet individual needs is circumscribed in local guidelines for needs assessment in Swedish elder care. The paper applies framing theory to the analysis of guidelines in 51 municipalities and maps the prevalence of guidelines. Framing theory highlights how different designs of local guidelines can create varying premises for the discretion of social workers. By illustrating how the guidelines provide social workers with the necessary guidance on how to interpret the law by circumscribing their discretion in standardised, and varying, ways, the findings point to the importance of further research on how the quest for standardisation in adult social work through local guidelines influences social workers' assessments in practice.

Reducing the need for child welfare interventions through additional income support: a qualitative analysis of Finnish social workers’ views

ABSTRACT Previous studies have found a link between the social disadvantage of families and child welfare involvement. Through financial support, a range of psychosocial problems in the families (or their escalation) can be prevented, although social disadvantage is a multifaceted phenomenon. This article examines Finnish social workers´ views on the significance of financial support in reducing the need for child welfare interventions. The study analyses the fundamental assumptions and issues of social work that social workers refer to when justifying their views on the matter. The study is based on a qualitative analysis of data collected by interviewing 23 social workers in different parts of Finland. Through the interviews, a diverse view of the significance of additional income support and child welfare services emerges. The interviewees raised matters related to concrete practices, family dynamics, and the principles of social work. The question of the use of additional income support as a means for preventing child maltreatment and the need for child welfare intervention appears to be controversial in the data. However, a shared understanding of the fundamental assumptions and issues of social work can be seen behind the different viewpoints. In particular, a shared view of the intertwining of families’ economic and psychosocial challenges, and the hidden nature of child maltreatment and social problems in families with children emerges. Overall, the research serves to emphasize the importance of professional discretion and long-term support in social work.

Hegemony, Common Sense and Good Sense: A Gramscian Study of Policymakers’ Perspectives on Dealing with Poverty in Child Welfare and Protection

Abstract The existing international research on the prevalence of poverty in Child Welfare and Protection (CWP) services points to a persistent discourse of ‘pedagogicalisation’, meaning that CWP interventions often construct social problems, such as poverty, as emerging from a failing education of families, and leave the social circumstances of the families unchallenged. Although front line practitioners in CWP can exercise professional discretion in dealing with poverty, policy and organisational cultures have a crucial impact on whether their efforts to engage with the lack of adequate societal resources of families remain informal and hidden or are being supported to transform CWP’s dominant approach to poverty. This study applies a Gramscian framework to examine instances of hegemony, common sense and good sense in policymakers’ discourses on CWP and poverty. Based on a qualitative content analysis of semi-structured interviews with n = 16 policymakers of the governmental organisation on CWP in Flanders, we provide insight into the hegemonic discourses of pedagogicalisation in Flemish CWP policy. Nevertheless, our results also provide evidence of counter-narratives. Although embryonic, instances of good sense hold seeds of change based on a recognition of the impact of poverty on families and of CWP’s role to strive for social justice.

Co-creating and co-producing learning environments in adult education through the World Café method

IntroductionThis article analyzes teachers’ efforts in preventing negative social control among newly arrived refugees at a Norwegian Adult Education Center (AEC). As the teachers realized that micro aggressive behavior hindered learning, they aimed for improving the learning environment. The World Café method (WCM) was implemented to change the learning environment in a positive way.MethodsData was collected by passive observation with participatory elements. This was followed up with individual and focus-group interviews on what happened during three World Café dialogues.ResultsThis article uses management theories to analyse whether and how the implementation of the World Café was successful. The findings emphasize professional discretion combined with co-creation and co-production as organizational prerequisites for a positive change within the learning environment. The leaders at the AEC conducted professional discretion by employing bilingual immigrants as assistants at the AEC.DiscussionThe bilingual assistants used their multilingual resources and experiences with secondary language teaching in the planning and implementation of the World Café sessions for the newly arrived refugees. They contributed by co-creation and co-producing the WCM together with Norwegian born teachers. Their participation was an innovation at the AEC and led to a positive change in the learning environment.

Norwegian Pharmacists´ Perceptions of the Phenomenon Professional Discretion

Norwegian Pharmacists´ Perceptions of the Phenomenon Professional Discretion

Social workers’ assessment of a child’s need for services as ‘craftwork’ practice

ABSTRACT This study examines assessment practices when social workers determine whether a child needs child welfare or child protection services. It describes the elements employed when constructing assessment practice. The data consist of 28 group interviews among assessment teams from child and family services. The analytical framework, based on the theory of decision-making ecology and thematic mapping, allowed for a theory-driven reflective analysis . Our results highlight the distinctive nature of the assessment process, which contains the following elements: 1) individual and holistic assessments, 2) changing structures, 3) conflicting or shared understandings, and 4) unclear legal guidance. The assessment process is case-related and situational, such that tailoring also contains elements that combine decision-maker, organisational, and external factors, leaving significant space for professional discretion. Such an assessment practice represents a contextually crafted practice.

