This thesis explores standardisation in Norwegian child welfare services (CWS), and how it influences CWS professionals and practices. CWS is a complex field that involves uncertainty and fallibility, in which there is much at stake for the families involved. CWS have often been criticised for poor and biased decision-making, for not putting effective measures into place when needed, and for lack of research-based practice (Bartelink, Van Yperen, & Ten Berge, 2015; Bufdir, 2020d; Gambrill, 2016; Munro, 2019). In response to this criticism, CWS in Western societies are increasingly incorporating standardised solutions (Munro, 2011; Vis, Lauritzen, & Fossum, 2019; Wike et al., 2014). A structured assessment framework and manualised home-based interventions are examples of this. Increased adherence to standardised guidelines is related to the ideas of the evidence agenda, such as evidence-based practice (EBP) and new public management (NPM) (Møller, Elvebakken, & Hansen, 2019). The aim is to ensure efficient and accountable services (Noordegraaf, 2015), involving a search for a more transparent notion of professional work (Evetts, 2011). Additionally, it is seen as a response to handle uncertainties and risky situations (Webb, 2006), and a way to enhance the quality of professional practice (Fluke, López López, Benbenishty, Knorth, & Baumann, 2020; Munro, 2011;
Thompson, 2016), which thus legitimises professionals’ actions (Timmermans & Berg, 2003).
Introduction
Standards and standardisation are seen as instruments of control and a necessary form of regulation (Brunsson & Jacobsson, 2000b;
Timmermans & Epstein, 2010). Moreover, they are recognised as managerialism that aims to ensure that services become predictable, accountable, and uniform through increased control and rationality (Timmermans & Berg, 2003, p. 8). EBP is also coupled to this understanding, in which standardised guidelines with a scientific basis are what guide practice (Timmermans & Berg, 2003). In this sense, EBP is referred to as the ‘guideline approach’, although this has been criticised for being a narrow understanding of EBP (A. Bergmark &
Lundström, 2011). Standardisation through regulation and guidelines may be seen as a contrast to acknowledging practice variations and flexibility (Timmermans & Berg, 2003). At the same time, standardisation may also be understood as an attempt to ensure predictable practices for service recipients (Skillmark, 2018), by decreasing professionals’ discretionary power (Ponnert & Svensson, 2016). However, critics have claimed that this limits professionals’ use of critical reflection (Timmermans & Berg, 2003), and de-professionalises social work (Ponnert & Svensson, 2016; White, Hall, &
Peckover, 2008), thus restricting professionals’ ability to use specialised abstract knowledge, a key feature of professional work (Abbott, 1988).
Accordingly, standardisation affects professionals’ autonomy and in this way their autonomy is conditioned by external power (Brante, 2011).
Scholars have questioned whether standardised tools in CWS are fit for their purpose (Drozd, Slinning, Nielsen, & Høstmælingen, 2020;
Introduction
Sørensen, 2018; Wike et al., 2014). At the same time, professionals are not passive receivers of standard rules and they alter the standards (Timmermans & Epstein, 2010). Norwegian child welfare policy promotes a knowledge-based, systematic and uniform CWS practice (Budir, 2020a; Bufdir, 2020d). As such, there has been a shift, in which local CWS (at local authority level) are now more regulated in choice of work methods, models or approaches that the government encourages through financial incentives (Bufdir, 2020b, 2020c). This shows that tension may arise between standardisation and professional practice, which is the topic of this study.
