Introduction: The treatment gap for addictive disorders is one of the largest in health care. Several studies have investigated barriers to treatment for different addictive disorders, but very few studies conducted have explored whether the barriers differ depending on substance or behavior or if they are common among all addictive disorders. In Sweden, addiction care is provided both by the healthcare and social services, where the latter is common, but also less popular. To our knowledge, there are no studies exploring whether the barriers are different depending on where the treatment is given.

Aim: The aim was to thoroughly explore both which general and social services-specific barriers to treatment that are common, which barriers that differs, and how the barriers are described among individuals with a problematic use of alcohol, cannabis and/or gambling.

Method: A mixed method convergent parallel design was conducted. For the quantitative measures, surveys including the validated Barriers to Treatment Inventory as well as questions regarding barriers in the Swedish multi-provider landscape, were collected from individuals with a problematic use of alcohol (n = 207), cannabis (n = 51), and gambling (n = 37). In parallel, 17 semi-structured interviews from the same population were conducted and analyzed with thematic analysis. Thereafter, the quantitative and qualitative data was compared, contrasted, and at last, interpreted.

Results: The quantitative data showed that the largest general barriers in all groups were privacy concern and poor availability, and the largest barriers for seeking help from the social services was stigma, unawareness of what is offered, and fear of consequences for all groups. The qualitative data resulted in five general barriers: stigma, ambivalence, accessibility, fear of consequences, and lack of knowledge about addiction and its’ treatments, and three barriers specifically towards social services: social services reputation, fear of meeting acquaintances, and lack of knowledge. The themes were developed from data from all groups, but different aspects of the themes were mentioned by different groups.

Conclusion: There are details and aspects that differentiates both the general and social service-specific barriers to treatment between individuals with a problematic use of alcohol, cannabis, and gambling, but in large they perceive similar barriers.

Shelters for abused women in Sweden today are transforming. This transformation can be described as a shift from a movement to a market, evolving from a history dominated by the nongovernmental feminist movement. Currently, over half of all shelters are operated by for-profit companies, indicating a formalization, professionalization, and marketization of these shelters.

The proposed symposium will feature three studies on shelters in Sweden. From Marie Cederschiöld University, Veronica Ekström, and Felicia Forthmeiier will present ongoing studies on how different actors (abused women, politicians, social services, and shelter representatives) perceive the quality of shelters. Their research aims to understand how these diverse constructions of quality can be contextualized in the ongoing processes of professionalization and marketization.

1. Domestic violence shelter - from the hallmark of the women's shelter movement to a service for sale on the Swedish welfare market

Felicia Forthmeiier and Veronica Ekström

Shelter is a key intervention for thousands of Swedish women who need to seek support and protection every year due to threats and violence in close relationships. Historically, the nonprofit women's shelter movement has been the sole provider of support and shelter to victims of domestic violence. The Swedish non-profit women's shelter movement was initiated in the late 1970s and has since offered support and later shelter to women and children exposed to violence. It has been a strong voice for women's rights and has promoted men's violence against women as a political issue. In the last decade, there has been a shift in the organization of shelters, where greater political interest in abused women has led to extended welfare services that include abused women. Political reforms have resulted in increased formalization and professionalization of shelters. Notably, sheltered housing is no longer primarily run by nonprofit women's shelters. Instead, it has become an intervention offered on the welfare market where non-profit organizations (women’s shelters) compete with new private profit-making actors for social services' placements in shelters. Through a document study in which we have analyzed a selection of parliamentary prints, we have aimed to understand how this development has taken place and what is the basis for the shift from a women's rights-driven movement's idea of sisterhood as a solution to men's violence against women to the fact that a place in a shelter is now bought as a service on the Swedish welfare market.

2. Quality in shelters for abused women – perceptions of quality among professional actors

Veronica Ekström

While most shelters for abused women in Sweden used to be run by the women’s movement, about half of the shelters are, today, operated by private companies. The social services’ procurement of these shelters has resulted in increased demands for quality and monitoring. The second presentation will focus on results from a research study on perceptions of quality inshelters among local politicians on a municipal level, managers in social services, and shelter representatives. The analysis shows that perceptions of quality range from adherence to the social services’' assignment orders to evidence, cost-effectiveness, and competence among staff both at the social services and shelters. Moreover, an overly ”caring” attitude among staff both at the social services and shelters is portrayed as problematic and unprofessional. Among representatives for shelters, aspects like employed and competent staff, a suitable housing environment, safety, and access to other kinds of support (adjusted for individuals and regarding children) constitute an overall construction of quality in shelters. Moreover, well-functioning social services are necessary for the shelter's possibility to provide good quality. An important conclusion from the two studies is that procurement and placements in shelters can constitute an unwieldy conflict surface where logic and practices typical of both market and welfare are pitted against each other.