Street-level quasi-bureaucracy and professional discretion: how transformational leadership and public service motivation influence village health volunteers' professional discretion

PurposeVillage health volunteers are community health volunteers in Thailand that have helped the government deliver public health services for many years, particularly during the coronavirus disease 2019 (COVID-19) pandemic. Though labeled as “volunteers,” the village health volunteers are recruited, trained and supervised in a manner similar to how a government agency recruits, trains and supervises its street-level bureaucrats (SLBs). This study examines the two factors that affect how these street-level quasi-bureaucrats use their professional discretion: transformational leadership and public service motivation (PSM). Transformational leadership means a leadership style that develops, shares and sustains a vision to elevate SLBs to higher levels of performance, while PSM is defined as an SLB’s predisposition to make a difference by working in the public sector with a sense of calling. This study attempts to analyze the mediating role of psychological empowerment in the relationship between transformational leadership, PSM and professional discretion.Design/methodology/approachThe paper uses a three-wave survey-based quantitative method to avoid common method biases. This method provides evidence gathered from 105 subdistrict health promotion hospitals and 798 village health volunteers (VHVs) in five provinces in Thailand.FindingsPSM and transformational leadership influence the village health volunteers' use of professional discretion indirectly through the psychological empowerment mechanisms that make them feel positive toward their village health volunteer role and responsibility. The authors' findings suggest that the hospital directors' transformational leadership induces the village health volunteers' use of professional discretion by making them feel competent to do their work and feel fulfilled and valuable about their work. Similarly, the village health volunteers' PSM leads them to use professional discretion by making them feel fulfilled and valuable and by convincing them of the social and community impact of their work.Research limitations/implicationsWhile existing research focuses on VHVs' role in alleviating capacity constraints on the health care system, this study revealed an equally important role played by hospital directors. These directors' transformational leadership was instrumental in enhancing VHVs' psychological empowerment – particularly their perceptions of the meaning of their work and their competence – that ultimately enabled them to use professional discretion in their work. This study also highlighted the importance of VHVs' PSM, which leads to their use of professional discretion via the meaning and impact dimensions of psychological empowerment. Based on this study, PSM should also be incorporated into the community health volunteers' recruitment criteria. Also, public health agencies should consider including transformational leadership in the hospital directors' training programs and their promotion criteria.Practical implicationsAs VHVs' high-PSM level was found to enhance their professional discretion, the process of recruiting ordinary citizens to serve as community health volunteers should incorporate assessment of the candidates' PSM. Also, the Ministry of Public Health should design and assign tasks that citizen volunteers, particularly VHVs, consider meaningful and at which they feel competent.Social implicationsAside from technical training, directors of the subdistrict health promotion hospitals should regularly receive soft skill training (i.e. leadership training) and transformational leadership characteristics should be included in the government criteria for promotion.Originality/valueWhile past research has examined the impact of other leadership styles on psychological empowerment, this study took a further step by examining the mediating effects of psychological empowerment on the relationship between transformational leadership and professional discretion among VHVs. The authors analyzed the mechanism linking PSM to the VHVs' professional discretion. In addition, by examining the relative importance of different dimensions of psychological empowerment, this study offers a nuanced understanding of the psychological processes by which transformational leadership and PSM shape the SLBs' use of professional discretion in their work.

‘There is a fear of not being SUPER knowledgeable’ – social workers striving to enhance children’s participation in the assessment process for disability support

ABSTRACT There is a need for more knowledge about how to enhance children’s participation in the assessment process when applying for support in accordance with the Swedish Disability Act (SDA). Here, Augmentative and Alternative Communication (AAC) has been highlighted as a successful way of letting children have a say in matters that concern their everyday lives. This study examines, from social workers’ perspectives, how increased participation can be made possible for children with disabilities during the process of decision-making and planning for support. Based on focus group interviews (N = 17) and individual interviews (N = 11) the findings reveal that the social worker shows a readiness to listen to children’s voices. However, they experience a range of both facilitating, but predominantly complicating, factors when meeting with the child and their parents. It is argued that the social workers’ professional discretion to some extent is influenced by the prevailing organisational culture, where a permissive work climate and proactive leadership are attributed great importance.