Against the background of the standardisation agenda and debates outlined above, the following questions are pertinent: What is at stake for child welfare work when standardised tools are introduced into practice? What does it mean that practice is informed by standardised tools? Standardisation and standards are considered instruments of control and a necessary form of regulation (Brunsson & Jacobsson, 2000b). Practice may thus be guided by predetermined actions that in turn restrict professionals’ ability to take contextual factors into consideration (e.g. Munro, 2020; White et al., 2008). Consequently, this may challenge the feature of the professional role that relates to the importance of treating complex cases with sensitive and local knowledge, both tacit and explicit, rather than codified information (Noordegraaf, 2015). The fact that standardisation also relates to the debates about EBP raises the crucial question of what counts as valid knowledge (e.g. evidence-based knowledge versus expert knowledge),
Introduction
and issues of sharing explicit and tacit knowledge (Grimen, 2009; Martin
& Williams, 2019). That said, social work is criticised for having an ambiguous knowledge base (Munro, 1998, 2020), and social workers are criticised for not reading research-based articles, but rather relying on their experience-based knowledge (Å. Bergmark & Lundström, 2002) This thesis is linked to two current debates. First, standardisation in relation to professional discretion, which is also linked to accountability (e.g. Banks, 2009; Evans & Hupe, 2020; Molander, 2016; Ponnert &
Svensson, 2016; Timmermans & Berg, 2003). Second, the debate about standardisation in relation to professional competency in CWS practice (e.g. A. Bergmark & Lundström, 2006; Munro, 2020; Møller et al., 2019). In this way, I contribute to informing the debate about standardisation in front-line practice by studying practices of standardisation in CWS at the micro level. Several studies have focused on the effects of standardised practice as well as evidence-based practice (e.g. Cassidy et al., 2017; Risholm Mothander, Furmark, & Neander, 2018), and have investigated the use of standardisation with a top-down approach. However, the ‘ongoing work’ that the actors engage in, which is carried out by ‘street-level’ professionals, has been little explored in previous studies (Breit, Andreassen, & Salomon, 2016; Cloutier, Denis, Langley, & Lamothe, 2015)
Introduction
1.1 Aim and research questions
This thesis aims to expand our knowledge about how standardisation affects professional practice. This study sets out to investigate how CWS professionals use standardised tools in their work and how practice is shaped by standard tools, including rules, knowledge or ideas that are embedded in these standards. Additionally, the relationship between standards, knowledge and discretion will be investigated. This will be done by examining two different tools commonly used in Norway, in addition to professional roles and actions, which together constitute a bundle of social practices (Schatzki, 2001a). More specifically, this thesis is concerned with standardisation of social practices, and how professionals respond to standardised tools. From this point of departure, the thesis is guided by the overall research question:
How do CWS professionals become carriers of standardised practice and how does standardised practice influence the professional role?
The main research question is operationalised into the following sub-questions to guide the analysis:
1. How are standardised tools adapted into professional practice in child welfare services? (Article 1, published 2020)
2. How do standardised tools influence the professional role of the child welfare professional? (Article 2, published 2020)
3. How does the Kvello Assessment Framework tool (KF) influence CWS decision-making processes? (Article 3, in review 2021)
Introduction
Social practices are in focus in this thesis. These form the basis for the research questions, which examine the dynamics between the tools, actors and actions embedded in social practices in the child welfare context. More specifically, this thesis focuses on the adaptation process (article 1), the decision-making process (article 2) and the professional role (article 3) in relation to standardisation.
1.2 Chapter outline
The thesis is organised in six chapters. In this first chapter, I have introduced the topic and outlined the aims and research questions of my PhD. In the next chapter, I present the background to this study, which includes perspectives on standardisation, the context of the study and previous research. Chapter 3 describes the theoretical framework and key theoretical concepts. There, I provide an overview of institutional theory, which constitutes the theoretical framework for this thesis, together with theoretical perspectives on the sociology of professions, which covers professional discretion and competency. Chapter 4 describes the research design and methodology. Here I present the rationale for choosing a case study design, followed by an account of the research process and ethical considerations. Chapter 5 presents a short summary of the three articles that form the basis for this thesis. The publications are included in full at the end of the thesis. Based on the three articles that constitute the core elements of this thesis, Chapter 6 discusses the findings in light of earlier research and relevant theories, followed by some concluding comments and the contribution of the thesis to the field.
Background and study context