3. Alone, Protected and Confined – Abused Women’s Constructions of Quality in Shelters

Felicia Forthmeiier

Intimate partner violence (IPV) shelter is an important and central intervention for women and children exposed to domestic violence. Despite this, we know little about women's perceptions and experiences of residing in shelters and how they define good quality in shelters. This study is based on 19 semi-structured interviews with women who had been staying in shelters and aims to answer how women construct quality in shelters. The thematic analysis reveals a complex and contradictory picture of shelters, where the quality of the housing environment, services, structure, and access to support varies greatly between shelters. We found that women experience feelings of confinement and control due to the structure and regulations of the shelter as well as extensive loneliness during their stay. At the same time, opinions on what good quality of a shelter is, are relatively unanimous; the shelter should be a safe place for recovery, provide a respite from violence, and should offer both counseling and practical support aiming to process previous difficult experiences and to help create a new life free from violence. Some shelters were described as perceiving children only as an appendage to the mother, where no specific adjustments or services were provided to the children, while others took a more holistic family-oriented approach where children's needs were perceived as equal to those of the mothers. Shelters adjusted for children’s needs were perceived as having better quality.

People in homelessness face significant health inequities, with tri-morbidity, exposure to violence, substance use- and post-traumatic stress disorder. The aim of this scoping review was to describe treatments for trauma-related conditions for persons in homelessness. Systematic searches were performed in three databases: PubMed, PsycInfo and Scopus, guided by the PRISMA checklist. Nine studies fulfilled the criteria and were included in the review. Results show no randomized studies specifically focusing on treatment of trauma-related conditions for people in homelessness. Studies described interventions or programs that focused on consolidating and developing participants’ own strengths and skills to better navigate life with the challenges of homelessness, trauma, and PTSD. Treatment of trauma-related conditions may have positive effects for people in homelessness, as for others. Multimodal treatments, developing personal strengths and skills for people in homelessness, show potential to decrease trauma symptoms, however, more robust studies are needed for inferences and recommendations. 

Background

Unhealthy alcohol use (UAU) affects not only the drinking individual, but also significant others (SOs), such as partners and children. Most of the harm to others caused by alcohol can be attributed to common, moderate drinking patterns, but existing studies have mainly included SOs of individuals with severe UAU. There is a need for increased knowledge regarding SOs of individuals in an earlier stage of UAU and efficacious support programs for this group. The aims of this study were to investigate reasons for seeking support as described by SOs sharing a child with a co-parent with UAU and to investigate how SOs perceived effects of a web-based self-delivered support program.

Methods

A qualitative design conducting semi-structured interviews with 13 female SOs sharing a child with a co-parent with UAU. The SOs were recruited from a randomized controlled trial of the web-based program and had completed at least two of four modules in the program. Transcribed interviews were analyzed using conventional qualitative content analysis.

Results

Regarding reasons for seeking support, we created four categories and two subcategories. Main reasons were wanting validation/emotional support and coping strategies for handling the co-parent, and negative perceptions of available support options for SOs. Regarding perceived effects of the program, we created three categories and three subcategories. Main effects were an improved relationship to their children, increased own positive activities, and less adaptation to the co-parent, though SOs also mentioned what was perceived as missing in the program. We argue that the interviewees represent a population of SOs living with co-parents with slightly less severe UAU than previous studies and therefore provide new insights for future interventions.

Conclusions

The web-based approach with potential anonymity was important for facilitating support-seeking. Support for the SOs themselves and coping strategies for co-parent alcohol consumption were more common reasons for seeking help than worry about the children. For many SOs, the program was a first step in seeking further support. Spending more dedicated time with their children and being validated as living under stressful conditions were described by the SOs as particularly helpful.

This article describes and discusses the cooperation between police and social services when working in accordance with the so-called Icelandic model. The aim of this article is to explore what cooperation within the Icelandic model during the “window of opportunity” means for police officers and social workers discretion and their possibility to perform their work in acute cases of domestic violence in families with children. Empirical data consists of interviews with police officers and social workers. Theories of new institutionalism and street level bureaucrats are used in the analysis. Results show that the Icelandic model has led to increased cooperation between police and social workers at the crime scene. The police and social workers state that they can focus to a greater extent on carrying out what they regard as their own tasks in acute cases of domestic violence when they work according to the model. At the same time, the model has entailed increased control of their work, which has reduced the degree of discretion and possibility for professional assessments and priorities. The perception that there is a “window of opportunity” is shared by the police and the social services and they believe that coordinated efforts in the acute phase are important.