If digitalization is the answer – what is the problem? An analysis of policy documents related to the digitalization of Norwegian child welfare services

ABSTRACT In this article, we have analysed policy documents related to the digitalization of the Norwegian child welfare services. The project ‘DigiBarnevern’ is a national initiative intended to develop and improve the digital tools in child welfare services. In our article, we explore which arguments for digitalizing child welfare are used in Norwegian policy documents. The analysis is inspired by Carol Bacchi’s analytical approach of ‘What’s the problem represented to be?’ This approach starts with the premise that policy documents are produced and implemented as answers to specific problems. Our analysis shows how the problems represented are inefficient services, a lack of systematization, arbitrary practices, and the lack of a quality system. Thus, digitalization seems to be the answer to comprehensive problems in child welfare services. By drawing on the literature of street-level bureaucracy and professional discretion, we discuss features of digital systems such as their potential to measure quality and how they can serve as tools to meet the aim of regulating frontline workers` room for discretion. Policy documents are not neutral tools. Instead, they are instruments and carriers of values that affect service provision and ultimately the clients.

Policy work in educational leadership courses: university teachers’ interpretations, translations and engagements

ABSTRACT This study investigates policy work in educational leadership courses at universities. It analyses the types of engagement present in university teachers’ policy work and in their interpretations and translations of policy intentions into teaching designs and practices. The study illustrates policy work as a phenomenon and draws on the theory of policy work; it examines one case from Norway and one from California. The data has been analysed through discourse analysis. Observational data and materials from teaching practices constituted the supporting data, while contextual interviews with university teachers formed the main data. In both cases, various types of engagement were identified, which reflected academic freedom and different policy contexts. The analysis also revealed that university lecturers use their professional discretion and experience when interpreting and translating policy intentions into teaching designs and practices. This has implications for higher education administration, especially for the achievement of coherence across programmes and courses.

Policy mechanisms and types of participation in the implementation of the Brazilian pay-for-performance programme PMAQ

PurposeThe study compares how distinct mechanisms that connect pre-established policy objectives to professionals' practices, and the health policy implementation context influenced different approaches to frontline staff participation. The authors analysed 26 teams in six cities from two Brazilian states, during the last cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ).Design/methodology/approachAbout 172 in-depth interviews were conducted with frontliners – community health workers (78), nurses (37), doctors (30) – and managers (27). Interview guides were based on key issues identified in the implementation and pay-for-performance (P4P) literature. Drawing on thematic analysis and synthesis of the literature, three types of participation mechanisms were identified: relational, motivational and incremental learning. They were analysed considering distinct contexts at the local level to understand how they influenced different forms of participation: mere adherence, result-oriented and transformative.FindingsAdministrations with stronger institutional organizational structures were able to control work processes and reduce professional discretion. However, sustained participation was more likely where there was greater integration between management and frontline health care teams. Motivation based only on financial incentives could not bring about transformative participation. This depended on the degree of professional's ideational motivation towards primary care. Finally, contexts with unfavourable working conditions tend to demotivate professionals, but incremental learning helps teams cope with these obstacles.Originality/valueThe study overcomes gaps in the literature in relation to PMAQ's implementation process. Overall, the study delves into which/how mechanisms alter frontliners participation in performance-oriented health programs.

Automating social assistance: Exploring the use of robotic process automation in the Swedish personal social services

AbstractMany European countries employ Robotic Process Automation (RPA) in the administration of public benefits. However, there is limited understanding of how RPA is applied at the client level. This article investigates the utilization and impact of RPA use on social assistance (SA) distribution in Sweden, drawing on a sample of 800 SA applications in four Swedish municipalities. The results show that RPA use correlates with applicants' country of birth, age and duration of SA receipt. Additionally, RPA implementation coincides with less generous decisions, disproportionately affecting financially vulnerable groups. Rather than a correlation between generosity and the technology itself, the results suggest a conflict between the reorganisation of SA administration during RPA implementation and the principle of individualized judgments inherent in SA casework. Hence, public organisations are encouraged to ensure that their adoption of RPA neither exacerbates unequal access to services nor compromises professional discretion in favour of efficiency‐driven measures.

Legacies of Change: Probation Staff Experiences of the Unification of Services in England and Wales

Abstract A discourse of professionalism has proved crucial to driving recent organizational restructurings of the probation service in England and Wales. The Coalition Government argued that bureaucratic, state provision of services had stifled probation practice—for which the introduction of market logic, via the 2014 Transforming Rehabilitation (TR) reforms, would restore professional discretion. And yet, the detrimental impact of TR on practice meant that re-professionalization was an important objective of yet more restructuring. This paper explores probation staff experiences of organizational change, particularly since services were returned to the public sector, in June 2021, through three dominant modes of workplace organization around which change has been articulated: professionalism, the market and bureaucracy. Drawing on semi-structured interviews with 38 members of staff, it argues that the exercise of professionalism in probation has been, and continues to be, shaped by a legacy of organizational change that is both bureaucratic and dependent upon market(-like) mechanisms. It contends that the ongoing impact of a ‘discursive battle’ between market and bureaucratic forces has further eroded professionalism in probation.