Fragmentation of social service and healthcare services has been given attention in many countries and a variety of strategies and models are used in attempts to remedy the problem. In a parallel development, demands have been made that users/patients should have more influence over their own care, and research has shown that user involvement can support the recovery process. This article focuses on how professionals view user involvement in collaborative efforts in care planning, using the Coordinated Individual Plan (CIP) in Sweden as an example. Since 2009, social service and healthcare agencies are required to draw up CIPs when they are judged to be needed, with the purpose of improving the care process. An additional purpose is to increase users’ involvement in their own care. Semi-structured interviews were conducted in 2019 with 20 professionals working within social service and healthcare agencies for people with mental health and/or substance abuse problems in the Stockholm region. Analysis was by qualitative content analysis. Findings show that professionals study experience ambivalence concerning user involvement in care planning. On the one hand, they support the user´s own demands of services and, on the other hand, they correct the user´s demands to fit the range of services and organisation of care. The user/patient's position is expressed as vulnerable, caught between caregivers who often safeguard their organisational duties and economical restrictions. These findings reflect the conflict predicted by Lipsky's theory of street-level bureaucracy. Professionals are expected to act as advocates for the user/patient, while at the same time exercising a controlling and gatekeeping function. The question is raised whether a model such as CIP provides sufficiently for factors which can counterbalance the power of the professionals relative to the user/patient in care planning.

中文翻译：

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在中间还是夹在中间？– 瑞典社会工作者和医疗保健专业人员对用户参与协调个人计划的看法

社会服务和医疗保健服务的碎片化已在许多国家受到关注，并采用了各种策略和模式来试图解决这个问题。与此同时，要求用户/患者对自己的护理有更大的影响，研究表明用户参与可以支持康复过程。本文以瑞典的协调个人计划 (CIP) 为例，重点关注专业人士如何看待用户参与护理计划的协作工作。自 2009 年起，社会服务和医疗机构被要求在判断需要时制定 CIP，以改善护理流程。另一个目的是增加用户对自己护理的参与。2019 年对斯德哥尔摩地区有心理健康和/或药物滥用问题的人在社会服务和医疗机构工作的 20 名专业人员进行了半结构化访谈。分析是通过定性内容分析。调查结果表明，专业人士研究在用户参与护理计划方面存在矛盾心理。一方面，它们支持用户自己的服务需求，另一方面，它们纠正用户的需求以适应服务范围和护理组织。用户/患者的立场被表达为易受伤害，夹在经常保护其组织职责和经济限制的护理人员之间。这些发现反映了利普斯基的街头官僚主义理论所预测的冲突。专业人员应充当用户/患者的倡导者，同时行使控制和把关功能。提出的问题是，诸如 CIP 之类的模型是否充分提供了可以平衡专业人员相对于用户/患者在护理计划中的权力的因素。