I denna tvärsnittsstudie undersöks 538 socionom- och sjuksköterskestudenters uppfattningar om sin kunskap om mäns våld mot kvinnor och våld i nära relationer. En betydande andel av studenterna skattar att de har kunskap om och erfarenhet av att arbeta med våld redan i början av sina studier. Kunskap som de fått via tidigare utbildningar och arbetslivserfarenheter. Studenternas skattningar indikerar att de aktuella utbildningarna innehåller våld, även om omfattningen varierar. Studien visar på få skillnader mellan sjuksköterske- och socionomstudenters upplevda kunskap och erfarenhet. Studenternas skattningar tydliggör att studenter tillägnar sig kunskap och erfarenhet även via undervisningen, VFU och arbete vid sidan av studierna och att studenter i slutet av utbildningarna skattar sin kunskap och förmåga att agera professionellt högre, jämfört med studenter i början av utbildningarna.

In this cross-sectional study, 538 social work- and nursing students percep-tions of their knowledge of men’s violence against women and domestic violence are examined. A percentage of the students estimate that they have knowledge and experience, already at the beginning of their studies, knowledge that they have gained through previous studies and work experiences. The students’ estimates indicate that both programs address issues of vio-lence, although the extent varies. The study shows few differences between perceived knowledge and experience of social work- and nursing students. The study indicates that students acquire knowledge and experience also through teaching, VFU and work alongside their studies and that students at the end of the educations rate their knowledge and ability to act professionally higher, compared to students at the beginning of the educations.

This article examines the window of opportunity concept and its implications for police officers’ and social workers’ perceptions of abused women’s agency. The study consists of a qualitative analysis of semi-structured interviews with eight police officers and eight social workers who have worked according to the so-called Icelandic model. This model is based on the assumption that a window of opportunity exists. It is thus a relevant case for analysing the concept’s implications for practical work with and support of abused women.We found that the empirical basis for the window of opportunity concept was meagre. However, the professionals working with domestic violence thought that the concept was relevant, useful and in accordance with their experiences. During the time period they perceived as the window of opportunity, they attributed agency to abused women, and considered it important to offer support before the window closed. At the same time, they tended to underestimate women’s agency, and viewed a choice not to accept support as a sign that the woman had returned to the abuser.

I denna litteraturöversikt kartläggs och beskrivs befintlig forskning om hur män som utövar våld i nära relation respektive kvinnor som utsätts för våld i nära relation motiveras till att ta emot stöd. 13 artiklar inkluderades i litteraturöversikten där två skilda angreppssätt identifierades; Second Responder program (SRP) och inledande motiverande insats. Båda visar på goda resultat i bemärkelsen ökad tillgång till och användning av stöd. Det är dock oklart vilka effekter insatserna har för återfall i brott. Framtida projekt och studier bör hantera tvetydigheten i återfall som utfallsmått och studier bör kompletteras med brukares egna röster om insatserna.

In this scoping review existing research on how perpetrators and victims of intimate partner violence are motivated to receive support is mapped and described. 13 articles were included in the scoping review where two different methods were identified: Second Responder Program (SRP) and initial motivational effort. Both show optimistic results in the sense of increased access to and use of support. However, it is unclear what effects the interventions have on recidivism. Future projects and studies should consider the ambiguity of relapse as an outcome measure and studies should be supplemented with users’ own voices about the interventions.

Having someone with problematic alcohol use in one’s life is connected to reduced personal wellbeing. For children in such families, support from a parent without alcohol problems can be a protective factor. However, there is a limited body of research on the challenges facing parents who do not have a drinking problem of their own but have children with someone who does. This study investigates how mothers are affected by the other parent’s problematic alcohol use and how mothers’ need for support can be understood. The study uses a qualitative design and consists of interviews with 23 mothers who have children together with a man who has a problematic alcohol use. The Stress-Strain-Coping-Support model developed by Orford and colleagues, is used in the analysis. Even though most mothers in the study are separated, they describe a lot of stress and strain, caused by the father’s problematic alcohol use. Parenthood can be regarded as a special form of stress. Constant worrying for your children is also a special form of strain affecting the parent without problematic alcohol use. Three areas of support needs are identified: therapeutic support, information and help to manage the father. However, the study also reveals great difficulties in finding support.